RitalinAbstractRitalin (Methylphenidate) is a mild CNS stimulant. In medicine,Ritalin’s primary use is treatment of Attention Deficit /Hyperactive Disorder(ADHD). The mode of action in humans is not completely understood, but Ritalinpresumably activates the arousal system of the brain stem and the cortex toproduce its stimulant effect. Recently, the frequency of diagnosis for ADHD hasincreased dramatically.
More children and an increasing number of adults arebeing diagnosed with ADHD. According to the Drug Enforcement Agency (DEA)(Bailey 1995), prescriptions for Ritalin have increased more than 600% in thepast five years. Ritalin has a long history of controversy regarding sideeffects and potential for abuse, however it greatly benefits those with ADHD. Psychological effects of RitalinRitalin (Methylphenidate) is manufactured by CIBA-Geigy Corporation.
Itis supplied in 5 mg. , 10 mg. , and 20 mg. tablets, and in a sustained releaseform, Ritalin SR, in 20 mg. tablets.
It is readily water soluble and is intendedfor oral use. It is a Schedule II Controlled Substance under both the Federaland Vermont Controlled Substance Acts. Ritalin is primarily used in thetreatment of Attention Deficit/Hyperactive Disorder (ADHD) (Bailey 1995). ADHD is a condition most likely based in an inefficiency and inadequacyof Dopamine and Norepinephrine hormone availability, typically occurring when aperson with ADHD tries to concentrate.
Ritalin improves the efficiency of thehormones Dopamine and Norepinephrine, increasing the resources for memory, focus,concentration and attention (Clark 1996). Ritalin has been used for more than 30 years to treat ADHD. Nervousnessand insomnia are the most common adverse reactions reported, but are usuallycontrolled by reducing dosage or omitting the afternoon or evening dose. Decreased appetite is also common but usually transient (Long 1996).
According to Clark (1996), children, adolescents and adults diagnosed with ADHDusually report the following effects when successfully treated with Ritalin:Improved concentration. Better “focus”. Improved ability to complete their work. Improved intensity of attention and longer attention span. Reduced distractibility. Reduced impulsivity.
Reduced restlessness and overactivity. Improved patience. More elaborate expressive vocabulary. Better written expression and handwriting (especially in children). An improved sense of “alertness”.
Improved memory for visual as well as auditory stimuli. Ritalin’s Effect on Neurotransmitter SystemsRitalin exhibits pharmacological activity similar to that ofamphetamines. Ritalin’s exact mechanism of action in the CNS is not fullyunderstood, but the primary sites of activity appear to be in the cerebralcortex and the subcortical structures including the thalamus. Ritalin blocks thereuptake mechanism present in dopaminergic neurons.
As a result, sympathomimeticactivity in the central nervous system and in the peripheral nervous systemincreases. Ritalin-induced CNS stimulation produces a decreased sense of fatigue,an increase in motor activity and mental alertness, mild euphoria, and brighterspirits. In the PNS, the actions of Ritalin are minimal at therapeutic doses(Clinical Pharmacology Online 1997). Ritalin is the quickest of all oral ADHD stimulant medications in onsetof action: it starts to achieve benefit in 20 – 30 minutes after administration,and is most effective during the upward slope’ and peak serum levels.
Ritalin’seffect is brief: Most people experience 2-3 hours of benefit, but after 3 hours,benefits drop off rapidly. Some individuals, especially children, may obtain 4or even 5 hours of positive effect (Clark 1996). Social Factors Leading to increased use of RitalinRecently, there has been a dramatic upsurge of interest in usingstimulants (mainly Ritalin) for children and adults for the increasingly populardiagnosis of ADHD. According to Persky (1996), the high frequency of thediagnosis of ADHD is a uniquely American phenomenon. Children and adults are nowunder greater pressure to perform and to do well academically or in theworkplace. The chilling message in school and at work is “Perform or Else.
“Because of this high intensity atmosphere, the use of Ritalin has becomeattractive. This has resulted in an acute “epidemic” of ADHD and the treatmentof choice is Ritalin (Persky 1996). For example, after education reformsspearheaded by Ross Perot in Texas in 1984, Ritalin use in the state doubled. One Texas mother says she is being hounded by teachers to put her two boys onRitalin against their psychologist’s advice. Another mother says she had to aska school board member to intervene when teachers at her child’s school alsopressed for Ritalin use(Critics say Ritalin, Houston Chronicle, May 1996). Ritalin is an effective treatment for people with ADHD.
Because itallows them to filter out distractions and improve concentration, some schoolsand parents force Ritalin on children who may have nothing more than a severecase of childhood. At a popular church preschool, approximately 20 percent ofchildren are on Ritalin. Even a Little League coach urged Ritalin for a 9-year-old catcher to improve his performance. Ritalin’s safety and efficacy is whathas turned it into teachers’ and parents’ little helper.
It solves, or in somecases masks, children’s behavioral problems (Critics say Ritalin, HoustonChronicle, May 1996). Social Impact of RitalinAccording to Clark (1996), people who have ADHD come from everyimaginable social, vocational, educational and emotional background. ADHD is acondition which may afflict physicians, attorneys, carpenters, actors,politicians, casino employees, executives, and homemakers. While Ritalin is avery important aspect of treatment, in many or most cases it is only part of theoverall treatment effort. Stimulants (mainly Ritalin) specifically affectattention span, concentration, focus, and distractibility. No alternativemedications, nor any other form of treatment, address these symptoms of ADHD aswell as stimulants like Ritalin.
Learning disabilities, such as readingdifficulties or anxiety, are sometimes misdiagnosed as ADHD or co-exist withADHD. Ritalin will help the child sit still in class, but may not deal with thereal culprits keeping the child from learning. Many pediatricians believechildren younger than 6 — even if they have ADHD — should wait to be medicateduntil they learn basic rules of behavior. Yet while liberal estimates are thatsix out of 100 children suffer from the disorders, six out of 30 preschoolers inone group at a Day School in Houston take Ritalin.
Teachers are often the onlyones who get an inkling that a child may have ADHD, and are within their rightsto call a parent and suggest the child be evaluated for the disorder. No teachershould be permitted to suggest a specific medication or pursue the topic oncethe parent demurs. (Critics say Ritalin, Houston Chronicle, May 1996). After aslowdown of Ritalin use in the 1970’s, the pendulum began to swing back in the1980’s. It has swung so far, that in 1994 about 9 tons of Ritalin was produced(DEA in Persky 1996).
Patterns of AbuseAccording to Bailey (1995), epidemiologists at the National Institute on DrugAbuse (NIDA) describe Ritalin abuse over the last two decades as “sporadic butpersistent,” and rates of use fluctuate over time. When purchased in pharmacieswith a valid prescription, Ritalin tablets cost 25 cents to 50 cents each. Inthe illicit street drug market, tablets sell for $3 to $15 each. While streetprices in the Midwest are now at the low end ($3 to $5 per tablet) compared withsome West Coast locations, they have been rising over the past few years.
In1994, an upsurge in illicit street use of Ritalin was reported on the U. S. WestCoast and in the Midwest. Non-medical use consisting of snorting crushed Ritalintablets or dissolving the powder in water and cooking it for intravenousinjection was reported at Chicago and Detroit. Anecdotal reports suggest thatsuburban, white abusers are more likely to snort Ritalin, while African Americaninner-city abusers are more likely to inject it (Bailey 1995).
ConclusionRitalin is an extremely useful medication. It has minimal side effectsafter the first few months. It works quickly, wears off quickly, and because ofthis targets some ADHD issues optimally. No other stimulant medication impactsso specifically on alertness, concentration and focus. Individuals with ADHD may respond well to psychotherapy, behaviormodification, and other interventions.
Successful treatment of ADHD begins withcareful diagnosis, followed by proper prescription of medications. An accuratediagnosis, in conjunction with carefully developed and targeted treatment,should limit abuse and ensure continued success in treating ADHD. ReferencesBailey, W. J. (1995). Factline on non-medical use of Ritalin.
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indiana. edu/. Clark, C. G. (1996).
Stimulant Medications. Diagnosis and Treatment of AttentionDeficit Disorder, on-line, pp. 1-12. Available: Http://www.
ADDCLINIC. com/. Clinical Pharmacology Online, Ritalin. .
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Net,on-line, pp. 1-3. Available:Http://www. Nando. net/. Long, P.
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