Ritalin

Abstract

Ritalin (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 Ritalin
presumably activates the arousal system of the brain stem and the cortex to
produce its stimulant effect. Recently, the frequency of diagnosis for ADHD has
increased dramatically. More children and an increasing number of adults are
being diagnosed with ADHD. According to the Drug Enforcement Agency (DEA)
(Bailey 1995), prescriptions for Ritalin have increased more than 600% in the
past five years. Ritalin has a long history of controversy regarding side
effects and potential for abuse, however it greatly benefits those with ADHD.

Psychological effects of Ritalin

Ritalin (Methylphenidate) is manufactured by CIBA-Geigy Corporation. It
is supplied in 5 mg., 10 mg., and 20 mg. tablets, and in a sustained release
form, Ritalin SR, in 20 mg. tablets. It is readily water soluble and is intended
for oral use. It is a Schedule II Controlled Substance under both the Federal
and Vermont Controlled Substance Acts. Ritalin is primarily used in the
treatment of Attention Deficit/Hyperactive Disorder (ADHD) (Bailey 1995).
ADHD is a condition most likely based in an inefficiency and inadequacy
of Dopamine and Norepinephrine hormone availability, typically occurring when a
person with ADHD tries to concentrate. Ritalin improves the efficiency of the
hormones 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. Nervousness
and insomnia are the most common adverse reactions reported, but are usually
controlled 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 ADHD
usually 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 Systems

Ritalin exhibits pharmacological activity similar to that of
amphetamines. Ritalin\'s exact mechanism of action in the CNS is not fully
understood, but the primary sites of activity appear to be in the cerebral
cortex and the subcortical structures including the thalamus. Ritalin blocks the
reuptake mechanism present in dopaminergic neurons. As a result, sympathomimetic
activity in the central nervous system and in the peripheral nervous system
increases. Ritalin-induced CNS stimulation produces a decreased sense of fatigue,
an increase in motor activity and mental alertness, mild euphoria, and brighter
spirits. 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 onset
of 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\'s
effect is brief: Most people experience 2-3 hours of benefit, but after 3 hours,
benefits drop off rapidly. Some individuals, especially children, may obtain 4
or even 5 hours of positive effect (Clark 1996).

Social Factors Leading to increased use of Ritalin

Recently, there has been a dramatic upsurge of interest in using
stimulants (mainly Ritalin) for children and adults for the increasingly popular
diagnosis of ADHD. According to Persky (1996), the high frequency of the
diagnosis of ADHD is a uniquely American phenomenon. Children and adults are now
under greater pressure to perform and to do well academically or in the
workplace. The chilling message in school and at work is "Perform or Else."
Because of this high intensity atmosphere, the use of Ritalin has become
attractive. This has resulted in an acute "epidemic" of ADHD and the treatment
of choice is Ritalin (Persky 1996). For example, after education reforms
spearheaded 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 on
Ritalin against their psychologist\'s advice. Another mother says she had to ask
a school board member to intervene when teachers at her child\'s school also
pressed for Ritalin use(“Critics say Ritalin,” Houston Chronicle, May 1996).
Ritalin is an effective treatment for people with ADHD. Because it
allows them to filter out distractions and improve concentration, some schools
and parents force Ritalin on children who may have nothing more than a severe
case of childhood. At a popular church