Ritalin Essay, Research Paper

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 preschool, approximately 20 percent of

children 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 what

has turned it into teachers’ and parents’ little helper. It solves, or in some

cases masks, children’s behavioral problems (?Critics say Ritalin,? Houston

Chronicle, May 1996).

Social Impact of Ritalin

According to Clark (1996), people who have ADHD come from every

imaginable social, vocational, educational and emotional background. ADHD is a

condition which may afflict physicians, attorneys, carpenters, actors,

politicians, casino employees, executives, and homemakers. While Ritalin is a

very important aspect of treatment, in many or most cases it is only part of the

overall treatment effort. Stimulants (mainly Ritalin) specifically affect

attention span, concentration, focus, and distractibility. No alternative

medications, nor any other form of treatment, address these symptoms of ADHD as

well as stimulants like Ritalin. Learning disabilities, such as reading

difficulties or anxiety, are sometimes misdiagnosed as ADHD or co-exist with

ADHD. Ritalin will help the child sit still in class, but may not deal with the

real culprits keeping the child from learning. Many pediatricians believe

children younger than 6 — even if they have ADHD — should wait to be medicated

until they learn basic rules of behavior. Yet while liberal estimates are that

six out of 100 children suffer from the disorders, six out of 30 preschoolers in

one group at a Day School in Houston take Ritalin. Teachers are often the only

ones who get an inkling that a child may have ADHD, and are within their rights

to call a parent and suggest the child be evaluated for the disorder. No teacher

should be permitted to suggest a specific medication or pursue the topic once

the parent demurs. (?Critics say Ritalin,? Houston Chronicle, May 1996). After a

slowdown of Ritalin use in the 1970’s, the pendulum began to swing back in the

1980’s. It has swung so far, that in 1994 about 9 tons of Ritalin was produced

(DEA in Persky 1996).

Patterns of Abuse

According to Bailey (1995), epidemiologists at the National Institute on Drug

Abuse (NIDA) describe Ritalin abuse over the last two decades as “sporadic but

persistent,” and rates of use fluctuate over time. When purchased in pharmacies

with a valid prescription, Ritalin tablets cost 25 cents to 50 cents each. In

the illicit street drug market, tablets sell for $3 to $15 each. While street

prices in the Midwest are now at the low end ($3 to $5 per tablet) compared with

some West Coast locations, they have been rising over the past few years. In

1994, an upsurge in illicit street use of Ritalin was reported on the U.S. West

Coast and in the Midwest. Non-medical use consisting of snorting crushed Ritalin

tablets or dissolving the powder in water and ?cooking? it for intravenous

injection was reported at Chicago and Detroit. Anecdotal reports suggest that

suburban, white abusers are more likely to snort Ritalin, while African American

inner-city abusers are more likely to inject it (Bailey 1995).

Conclusion

Ritalin is an extremely useful medication. It has minimal side effects

after the first few months. It works quickly, wears off quickly, and because of

this targets some ADHD issues optimally. No other stimulant medication impacts

so specifically on alertness, concentration and focus.

Individuals with ADHD may respond well to psychotherapy, behavior

modification, and other interventions. Successful treatment of ADHD begins with

careful diagnosis, followed by proper prescription of medications. An accurate

diagnosis, in conjunction with carefully developed and targeted treatment,

should limit abuse and ensure continued success in treating ADHD.

References

Bailey, W. J. (1995). Factline on non-medical use of Ritalin. Factline Number

9 November 1995, [on-line], pp. 1-7. Available: Http://www.drugs.indiana.edu/.

Clark, C. G. (1996). Stimulant Medications. Diagnosis and Treatment of Attention

Deficit Disorder, [on-line], pp. 1-12. Available: Http://www.ADDCLINIC.com/.

Clinical Pharmacology Online, Ritalin.. (1997). Clinical Pharmacology Online.

Gold Standard Multimedia Inc., [On-line], Available: Http://www.gsm.com/., p. 1.

Critics say Ritalin has become panacea for children’s scholastic,

behavioral problems. (1996, May 23). Houston Chronicle via Nando.Net,

[on-line], pp. 1-3. Available: Http://www.Nando.net/. Long, P. W. (1996).

Methylphenidate, Brand name Ritalin, Drug Monograph. In, Internet Mental Health

Drug Monograph.

[On-line], Available: Http://www.mentalhealth.com/. (pp. 1-7). Ottawa,

Canada. Persky, M. (1995, May). LISTENING TO RITALIN: The New Epidemic.. The

Northern California Psychiatric Physician, 5, 43-45.