Ritalin and Other Methylphenidates - Overview
Overview
Methylphenidate is one of the most commonly prescribed medications for the treatment of ADHD. Ritalin is among the most frequently prescribed brands of methylphenidate and is probably the most familiar medication for ADHD. Other methylphenidate brand names include Concerta and Metadate. There are also generic (non-brand name) forms of the drug. A related medicine, dexmethylphenidate, is sold under the brand name Focalin.
Methylphenidate was patented in 1950 by the CIBA Pharmaceutical Company, a Swiss company that later became part of Novartis. A global pharmaceutical company, Novartis is the maker of Ritalin. In 1955 the U.S. Food and Drug Administration (FDA) approved methylphenidate for various psychological disorders. A 2004 article on methylphenidate in the Journal of Child and Adolescent Psychiatric Nursing noted that treating children who have ADHD with stimulants such as methylphenidate and amphetamines is 80 to 90 percent effective. Methylphenidate treatment can decrease symptoms by 50 percent in some patients.
Abuse of Ritalin and Other Methylphenidates
Some people take Ritalin and other methylphenidates without a prescription for nonmedical purposes. High school and college students have been known to take the drug to stay awake and increase their attention span when studying. The drug is also used recreationally in combination with alcohol. "Recreational" refers to using drugs solely to get high, not to treat a medical condition. Alcohol is a depressant and drinking too much of it slows people down and makes them feel tired. So some people combine methylphenidate and alcohol because it allows them to stay awake and interact with others while continuing to drink. Other abusers mix Ritalin with heroin, cocaine, or both for a stronger stimulating effect. The abuse of methylphenidate, with or without other substances in the mix, can cause serious psychological and physical harm to the user.
Who Has ADHD
ADHD affects both males and females of all races and ethnicities. It is one of the most commonly diagnosed mental disorders in children and adolescents. In May of 2000, Terrance Woodworth, then-deputy director of the Office of Diversion Control at the U.S. Drug Enforcement Administration (DEA), testified before Congress on Ritalin use. He noted that about 80 percent of the prescriptions written for the two major drugs used to treat ADHD (methylphenidate and amphetamine) were for children. Woodworth also noted that between 1991 and 1999, U.S. sales of methylphenidate increased by nearly 500 percent. And that trend has continued. According to the article "ADHD Drugs Move into the Workplace" on MSNBC.com, "U.S. retail sales of the total ADHD drug market more than tripled between 2000 and 2004."
Who has ADHD is a matter of debate. Many studies indicate that the condition occurs much more frequently in boys. However, some believe that this is no longer the case. The organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) released a fact sheet titled "Evidence-Based Medication Management for Children and Adolescents with ADHD." According to that fact sheet, "recent research shows that the … numbers [of boys and girls with ADHD] may be nearly equal." In all, about 3 to 7 percent of the school-age population in the United States has ADHD.
In a study conducted by researchers at the Mayo Clinic, however, more boys were found to have ADHD than girls. But the study also indicated that parents' education plays a role. "Our [study's] results confirm that male sex and low parental education significantly increase ADHD risk," according to researcher Jennifer St. Sauver, as quoted on CBS News. In the report, issued in 2002, the scientists commented on their findings about the parents in their study sample. "Less educated parents may have less effective parenting styles and may provide a less structured environment" that could cause the ADHD to intensify. Plus, it's possible that the parents had difficulty in school themselves because they had ADHD as well.
ADHD begins during the preschool years, and it is usually diagnosed by the time a child is in kindergarten or early elementary school. However, the disorder continues into adulthood, and sometimes it is not even diagnosed until later in life. Although the exact causes of ADHD are unknown, research indicates that it runs in families, meaning it is an inherited condition. According to the CHADD fact sheet, "problems in parenting or life situations may make ADHD better or worse, but they do not cause the disorder."
Diagnosing ADHD
ADHD is a condition that becomes apparent in some children in the preschool and early school years. It is hard for these children to control their behavior, pay attention to a teacher, or focus on an assignment. People with ADHD may be fidgety, forgetful, and do impulsive things. They often interrupt conversations and act without thinking about the consequences. These behaviors can interfere with social interactions and school performance. But not everyone who displays symptoms of ADHD has the disorder. Being very talkative and showing signs of inattention are traits that exist in many children and adults, but at a low level or over a short period of time.
Diagnosing ADHD is a complex process. The symptoms of ADHD must continue for at least six months, and the behaviors must create a real handicap in at least two areas of a person's life. These areas include academic, social, and family aspects of life. An individual who shows some symptoms of ADHD, for example, but whose schoolwork and friendships are not harmed by these behaviors, would not be diagnosed with the disorder.
Prescriptions Increase
By 1975, more than 1 million U.S. children had been diagnosed with ADHD, according to "The Top Pharmaceuticals That Changed the World: Ritalin," a 2005 article in Chemical & Engineering News. About 500,000 of those patients were being treated with drugs, the article stated, with more than half of them receiving Ritalin. In the mid-1990s, ADHD diagnoses nearly doubled to 2 million. In a 2000 article in USA Today, the American Academy of Pediatrics put the number of students with ADD/ADHD at nearly 4 million. Mayo Clinic researchers announced in 2002 "that 7.5 percent of children up to the age of 19 have ADHD," according to CBS News. A 2003 booklet titled "Attention Deficit Hyperactivity Disorder," released by the National Institute of Mental Health, noted that 80 percent of children medicated for ADHD will still need the medication as teenagers. Half of those teens will continue on medication as adults. "The kids of the ADHD drug boom are growing up, and some are finding that what they thought would be a school-age ailment may in fact last a lifetime," noted MSNBC.com in May 2005.
Many studies have found that the number of children using ADHD medication differs depending on where the children live. For example, a 2003 study published in Pediatrics found that among commercially insured U.S. children, those living in the Midwest, compared with those in the West, were 1.55 times more likely to use at least one stimulant medication. Those living in the South were 1.71 times more likely that those in the West to do the same. In the study, about 65 percent of all stimulants used were methylphenidates. Many factors could play a part in this regional variation, including different state laws on illegal use of substances, drug advertising, physician style, and expectations of parents and teachers in the community.
In the 2000 article "Just Say Yes to Ritalin!: Parents Are Being Pressured by Schools to Medicate Their Kids—Or Else," Dr. Lawrence H. Diller noted that some "4 million children [are] taking Ritalin in America." He also explained that some doctors think that Ritalin is being overprescribed for some and underprescribed for others. "Data shows, for example, that African-American families use Ritalin at rates one-half to one-quarter of their white socioeconomic peers. Asian-American youth are virtually absent in statistics for Ritalin use."
Overdiagnosis of ADHD?
A dramatic increase in the number of both children and adults being diagnosed with ADHD has prompted controversy. Some parent and health groups say that doctors are overdiagnosing ADHD, especially among children. The result of overdiagnosing, they say, is that children may be taking unnecessary drugs, which can lead them to experience unnecessary side effects.
In some cases, the concern is that methylphenidates (and other ADHD drugs) are being prescribed to control "problem" children so that they will not disrupt class or home life. Other concerns are that naturally energetic and imaginative children are being labeled as having ADHD because these characteristics and the symptoms of the disorder are similar. Psychologist Deborah Ruf told Colette Bouchez of WebMD Health that "an alarming number of children who are simply creative, gifted individuals are mistakenly being diagnosed with ADHD." Many health organizations, however, say the growth of ADHD cases suggests that the disorder is better understood, more easily recognized, and more generally accepted within the medical communities. They also defend a parent's right to seek drug therapy for ADHD children.
Parents Pressured to Medicate
Some parents and their children believe that taking medications, such as Ritalin, are unnecessary, and they refuse to participate in what they call the "drugging" of America's children. They are concerned about the side effects of ADHD drugs and the fact that the long-term effects are still unknown. Anti-Ritalin groups contend that such drugs interfere with a child's personality and creativity. However, some teachers find it difficult to manage students who have ADHD and aren't taking any medication. They believe that ADHD drugs will benefit children who are too disruptive in class. Some schools have told parents that their children need to be evaluated to see if they would benefit from taking ADHD drugs.
A number of parents have refused, only to be told by school staff that their children are just too hard to handle. They are advised to "Medicate or Else!," according to Diller. He added that such schools "will not allow students to attend [regular] classes unless they are medicated." Some parents have had to make that choice—put their children on medication or put them in special education classes. Some parents relunctantly agree and have their children put on ADHD drugs. Others fight the schools and even file lawsuits against what they call "legal drug pushing."
A small percentage of parents have pulled their children out of public schools to homeschool them instead. In "Teaching Children Well, from Home" on MSNBC.com, a mother described her frustration with her daughter's educational experience in public schools. Rather than place her child in special education, the mother decided to homeschool her daughter. "Three years later, she's off Ritalin and working above her grade in many subjects," noted the authors of the article. Homeschooling is believed to help some ADHD sufferers because they receive more individual attention in a more structured setting.
Parents who don't want to medicate their children have also been subjected to legal trouble. "In the most extreme cases," noted Diller, "parents unwilling to give their kids drugs are being reported by their schools to local offices of Child Protective Services, the implication being that by withholding drugs, the parents are guilty of neglect[ing their children]." According to USA Today, "some parents are medicating their children for fear of having them hauled away." Parents have also been pressured to medicate their children by neighbors and relatives. In some situations, divorcing parents disagree on whether their child should be medicated, so the decision falls to a judge.
Taking the Stand Against Ritalin
Various groups of parents and other concerned individuals believe that ADHD medicines are greatly overused in the United States. Testifying before Congress in 2002, Lisa Marie Presley of the Citizens Commission on Human Rights stated: "I find it alarming that in my 13 years of motherhood, the use of Ritalin for ADHD has increased 700 percent. Today it is estimated that between six and eight million American children take psychiatric drugs for ADHD and other so-called learning and behavioral disorders." Urging Congress to look into finding drug-free alternatives, she described the situation as "the totally needless and tragic drugging of innocent children."
Methylphenidate and Narcolepsy
Methylphenidate is also used to treat narcolepsy, a life-long sleep disorder. Although the disorder can affect people of any age, in most cases the symptoms are first noticed in teenagers and young adults. However, it is not uncommon for there to be a delay of ten years between the onset of the symptoms and a final diagnosis.
Narcolepsy was first described in 1880 by a French physician who gave the disorder its name. The name comes from two Greek words: narke, meaning "to numb," and lepsis, meaning "seizure." People who have narcolepsy are frequently drowsy and can fall asleep suddenly and deeply, often in the middle of an activity. The effects of this disorder can cause serious problems. People may fall asleep at work or school, while having a conversation, playing a game, eating a meal, or even driving a car. Orphan Medical, Inc., the maker of a new non-methylphenidate narcolepsy drug called Xyrem (ZY-rem), reported in 2005 that narcolepsy affects about 100,000 to 140,000 Americans, but only 50,000 of these individuals receive treatment for their symptoms.
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