ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Medication

When it comes to ADHD medication, Ritalin is the grand-daddy of them all. Ritalin is the brand name for methylphenidate, first developed in the early 1950s by Ciba (now known as Novartis). It was used at first to treat depression and chronic fatigue but by the early 1960s it was being used to treat what was then called Minimal Brain Dysfunction or Hyperkinetic Disorder of Childhood. What we now call ADD or ADHD.

Ritalin has become the poster-child for the debate over childhood behavioral problems and whether they should be treated with medication. Web sites such as Ritalin Death and Novartis’ own site ADHD Info represent the two extremes of the debate. Part of the reason for this split over Ritalin is the rapid increase of prescriptions for methylphenidate (Concerta is also a methlphenidate) in the early 1990s. On study found a ten fold increase in perscribtions between 1990 and 1996.

Part of this rapid increase in Ritalin usage may be attributed to CHADD, an advocacy and support group for ADD / ADHD sufferers. It is the largest ADHD organisation and in the mid-1990s started campaigning the Drug Enforcement Agency (DEA) for Ritalin to moved from a Schedule II drug to a Schedule III drug. This would mean that it is easier to get repeat prescriptions and there would be less monitoring of its usage. CHADD was supported by supported by distinguished medical bodies, including the American Academy of Pediatrics, the American Psychological Association, and the American Academy of Child and Adolescent Psychiatry.

However it then came out that CHADD had received approaching $1 million from the makers of Ritalin over five years and that this had not been properly disclosed. The DEA’s repsonse to this was damming: “methylphenidate is routinely portrayed as a benign, mild stimulant that is not associated with abuse or serious effects. In reality, however, there is an abundance of scientific literature which indicates that methylphenidate shares the same abuse potential as other Schedule II stimulants.” CHADD failed to get Ritalin and other methylphenidate tablets reclassified.

Ritalin and other generic methylphenidate tablets come in 5, 10 and 20mg doses. The usual starting dose is 5mg, twice a day but the prescribed dosage is likely to rapid increase. The average dose is 20 – 30mg a day but doses as high as 60mg a day are not unusual.

As with all methylphenidate ADHD treatments, it is not known how Ritalin effects the ADHD symptoms. To quote the Ritalin label information: “There is neither specific evidence which clearly establishes the mechanism whereby Ritalin produces its mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system.”

Because Ritalin was first approved before modern, double blind placebo trials were required by the FDA, the makers have never had to publish any results of Ritalin’s effectiveness. The drugs safety for short-term usage has been well established by its years of use however no long-term trials have been conducted.

Recently the FDA amend the patient information on Ritalin to include more warnings on it. Warnings on sudden death from cardiac failure and psychiatric problems such as Bipolar have been incorporated. There is also concern over long-term suppression of growth in children using Ritalin. Children taking Ritalin everyday for a year exhibited 2cm less growth than their unmedicated counterparts. The drug has not been tested on children six or younger and the manufacturers specifically warn against prescribing Ritalin to very young children. However reports suggest that Ritalin is being given by doctors to these very young children, including a child just 15 months old.

Ritalin Ingredients: D&C Yellow No. 10 (5-mg and 20-mg tablets), FD&C Green No. 3 (10-mg tablets), lactose, magnesium stearate, polyethylene glycol, starch (5-mg and
10-mg tablets), sucrose, talc, and tragacanth (20-mg tablets).
Generic equivalents of Ritalin may contain different ingredients.

Prescription of methylphenidate to children and youth, 1990–1996
Ritalin Patient Information Sheet [ PDF ]
NHS go-ahead for hyperactivity drug

ADD / ADHD, ADD / ADHD Medication, Medication

Concerta is one of the big name Methylphenidate stimulants used to treat ADHD. The main difference between Ritalin and Concerta is that Concerta is a timed-release formula that is designed to give out a steady supply of stimulant through-out the day. It was first introduced in 2000 and since become major seller with Johnson & Johnson reporting sales $0.9 billion. A rise of 20% over 2005.

The original patent for Concerta expired in 2004 but the FDA have not approved any generic substitute drugs yet. To extract as much money as possible from Concerta, Johnson & Johnson have taken out two other patents on Concerta relating to its slow release mechanism. This has resulted in legal action against Andrx who are trying to produce a generic version.

Concerta tablets come in four strengths containig 18, 27, 36, or
54 mg of methylphenidate. One tablet should be taken daily and the company claims it provides effective treatment for 12 hours. The tablet has an outer coating of methylphenidate that dissolves within an hour of swallowing providing an immediate dose.

Over the next few hours, liquid from the stomach seeps into the tablet through a semi-permeable coating causing a reaction that forces the medication out of the Concerta tablet through a tiny laser drilled hole in the tablet. After six hours the rate of release increases to counteract the diminishing effect of the initial outer coating. The FDA found that Concerta in the blood stream increases rapidly reaching an initial maximum at about 1 hour, followed by gradual ascending concentrations over the next 5 to 9 hours after which a gradual decrease begins. Average times to reach peak effect across all doses of Concerta occurs between 6 to 10 hours.

The biologically inert components of the Concerta tablet remain intact during gastrointestinal transit and are eliminated in the stool as a tablet shell along with insoluble core components. It is possible that Concerta tablets may be visible on abdominal x-rays under certain circumstances, especially when digital enhancing techniques are utilized. The methylphenidate is most passed out of the body in urine.

In patients, there were no difference in the performance of Concerta when administered after a high fat breakfast. There is no evidence of the effectiveness of Concerta being effected by the presence or absence of food.

Concerta approval by the FDA is based on four double blind, active and placebo controlled studies. Three of the studies were on a total of 416 children aged 6 to 12 and each study lasted only a few weeks. The effectiveness of Concerta was measured by the teachers assessing the children’s behaviour for inattention or overactivity. The result showed a statistically significant reduction in symptoms, about 30-40%. However the value of such subjective measures is debatable and it is only with access to the full data set from the studies can you get an accurate understanding of Concerta’s impact.
One trial on teenagers taking Concerta was run, involving 177 adolescents between 13 and 18. Over a four week trial, Concerta led to a reduced score on an ADHD rating scale compared to a placebo.

No trials were run using Concerta on adults or on its effectiveness when used for more than 4 week. The FDA recommend that doctors prescribing Concerta for extended period regularly be reassessed to ensure the drug remain effective and safe.

What Concerta actual does to alleviate ADHD symptoms is in unknown. Methylphenidate is thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. But it has not been proven that this is linked to the changes of ADHD symptoms reported by uses of Concerta.

The contrainciations of Concerta are numerous. Particularly patients with marked anxiety, tension, agitation, glaucoma and tics may find their symptoms increase whilst on Concerta. Patients who are taking monoamine oxidase inhibitors (antidepressants) should discontinue their treatment and leave a 14 day gap before taking Concerta. Because of the indigestible nature of the tablet, Concerta should not be used by people with gastrointestinal problems. Adverse reaction to Concerta include insomnia, twitching, nervousness, emotional lability, abdominal pain, and anorexia.

In addition to the active ingredient, methylphenidate, Concerta contain also contains the following ingredients: butylated hydroxytoluene, carnauba wax, cellulose acetate, hypromellose, lactose, phosphoric acid, poloxamer, polyethylene glycol, polyethylene oxides, povidone, propylene glycol, sodium chloride, stearic acid, succinic acid,
synthetic iron oxides, titanium dioxide, and triacetin.

Concerta Patents
Johnson & Johnson 2006 Annual Report [ PDF ]
FDA Concerta Product Information [ PDF ]

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Medication

The Bonker’s Institute highlights the shallow, money driven way big pharmaceutical companies ‘educate’ the public through advertising. They have a nice take on ADHD in their Science Made Simple articles.

By taking genuine copy from Novartis, Eli Lilly, McNeil and other drug companies’ adverts the Bonkers Institute show in ADHD Made Simple how vacuous their sales pitches are. This is all nicely offset by the inclusion of details of the drugs side effects.

ADD / ADHD, ADD / ADHD Medication

Depending on your point of view, Ritalin is an essential medication that has helped millions of ADHD children or it is a unsafe substance that is forced down the throats of children by manipulative drug companies. Myomancy has reported on both sides of this dispute.

On the positive side is Why Parents Give Their Kid’s Ritalin that looks at a successful use of Methylphenidate mediation. A troubled little boy is turned into a bright attentive child by simply taking a couple of pills a day.

All this medication is big business. Over the last few years there has been a surge of spending on Ritalin and related ADHD medication for the under fives. Overall the ADHD drug market is $2.7 billion with much of that cost being picked up by insurers who ask ‘Do drugs like Adderall work‘. Despite this medication usage grows and the cost of treatment increases.

Some of the rapid growth in Ritalin prescriptions can be linked to how teachers view ADHD and stimulant drugs though drug companies and their marketing influences doctors. Of course parents play a part in this and some parents push for stimulants.

Many worry that medication is being over prescribed. This doesn’t just effect Ritalin. Children are using more sleeping pills than ever. Medication also has side-effects and 3100 people go to ER due to ADHD medication. The direct health risks of using ADHD medication are real. The FDA has strengthen its warnings about health risks and Ritalin. There are problems with ADHD drugs and the packets lists the side effects such as insomnia and loss of appetite. Some research has linked ADHD medication to stunted growth.

The link between Methylphenidate stimulants and illegal, street drugs is very close. Chemically, the brand name medications are similar to speed, and there has been a lot of research on Ritalin and Cocaine. Not directly related but interesting is this research on the treatment of ADHD adults who are cocaine users. There is also good research between childhood medication and adult drug abuse.

Another aspect of the link between Ritalin and illegal drugs is when Ritalin itself is abused. There are reports of people faking ADHD in order to get medication. There are also reports of addiction to Adderall and its general abuse.

For the cost conscious there is a guide to Ritalin best buys.

Research into newer and more effective drugs than Ritalin continues with a patch for ADHD being developed and approved despite doubts of its safety. Also under development is Lisdexamfetamine Dimesylate. Its an strange fact that drug companies research always show better results than independent studies of the same drug.

There is an alternative to commercial medication that is cheaper and most of us have in the house already. Caffeine like ADHD medication is a stimulant and one the majority of adults use everyday. In fact Caffeine and ADHD has been researched many times including in this study: Forget Ritalin, Drink Coffee.

Sometimes you have to look at the funny side of Ritalin. You might just have to ask yourself, If Ritalin is safe, why not give it to all the kids?

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Over the last few weeks this website has been attracting comments from various members and ex-members of staff of the Dore Achievement Centres. This has come to the attention of the CEO of UK branch, Bob Clarke, who has posted comments on Myomancy and also to Wynford Dore himself who has phoned me. Conversations with Wynford are always enjoyable but challenging because Wynford believes so passionately about what he does. So when Myomancy runs a negative story about the Dore Program he tends to forget all the places on Myomancy where I’ve said the Dore Program works and that it changes lives.

In light of all this I thought it wise to make a clear statement to all my readers about why I devote a considerable amount of time and money to running Myomancy.

  • The goal of Myomancy is to provide independent information on treatments for dyslexia, ADHD and autism so that parents and sufferers can make an informed choice about what is the best approach for them.
  • Myomancy is a blog, a personal web site. It represents my views and my views alone on all things connected with ADHD, dyslexia and Autism.
  • These views are researched and expressed on Myomancy to the best of my abilities but I am not a scientist, teacher or a professional writer. I am just someone who’s life was changed by the Dore Program and felt a need to express myself.
  • I believe in free speech which is why I allow anyone to post comments on the articles regardless of whether they are for or against my views. Only post that are illegal or purely offensive are removed.
  • Myomancy generates a small amount of income for advertising. I would like it to be more so that I can afford to spend more time on Myomancy. It is up to the reader to decide what, if any, impact that has on the independence of Myomancy.

With reference to the above I have removed one comment from the website that is highly critical of the Dore Program and, based on additional evidence I have at my disposal, is completely false.

ADD / ADHD Medication

Sorry for the lack of postings and general failure to answer emails over then last few weeks. A few work and personal issues have been consuming my time. I hope to be back posting regularly soon.


ADD / ADHD, ADD / ADHD Medication

I’ve written before on how non-ADHD students are abusing Adderall or faking ADHD. Now parents are pushing Doctors to prescribe stimulants to their non-ADHD children purely because the child’s grades are slipping.

A 15-year-old girl and her parents recently came in for a chat with Dr. James Perrin, a Boston pediatrician, because they were concerned about the girl’s grades. Previously an A student, she was slipping to B’s, and the family was convinced attention deficit hyperactivity disorder was at fault — and that a prescription for Ritalin would boost her brainpower.

Seeking straight A’s, parents push for pills

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Food and Drink

Does ADHD have anything to do with enzymes and can No-Fenol enzyme supplements help?

Mary, a long time friend of Myomancy, dropped me a line recently about ADHD and diet with a link to information on enzymes and ADHD. Enyzmes act as a catalysts for the chemical reactions that drive our biology and each has a specific role to play. The article promotes the use of No-Fenol, an enzyme supplement that is typical of the type on the market.

When I looked at ADHD and diet, I found there was no evidence of a poor diet causing ADHD. The best advice I could find was to eat a balanced diet with plenty of fresh fruit and vegetables. This won’t directly help with the ADHD but you will feel better and it helps to avoid weight problems (see ADHD and Obesity). However there was connection between omega-3 and ADHD . Supplements of fish oils did help some people on some specific tasks. Could enzyme supplements help ADHD in the same way?

The logic behind enzymes supplements is that by increasing the number of enzymes in the digestive system all the food you eat will be processed more efficiently. This will ensure that all the vitamins and minerals needed at picked up from our food. This presupposes that ADHD is caused by vitamin or mineral deficiencies, a position that is questionable.

Searching both Google Scholar and the maker of No-Fenol’s web site I can find no evidence to say that enzymes supplements help ADHD. In fact I can’t find a single piece of evidence that enzymes supplements can help with anything other highly specific medical conditions such as cystic fibrosis.

Diet and ADHD is an area that is rich in advice, supplements and books. Most of these are done with the best intentions but lack any direct evidence for their claims. Companies use science to show how Ingredient X helps with Vitamin Y that has been linked to Problem Z but that doesn’t mean the taking more X or Y will help with Z. Before taking any supplement its worth asking to see research showing that the specific product you are considering buying works on your problem. If they can’t then their claims are speculation at best.

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ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment

Do ADD / ADHD medications increase the risk of drug and alcohol abuse problems in later life?

According to a 2003 study, the answer is no. In fact the use of ADD / ADHD medication significantly reduced the chance of drug and alcohol use in later life. THe study analyzed the data from six different studies covering a total of 674 people with ADHD who were medication and 360 who were not. All the participants progress had been followed for at least four years and monitored for drug or alcohol problems. This runs counter to animal research on the effects of ADHD medication on drug usage and just demonstrates how complicated this area is to research.

There are many different factors from genetics to poverty that can influence people’s decent into addiction. It has been thought that the use of ADD / ADHD medication might train or condition the central nervous system to expect stimulation. This might drive the user to pursue other forms of stimulation either through drugs or other high risk behaviour. This study suggests that by using the medication, the person with ADD / ADHD gets more control over their life and is less tempted by alternative medication.

Previously on Myomancy:
ADHD, Children and Medication
Stim Nation: Ritalin and Cocaine Addiction
Stim Nation: Adderall Use, Abuse & Addiction
ADD / ADHD Medication

Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature