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

Ritalin: What Every Parent Should Know

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.

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