What Is Ritalin (Methylphenidate)?
Ritalin is the brand name for methylphenidate, a prescription medication that stimulates underactive parts of the central nervous system. It increases concentration and attention span and also helps to regulate impulsive behaviour. In the United Kingdom, Ritalin is used solely to treat attention deficit hyperactivity disorder (ADHD) in children over 6 years old. It is not licensed for use in adults or infants younger than 6 years old with ADHD due to inconclusive evidence as to its safety for these groups.
The drug was first patented in 1954 as a potential cure for Mohr’s disease, a rare genetic disorder that causes physical deformities. Doctors started using it for what they deemed hyperactivity or minimal brain dysfunction in the early 1960s. The public understanding of neuroscience and mental health developed considerably in the time between the 1960s and today, and production has steadily increased to meet the demand for increasing ADHD diagnoses.
Those who have used MAO inhibitors such as linezolid, isocarboxazid, methylene blue injection, phenelzine, selegiline, rasagiline or tranylcypromine cannot take Ritalin until 14 days after their last dose. Extreme caution must also be exercised when prescribing to individuals who have suffered from high blood pressure, mental illness, depression or bipolar disorder. There is evidence that methylphenidate can exacerbate psychosis.
Seek medical attention immediately if someone who is using the drug shows signs of chest pain, shortness of breath, light-headedness, paranoia, unexplained behaviour, seeing or hearing things that aren’t real, aggression or signs of circulation problems such as unexplained wounds on their fingers or toes.
Common Medical Uses of Ritalin
Attention deficit hyperactivity disorder
The main use for Ritalin in the UK is as an aid to help children over the age of 6 to control symptoms of ADHD. It must be prescribed by a doctor who is experienced in behavioural problems amongst children and young people. The drug cannot be given as a stand-alone treatment but will be offered as a component of a treatment programme that consists of psychological, educational and social therapy. Ritalin is not a cure for ADHD, as yet there is no known cure, but it helps young people and their parents to manage the condition.
Neuroprotection refers to the preservation of the structure and/or function of a neuron in the brain. Methylphenidate has the ability to protect the brain from the neurotoxic effects of methamphetamine and potentially Parkinson’s disease. Scientists believe both lead to the abnormal buildup of dopamine in the brain, and Ritalin, which encourages secretion of dopamine, prevents this buildup. Studying this connection is giving scientists an insight into a range of disorders that are linked closely with the dopaminergic systems, from Parkinson’s disease to substance abuse disorders.
As a stimulant, Ritalin is highly effective at promoting wakefulness and lowering the likelihood for a sufferer of narcolepsy to fall into a sleep attack. While the drug is not licensed for use outside of ADHD in children in the UK, specialist doctors may use it to treat excessive daytime sleepiness in cases of chronic narcolepsy. Unlicensed means that while the manufacturer of the product has not specified that it can be used in a certain way, overwhelming evidence shows that it can be effective. As with ADHD, methylphenidate cannot cure narcolepsy, but it can offer much-needed help to the person suffering from the illness. Due to strict controls on the drug, it can only be obtained from an outpatient pharmacy as opposed to any local community pharmacy.
Using Ritalin as a treatment for depression is controversial, as studies have shown it can exacerbate certain symptoms for sufferers who use it for long periods of time. Those who are experiencing depression due to a fatigue-related illness have found the effects to be positive to a life-changing extent. (5) Medical studies have also shown that compared to a placebo, Ritalin initially gives people a significant reduction in the symptoms of depression. Due to the potential for abuse of the drug and inconclusive evidence from long-term studies, doctors only prescribe methylphenidate for depression in very particular circumstances.
Chronic fatigue syndrome (CFS)
The National Institute for Health and Care Excellence states that Ritalin should not be used as a treatment for CFS. In a study, 48% of patients found that their fatigue symptoms improved compared to a placebo. However, the side effects that they endured when stopping the drug included agitation, dry mouth and heart palpitations. The difficulty people found in coming off the drug and negligible long-term results are what make doctors reluctant to use it as a treatment for CFS.
Ritalin Legal Status (UK)
Ritalin is a Class B controlled substance under the UK government’s Misuse of Drugs Act 1971. This categorizes controlled drugs in three groups according to the amount of harm they pose to the community: A, B and C. Class B drugs can have a devastating impact when misused and are considered to pose the second-greatest risk to society after Class A. Class B drugs become Class A when they are prepared for intravenous use.
Examples of other Class B drugs include cannabis, barbiturates, amphetamines, ketamine, mephedrone, pholcodine, codeine phosphate and dihydrocodeine. The penalties imposed according to each class are based on the harmfulness associated with a drug when it is misused. Those with a history of drug offenses face up to five years in prison or an unlimited fine if caught by police with a Class B controlled drug.
Ritalin is a schedule 2 controlled drug alongside cocaine, heroin, morphine, ketamine, amphetamines, cannabis products designed for medical use in humans and methadone hydrochloride, among others. This is the second-highest category out of five schedules that determine who can produce and distribute controlled substances.
Schedule 2 drugs must adhere to the full controlled drug requirements relating to safe custody, prescriptions and the requirement to maintain a controlled drug register. Procurement, supply and possession are authorised only to pharmacists and other persons named in the Misuse of Drugs Regulations 2001.
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Routes of Ritalin Administration
Ritalin is predominantly ingested orally but is also available is a slow-release patch. Initiation, stabilisation and titration of the dose will be determined by the doctor according to the individual. Usually dosing levels will be incremental, starting off very low to see how the person reacts and then increasing the dose if and when appropriate.
Immediate-release methylphenidate is usually directed to be taken orally once a day in the morning. It can be taken on an empty stomach, but it is advisable to take it after a meal to avoid feelings of nausea.
Pharmacological Actions of Ritalin
Ritalin is a psychostimulant that increases central dopamine and norepinephrine activity, improving attention and executive functions. Methylphenidate induces a number of actions, including inhibiting dopamine and norepinephrine transporters. It also causes agonist activity at the serotonin type 1A receptors and redistributes the VMAT-2. Evidence has also been found of interactions between opioid and glutamate systems.
As a result of the interactions between the 5-HT1A receptor and the redistribution of VMAT-2,
Ritalin raises the extracellular levels of dopamine and norepinephrine. The influx of these neurotransmitters causes them to bind to their respective transporters or receptors and dramatically increases an individual’s ability to focus on a task and gain pleasure from its completion.
The drug has also been found to interact with the receptors responsible for the regulation of adrenaline. It stimulates cortical excitability by activation of the α2 adrenergic receptors, which leads to an increased desire to carry out tasks to completion. Further evidence has been found in data that shows that the procognitive effects of Ritalin are blocked by a2 antagonists.
The drug has a greater effect on mental as opposed to motor activities. While its exact mode of action isn’t entirely understood, it is known that it encourages the inhibition of dopamine reuptake without encouraging the production of more dopamine. Methylphenidate is a racemic mixture that contains d- and l-enantiomers; it is the d-enantiomer that is pharmacologically active.
Chemical formula – C14H19NO2
Methylphenidate is a chemical compound that goes by several other identifiers. Its IUPAC name is methyl 2-phenyl-2-piperidin-2-ylacetate, its CAS is 113-45-1 and its EC number is 204-028-6.
Some of the other names it goes by include:
- Hydrochloride, Methylphenidate
- Methylphenidate Hydrochloride
- Ritalin SR
Chemical components of Ritalin
Methylphenidate is an amino acid ester that has been derived from methyl phenylacetate where one of the hydrogens alpha in relation to the carbonyl group has been replaced by piperidin-2-yl. The drug is a piperidine, methyl ester and beta-amino acid ester.
Understanding Ritalin Addiction
Ritalin is a Class B and section 2 drug in the UK, which is an indication of its severity as a controlled substance. Even though it is a legal drug that can be prescribed by a doctor, it can still cause considerable damage to a person’s mental and physical health if not used properly.
When taken in larger doses than prescribed, it can induce euphoria, which is attractive to some drug users. (12) As well as chasing a high, there is a growing trend for people to use Ritalin as an intellectual performance enhancer for exams or work.
Long-term use of Ritalin can lead to the individual gaining a tolerance, which in turn means they require a higher dose in order to feel the same effects. It may be difficult to discern whether a long-term user has developed an addiction, but signs of abuse include paranoia, anger, difficulty sleeping, psychosis and fatigue.
Due to the fact that Ritalin is predominantly prescribed to children in the UK, parents should remain vigilant for signs of abuse, especially among teenagers. The tablets may be crushed up and snorted to be used recreationally and shared among friends, which would be classified as distribution of a Class B drug. In extreme cases, people have been known to crush the tablets, mix them with water and inject them intravenously. Class B drugs become Class A when injected.
Addiction to methylphenidate that stems from a desire to perform better on exams or at work should be treated with psychotherapy to address the compulsive underlying antisocial behaviour that it stems from. It can be a complex habit that leaves the user in a cycle that continually affirms their use of the drugs due to the increased social and educational performance.
How addictive is Ritalin?
If taken at the correct dosage and correctly monitored, the use of Ritalin should not lead to addiction. There are, however, several factors that increase the addictivity of Ritalin, including the feeling users get of being more chatty and sociable, weight loss, an increased attention span for studying and the feelings of euphoria from large doses. It is also more likely that those who snort the drug nasally or inject it intravenously are at a higher risk of developing an addiction.
Ritalin can serve as a gateway substance for young people at school or university. As a prescription drug that can be procured legally, it may be the first drug a young person deals or buys. Because it increases the presence of dopamine in the brain, it increases pleasure, movement and attention. Dopamine is the neurotransmitter most closely linked to substance abuse of all kinds.
How Ritalin Abuse Typically Starts
People describe a feeling of utmost clarity when they are using the drug. Its effects lead them to feel like excellent conversationalists and enable them to get engrossed in their studies for hours. The most common place to find Ritalin abuse is in university classrooms, where students who are desperate to reach their grades will go to any lengths to achieve results. Many people aren’t aware of the dangers associated with prescription medication.
The little-known side effects of methylphenidate such as decreased appetite and weight loss can lead vulnerable
people to plummet further into addiction. It is usually these vulnerabilities, such as low self-esteem, lack of familial support or anxiety, that lead to people developing an addiction to Ritalin. It offers a quick fix to some people, especially those who aren’t aware of the debilitating come-downs or catastrophic consequences of abuse.There are even young people who pretend to have ADHD in order to gain access to the drug, so parents should pay close attention to their children’s motives.
High dosing is an early sign that an individual is developing a dependence on Ritalin, it may begin because the regular dose no longer has the effect the person desires. It should be noted that one characteristic of substance abuse is taking more of a drug than prescribed by a doctor.
If an individual or a loved one is found to be taking more of their medication than their prescription denotes, they must seek medical attention immediately. The quicker an intervention is offered, the greater the chance of recovery a person has.
The non-medical use of prescription drugs accounted for a record number of deaths in the UK last year. Medical researchers believe there are a multitude of reasons behind this increase, but availability on the Internet is seen as the biggest one. People can import medication from all over the world with little more than a credit card.
The use of Ritalin for appetite suppression, increased intellectual or social performance and recreational purposes accounts for the majority of non-medical uses of the drug.
Snorting Ritalin is a sure-fire way to discern that substance abuse is taking place. Crushing the tablets, mixing it with glucose and then inhaling the dust is a much faster administration route than oral ingestion and indicates an individual cannot wait to get their fix. It is the method of administration most closely associated with cocaine use, and some behavioural scientists believe crushing and snorting medication can be a gateway to cocaine use later in life.
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Risk Factors for Ritalin Abuse
Compulsive and excessive behaviours are linked closely with the activity of certain neurotransmitters within the brain, as well as aberrations in the metabolism. Methylphenidate causes an increased presence of the neurotransmitter dopamine by inhibiting its uptake by dopamine receptors. This means Ritalin is interacting with one of the primary neurotransmitters thought to affect substance abuse disorders in individuals who are prone to compulsive harmful behaviour.
It is widely thought that chemically inducing dopamine by using legal or illegal drugs can affect an individual’s ability to regulate production naturally. It is thought to induce the compulsive need for someone who is addicted to keep on taking the substance to maintain a base level of dopamine. This is particularly true for those with a genetic predisposition to compulsive behaviour.
One of the most pertinent risk factors for developing an addiction to methylphenidate is the method of use. Crushing the power and inhaling it gives the user a much more potent, immediate high and quickly leads to tolerance in the majority of individuals. It also emulates the predominant method of administration for cocaine use, which can be glorified among naive groups of young people.
Injecting the drug reclassifies use and distribution to Class A, and an individual found using Ritalin in this way should seek medical help or be advised to seek help to detox as soon as possible. This also means that anyone found sharing or selling their prescription in this manner is subject to be prosecuted for supplying Class A drugs.
Young people who have seen older family members snorting substances are at a high risk of developing an addiction to prescription medications. Those who have an anxious disposition and are low in confidence would be more inclined to take the drug to enhance their performance. Doctors should always screen ADHD patients for these symptoms before prescribing Ritalin.
Mental health co-occurring disorders
According to a survey carried out in 2010, 45% of individuals who are suffering from problems with addiction in the UK have also received a diagnosis for a co-occurring disorder. Also known as dual diagnosis, this is where a client is suffering from a mental health disorder as well as a substance abuse disorder.
The treatment, in this case, must be predominantly focused on treating the underlying mental health issue, which is often a major contributing factor to the development of the addiction. (19) Often, those who abuse Ritalin for the purposes of doing better at school or university suffer from anxiety disorders that lead to an irrational fear of failure.
Individual plans designed by experienced therapists are strongly advised for those who are suffering from concurrent mental health and substance dependence disorders. Usually, the client undergoes inpatient treatment to deal with drug addiction and offer emergency therapy and then receives ongoing outpatient treatment in the form of group and individual therapy.
Mental States and Psychological Effects of Ritalin Use
Side effects are often well tolerated and mild when the drug is taken exactly as prescribed by the doctor. However, when the drug is abused, there can be extremely detrimental effects on physical and mental health. The long-term effects of abuse on the mind can include psychological disturbances, hallucinations, paranoia and delusional disorders. The effects on the body include loss of circulation, heart problems, stroke and suicide.
- Feelings of euphoria
- Suppressed appetite
- Increased alertness
- Sleep disturbance
- Behavioural changes
Physical Signs and Symptoms of a Ritalin Addiction
Ritalin is closely related to amphetamines, and its potential for abuse is similar in that it can be used for performance enhancement, for weight loss and recreationally to bring on a high. The feelings of increased control and alertness often have positive initial effects that cause the user to use the drug in greater quantities more often.
Parents and students should be vigilant as it is young people who are among those at the highest risk of gaining access to the drug. In the UK it is licensed to treat children and young people who are suffering from ADHD. The license does not mean that the drug cannot be prescribed for other conditions such as narcolepsy, chronic fatigue syndrome and sometimes depression, so it can be distributed among other demographics.
General signs of addiction to look out for are anxiety surrounding the substance and a fear of running out that causes an extreme emotional reaction. The individual may become more secretive and withdrawn, and mood swings are often observed depending on how recently the user has had a fix and how much of their supply they have left.
Specific signs to watch out for when assessing whether you or someone you know may need help addressing and treating an addiction to Ritalin include:
- Chest pain
- Poor circulation
Stages and Symptoms of Ritalin Withdrawal
Withdrawal from stimulants is best carried out with medical supervision, ideally either staying at or regularly attending a drug rehabilitation centre. It is not advised that individuals suddenly stop taking their medication as this can lead to serious health repercussions, especially if the person has been using the substance for a long time.
Early withdrawal symptoms
Initially, the client experiences a crash period whereby their body is struck by the reduction in the stimulant. This is more pronounced the longer the person has been abusing the drug and will be especially amplified if the user was binge-using Ritalin. Early withdrawal often manifests itself in feelings of despair, extreme cravings, anxiety, sadness and agitation. The initial crash is often followed by intense physical and mental exhaustion.
This stage of withdrawal can bring on bouts of depression and feelings of helplessness. It is often very difficult for the client to sleep during the early stages, and this can bring on ‘tweaking’ behaviour such as jerky movements, irritability, delusions, paranoia and rapid eye movements.
Acute withdrawal symptoms
These symptoms will usually begin to develop 24 to 36 hours after the initial crash and withdrawal period. The overriding sensation for most people is an extreme desire for prolonged sleep that is often accompanied by the inability to actually fall asleep. Mental and physical energy levels are often low to non-existent due to the body’s energy resources fighting to counteract the effects of withdrawal and heal the body and mind.
The lack of dopamine in the brain gives a pronounced feeling of listlessness, and people often have great difficulty gaining pleasure from anything during withdrawal. People are often tempted to try alcohol or other substances to aid with sleep, but this is strongly advised against due to potential unintended and dangerous consequences.
Late withdrawal symptoms
The final stage of withdrawal is characterised by prolonged night-time and daytime sleeping, where periods of wakefulness may bring on an increased appetite in some individuals. Loss of energy, a decreased sense of pleasure and other depressive symptoms may continue for several weeks and sometimes months after the initial phase, depending on the individual and the length of time they were abusing Ritalin. Continued detox and abstinence eventually leads to a reversal in the feelings experienced during withdrawal.
Ritalin Overdose Explained
The effects of an overdose on methylphenidate present themselves similarly to an overdose on amphetamines. Psychiatric symptoms can include hallucinations, toxic psychosis, confusion, delirium and euphoria. Symptoms of extreme anger, violence and suicidal intentions have been noted in people who have been admitted to the hospital while experiencing an overdose on Ritalin.
Physical effects the drug can have on the body include heart attack, stroke, loss of circulation, coma and death. It has also been reported that long-term abuse can even lead to brain injury by causing long-lasting changes in brain function and cell structure.
Treatment for a Ritalin Addiction
Cognitive behavioural therapy (CBT)
CBT can be extremely useful for the treatment of addiction to Ritalin because it aims to challenge and amend patterns of behaviour and the underlying beliefs that drive individuals to make the choices they make. Once a person understands what drives them to take action, they can begin to develop alternative coping strategies that replace the need to abuse the drug.
It can also be used to treat clients who are suffering from ADHD and have developed an addiction to their medication. ADHD can also be addressed by the mechanisms of behavioural therapy and is particularly helpful when combined with medical treatment using a non-addictive substance such as Straterra.
Inpatient Ritalin treatment
In severe circumstances where abuse of Ritalin has been prolonged and the sufferer cannot function, residential rehab may be recommended. In this setting, an individual has access to 24/7 care from a group of medical professionals. There is a strict daily schedule that all inpatients must follow, and this sense of routine is encouraged to be adopted in the daily lives of clients once they have left the facility.
Due to the fact that there have not been any drugs confirmed to genuinely aid people who are coming off Ritalin, individuals are forced to endure the withdrawal symptoms, which is often easiest to do in a residential setting with constant supervision from staff.
The matrix model
This is a combined treatment program that incorporates aspects from behavioural therapy, individual counselling, the 12-step programme and family education and also uses regular drug testing. It has been developed to address the problems that can lead to stimulant addiction and is one of the most effective therapy subtypes for treating the problem. The individual will be closely supported by a therapist who guides them through the process.
Dialectical behavioural treatment (DBT)
The goal of DBT is to help people manage without relying on abusing prescription medication by teaching them strategies to cope and helping them to understand why they feel the way they do. A mixture of group therapy and individual therapy is used to teach the client how to regulate their emotions and avoid feelings that lead to the intense desire to escape into drug use.
The most commonly occurring dual diagnosis with Ritalin abuse disorder is ADHD, the disorder it is prescribed to treat. Due to the link between the dysfunction of the neurotransmitter dopamine in sufferers of ADHD and the role it also plays in substance abuse disorders, treating those with a dual diagnosis is challenging. Doctors are often reluctant to treat those who are already suffering from a substance abuse disorder with stimulants and instead prefer to use non-addictive medications.
Outpatient Ritalin treatment
Outpatient treatment is recommended for the majority of people who are suffering from an addiction to Ritalin. This will usually involve the client visiting the rehabilitation centre around five days a week and attending regular therapy sessions. While there is a risk of the client sneaking themselves medication more easily, they are freer to carry out regular daily activities. This is particularly useful for those who are functioning addicts.
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