Ritalin: What it is, How it Works

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One Ritalin Pill

Ritalin, or methylphenidate, is the most popular medication used to treat attention deficit disorder, with or without hyperactivity (ADD & ADHD).  It works by activating pathways in the brain associated with attention, focus and motivation and is extremely effective for treating ADD/ADHD.

But as a Schedule II medication, Ritalin is a potent stimulant with potentially serious side effects.

How well does Ritalin work?

Ritalin is a stimulant and the stimulants in general work to significantly treat ADHD symptoms in roughly 70-80% of those who take them.  That number, however, is in combination with therapy – without therapy, the response rate is only about 50%.

But why is there such a big difference in efficacy between medication alone and medication with therapy?

The reason is likely because Ritalin makes it possible for you to behave in a less “ADHD fashion” but that you still have to learn to do so.  You may take Ritalin, for instance, and still forget to pack an important item before a meeting because you weren’t organized.

How does Ritalin work?

Let’s first explain the biochemical action then explain what it actually means.

Biochemically, Ritalin has a few effects.  Mainly, it works on the dopamine transporter in the brain, inhibiting it.  This prevents it from removing dopamine from the space outside cells.  Since dopamine remains longer outside cells, it has more time to activate receptors.  This treats ADHD symptoms because dopamine is associated with focus and motivation.

But what does that mean?

When your brain experiences a stimulus, it has to decide whether or not it is important.  If it is important, you pay attention to it.  In ADD/ADHD, an increasing amount of research shows that this attention pathway is dysregulated.

Paying attention to something boring for someone with ADHD is a lot like trying to lift a weight after someone injected a tranquilizer into your arm.  It takes something being very, very important or interesting to achieve the same “this is important” decision that someone’s brain without ADD easily makes.

Ritalin helps your brain process signals and decide which ones are important.  And beyond helping your brain do that, it helps you keep focused on whatever it is for longer than you could otherwise.

Is instant release or extended release better?

A lot of research is starting to indicate that extended release forms of stimulants for ADHD are a lot better than instant release.  It makes a lot of sense!  Would you rather take 2-3 pills a day or just one?

Beyond the once-daily dosing, extended release formulations provide smooth drug release.  Taking instant release forms of Ritalin is a lot more intense, with drug levels spiking up then shooting down – several times in one day.

Supporting this claim are studies which show that more people experience ADD/ADHD symptom remission on extended release Ritalin (Concerta) than instant release.  In one study, 44% of those on Concerta had complete symptom remission versus only 16% of those on instant release.

Because of these advantages, clinicians tend to prefer extended release forms over instant release.

What are the side effects of Ritalin?

The most common side effects of Ritalin include dry mouth, decreased appetite, moodiness, mood changes including increased sadness or anxiety, decrease in appetite and weight.  This list is not complete; see manufacturer’s insert for more.

In one study, about 10% of adults taking Ritalin and 5% of adolescents stopped taking Ritalin due to side effects.

Does Ritalin work if you take it daily for a long time?

There is limited research into whether or not tolerance into stimulants like Ritalin develops.  That said, most researchers and clinicians believe that tolerance is quite rare – but possible.  In most cases, once you find a dose that works for you, you can take it daily for years without tolerance developing.

10 COMMENTS

  1. I have been on Riralin and/or adderrall for 3 yrs. now. The adderrall worked womders, but

  2. I took Ritalin as a child. Now, I am 27. After Ritalin, I then took Adderall, for about a year, but it didn’t work wonders. The Ritalin worked well, but I thought I would try something new, in high school. However, a year after on Adderall, I decided to take Concerta in which I took for quite a while, off and on. After quite some time, I then decided to go down the nonstimulant route. But, at this time, the only nonstimulant out there approved for ADHD was Strattera which did not agree with me at all. It made me sick and my judgment was a little more off then usual. So, with that said, I went back to Concerta up until recently. I am still taking Concerta, but I do have Methylphenidates as well, the instant release which works wonders. I love it because it gives me that boost of energy needed in the morning. I kinda like it better then the Concerta. However, I am not into the whole taking several pills a day. That’s my only complaint. Now, I do like the fact that I can choose whether to take it in the afternoon or not unlike the Concerta that once I take it slowly goes into the system as the day goes on and you can’t do anything about it. If you want to take a nap, forget it. At least, I couldn’t when on the medication. My mind would be on the go even though my body, after working hard on something, was tired. So, I am kind of trying to weigh out the options. At the moment I am going to try, I think, taking the Methylphenidates throughout the day as needed and see what happens. I am currently taking 10 mg of that and 36 mg of the Concerta, of course not to together. I flip flop. I usually take the Concerta when I have a lot to do throughout the day and when I don’t and I just need something for the morning chores I take the Methylphenidate and forget about the second dose in the afternoon. So, maybe I’ll stick to that. I’m not sure. I do kind of like how the instant release works. I like how it releases immediately and gives that jolt and I feel it consistently all morning. That is my complaint about the Concerta. I feel like it wears off throughout the day and then gives that big jolt all over again when it thinks it’s time to.

  3. Oh, I also failed to mentioned that before the Ritalin and Concerta, most recently, I tried Vyvanse and that was horrible. First off, I started on the 30 mg and that was okay. My mother didn’t think it worked great. So, what did I do? I decided up the dose to 40 mg. That was a bad idea from the start. I started to have bad reactions, gradually, with the 40 mg. I was gradually becoming irritable, stubborn, and argumentative. I was basically becoming the “Overfocused ADD” type. That wasn’t fun. Finally, over time, I exploded and turned into this mad women screaming and at that point I felt like I was rapid cycling and turning into “The Ring of Fire ADD” type. That was the worst and I stopped that medication real fast. That was enough for me. So, that’s how I got back to taking the Concerta along with the Methylphenidates. I had come to the conclusion that anything other then Methylphenidates have backfired on me. Non of the other stimulants agreed with me for one reason or another. I should have known, but I guess I had forgotten that the 20 mg of Adderall, which is pretty much the same thing, didn’t really agree with me either. My said that even with that dose I was a little more irritable and argumentative. I wasn’t as bad as this past time, but still, she didn’t think it was working great then and I guess that’s how I got started with Concerta. Oh well…Now, I think I have the right meds. It’s just how I am going to approach the whole taking meds idea. I don’t want to get addicted to them while at the same time I want to get the full effect. I am going to school, again, soon, to hopefully become a medical assistant and I am going to need something to keep my focus and attention on school. The lack of focus and concentration seems to get in the way of my true capabilities and I don’t want that to happen if Medical Assistant is what I want to become in the end…

  4. Oh, also, after that episode, I didn’t completely chuck the whole idea. I still had 30 mg pills and since the 30 mg was okay before I decided to drop the dose back down since upon research I had seen a lot of people doing so after getting the same or different other reactions to the Vyvanse. But, that didn’t agree either. I wasn’t as bad, but my argumentative/stubborn attitude still exhisted. Plus, my irritability was mild. So, I finally chucked the whole Vyvanse idea even though it sounded like a good idea…12-14 hours of release time. Oh well. Back to Meths again. I figured if that’s what worked the best why mess with a good thing….

  5. Tina; I would love to chat… I am on Ritalin at this time just would love to ask you a few things if you would like you can write me at rouge_angel@live.com any time Nikki

  6. Hi my name is Shanon, Im 44 yrs old and have been trying to find out what was wrong with me since i was 22 yrs old..It all startyed after i had my twins, They told me it was postpartum depression, Never believe anyone when depression is the first thing they diagnose you as!! So many years went by and i have taking so many different meds i soouldnt even alive.. So all yhose years go by im depressed right? Then they decide im Bi-Polar.I thought omg, i havent heard good things about this, So then im treated for Bi-Polar for oh the next 8-10 years, Now some of those meds will indeed make u think your anything just help me please!! So my pshych moves to another town i go to a knew one. He totally came on to me but i had time to mention that my son was adhd, He said if my son was than i was, So he prescribed adderrall 20 2 times a day. OMG, I went off about 9 different meds, He also put me on Geodon that made my mood swings stop which also is a symptom of adhd..My life changerd!! I couldnt believe it..No more being so stressdd that i couldnt handle it no more thinking everyone was judging me, It all went away.. So a few years went by they came out with Vyvance, So they ask me to try it, WOW, Even felt better than with the adderrall… But after a couple of years it quit working, So i went back on adderrall. Ive waited about 1 year and a half now cause im gonna try the vyvance again.. To everyone thats been diagnosed as depressive disorder or Bi-Polar just ask to try being tested for adhd or add, This can save your life in many ways,, My Best To You All <3

  7. Methylphenidate, Concerta, and Ritalin  seem to be the same thing – I just looked it up.

  8. Wow Tina you should write a book.

  9. Shanon, you make a good point. I was also told I had pretty bad depression (which I already knew) and then some doctors thought I had biplolar, others thought I had anxiety. I was on a number of anti-depressants and anti-anxiety that didn’t help. I finally went another doctor and he right away thought I had adhd. I was always a very active kid, but in the 60’s they didn’t recognize adhd then. My mind races and I am always figity. I have even been diagnoses with rls (restless leg syndrome), which I’m not even sure that isn’t attritubable to adhd. I was put of ritilan for the first time in my life and it’s worked wonders for my depression and anxiety. I thought I would have to “exist” in this depressed fog for the rest of my life. I’m so happy I found this doctor!

  10. i just started takeing ritaln but i wounder if atteral works better i also have bypolor and have ups and downs this med makes me shake so any idles out there>

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