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.