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.

ADHD and ADD Online Diagnostic Test

ADHD/ADD Natural Remedy Report

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Adderall vs Ritalin:

By the time you’re done reading this article, you will know how Adderall and Ritalin compare.  Is one better than the other?

If you want to know what Ritalin actually is and how it works, see here.

And are you confused by all your medication options?  (Ritalin, Adderall, Focalin, Vyvanse, Intuniv, Metadate, Pemoline – and that’s just getting started!)  Figure things out – a Full List of ADHD Medications tells you what you need to know.

The Chemical difference

Ritalin goes to brain cells and stops them from taking up dopamine and norepinephrine, which are chemicals associated with focus, motivation and pleasure.  That increases the amount of them in the general space between cells.

Adderall does the exact same thing.  It also, however, goes inside cells and makes them pump out dopamine.  It not only blocks the reuptake of the substance but also acts to increase its levels directly.

It is this mechanism that may explain its slightly higher strength in some ways.

More about Ritalin

Ritalin is the most commonly prescribed stimulant for ADHD, far outselling Adderall, but this doesn’t mean it’s better.  It’s just been out a lot longer.  Ritalin and ADHD are pretty much synonyms, and that association makes a big difference in doctors’ prescribing habits.

Chemically, Ritalin is derived from an amphetamine and has very similar biochemical behavior.

It is a very effective treatment for ADHD.  Roughly 55% of those who use Ritalin experience benefit. Combined with therapy, however, that number goes up to 70% or even 80%.

The reason for this difference is likely that Ritalin, at the right dose, enables you to perform in a less “ADHD” style, but you still have to learn how to do so.

You can get Ritalin in an instant release (IR) and extended release (XR) form.  On the one hand, extended release means more consistency and more convenience.  On the other hand, instant release might provide more of a “punch” so to speak.

Clinicians we’ve spoken to tend to highly prefer the extended release form as it is less variable and makes life a lot easier than instant release.

More on Adderall

Adderall is a mix of amphetamine salts, and it works about as well as Ritalin. It too is available in IR and XR form. It’s become increasingly popular since its introduction in the 90s. And it might just be a little stronger than Ritalin.

Some studies show that kids need to take 2 instant release pills of Ritalin to cover a day at school, while 1 IR of Adderall works similarly well. It is possible that an instant release of Adderall works for 5-6 hours, although officially, it is supposed to work 3-4 hours.  Molecule for molecule Adderall is more potent. But that might just mean you take less of it than Ritalin.

Some other studies show that Adderall produces a slight advantage over Ritalin in treating certain symptoms. One study showed that Adderall had significant advantage in keeping people on task and helping stay focused.  But please take that study in context.  It wasn’t a rigorous clinical trial, and only examined 37 patients.

Larger, more scientific studies have also shown a slight advantage of Adderall over Ritalin.  The difference is so small that in any one given study it might not mean anything. What makes it significant is that the slight advantage of Adderall seems to occur in multiple studies.

More interesting is that people who start Adderall might be more likely to keep on using it than Ritalin.

And in a summer school study at SUNY Buffalo, Adderall was viewed to be slightly more effective. Staff clinicians especially liked it, favoring it 3 to 1 over Ritalin, but of course they weren’t the ones taking it.

Efficacy:

Dr. Tuckman, a clinician who has treated hundreds, if not thousands, of adults with ADHD has this to say: Roughly 1/3 of people with ADHD respond best to a Ritalin type medication, 1/3 to an amphetamine type such as Adderall and Vyvanse, and 1/3 respond equally well to both.

So Adderall and Ritalin are about as effective for treating ADHD, and some people respond better to one or the other.

Side Effects:

Adderall may be slightly stronger than Ritalin. It may also have slightly different side effects. One clinician’s study showed that Adderall was less likely to cause anxiety and agitation, while being more likely to cause insomnia.

Adult ADHD:

ADHD can be a lot different in adults than in children.  If you are concerned that you have ADHD and are over 18, see an ADHD Test Made for Adults.

Learn what the 4 Secrets To Success with ADHD are – it could really help you understand what’s going on in your life.

Related Articles:

1. Long Term Effects of Adderall
2. Adderall vs Vyvanse
3. What’s the Story with Intuniv?
4. Is There a Physical Test for ADHD?

ADHD and ADD Online Diagnostic Test

ADHD/ADD Natural Remedy Report

Overcoming ADHD: A Guide for Parents

ADHD is most often treated by stimulants like Ritalin, Adderall, and Dexedrine. I’m sure you’ve heard of these medications – but what are they? What do they do?

And most importantly – are they safe?

Are Stimulants Safe?

Stimulants are powerful medications, potentially addictive, and can have very serious side effects.

They’re commonly used because they’re effective.  Up to 70% of people experience significant symptom relief on them.  And the majority of the millions of people who use them are fine.  But they do have common side effects, and can rarely cause some quite nasty things.

The most common issues with stimulant use include increased anxiety, nausea or loss of appetite, and insomnia.

The rarer and very serious side effects?  To quote an ad for Vyvanse, an ADHD medication, “new psychosis, mania, aggression, growth suppression and visual disturbances” are possible.

Heart Damage?

Stimulant use might cause heart damage over time. Stimulants typically increase heart rate by ~3-5 beats per minute and also raise blood pressure.  One study of more than 50,000 children using stimulants showed an 20% increase in risk of emergency treatment for heart problems.

Use of stimulants by someone with a preexisting heart condition is a big no-no, as they may increase risk of cardiac failure or sudden death.

Psychological problems

As mentioned, a rare but serious side effect is that stimulants can cause psychosis, or a break with reality such as paranoia, delusional thinking and hallucinations.  Most psychosis occurs in people who were already at risk – but stimulants can cause psychosis in normal people at normal doses.

Stimulants can also cause serious problems with regulating or controlling mood. They can trigger mania in bipolar patients, and cause extreme mood variation even in people not normally at risk for bipolar.

Stimulants change the brain

Do stimulants cause brain damage?  Maybe.

Studies in rats have shown that extremely high doses of amphetamines given over a short period of time cause serious damage to the production of dopamine and its transport in the brain.  This happens by causing build up of radicals and reactive oxygen species.  Methylphenidate, or Ritalin, does not cause this damage, possibly because it only blocks the receptors for reception of dopamine.

But what about normal use?

The rats did not experience neural changes or damage from doses in the normal range.  The news isn’t all good, though. Baboons and monkeys, however, did experience brain damage at normal doses, showing a significant reduction in natural production and handling of dopamine.

It’s not clear what this means.  Children who take ADHD medication, after all, have larger white brain matter than unmedicated children, indicating a neuro-positive effect.

Remember: use of stimulants in children requires extreme caution and psychological analysis because they are young, more susceptible to side effects, and still developing.

Do stimulants like Adderall and Ritalin stunt growth?

This question is extremely contentious. A number of studies have shown that stimulant use is associated with slightly reduced growth, and, on the other hand, a number have shown that they aren’t.

The evidence, in my opinion, seems to be in favor of a slight reduction in height associated with long term use.

Both sides agree  that stimulant use initially slows growth somewhat; the question is if that delay is made up for in the long run.

Stimulant use is, however, associated with some degree of weight loss in the long run.

Conclusion:

Stimulants are extremely commonly used for a reason. They work. That said, they are potent substances, and often require supportive psychological therapy on the side to achieve best results.

For someone with a history of anxiety or other psychological problems, or someone with cardiac issues, use of stimulants should be exceptionally cautious if at all.  Use in children should also be done with extreme caution and only after appropriate psychological evaluation.

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Sources:

Potential Adverse Effects of Amphetamine Treatment on Brain and Behavior: A Review
Comparative Efficacy of Adderall and Methylphenidate in Attention-deficit/Hyperactivity Disorder: A Meta-Analysis
Cardiac Safety of Methylphenidate Versus Amphetamine Salts in the Treatment of ADHD