Talk:Methylphenidate

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price and daily dose for an adult

1. What would be the range of a typical dose for an adult? The German article mentions a range of 5-60mg. 2. What does that stuff actually cost? I'm living in a country where you can't buy it, only prescriptions (as far as I know) and I'm having trouble to find reliable (not fishy online offers) prices for it. Any help would be appreciated. Might be interesting for the article as well, no? Apologies if I missed them. 134.106.199.5

Illegal Abuse

The article mentions about illegal abuse, but should the article also mention standard and new prevention methods that drug companies and brands are using to prevent this. I don't know many of the methods but I know that there are methods that exisit.

The new time-released medications, such as Concerta, are not just used for their efficacy, but also for their low abuse liability (time-release capsules are very difficult to crush and snort, for instance). I'll find a place in the article to mention it. --Muugokszhiion 18:04, 4 April 2006 (UTC)

While in High School and my first year of College I abused Concerta, (I later found out that I was essentially doing a "safer" version of cocaine) and my doctor was actually the one who told me how to do it ("now don't take this with _____, _____, or ______, because you'll destroy the time release and all the medication will get released at once")...it's not hard to do, I just don't want to put exactly what it is on the net, it's probably out there, but I don't want it on my conscience. anyway, there are simple ways around that, and the problem is when doctors tell patients what not to eat/drink with the concerta, it's also telling them how to get a bit of a high on it. Wasdeadthenalive 13:02, 2 August 2006 (UTC)

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From the article:

According to the DEA, "The increased use of this substance [MPH] for the treatment of ADHD has paralleled an increase in its abuse of young children among adolescents and young adults who crush these tablets and snort the powder to get very very very high.

Teh. Interestingly, in my experience, while insufflation is the most popular method of black-market methylphenidate self-administration, taking the same dose by mouth is more effective. --CKL

Stimulant or depressant?

What is not clear from the perspective of someone reading this article for the first time are the apparently conflicting statements that this substance is a stimulant yet has a calming effect and can cause a zombie-like state. Is anyone reading this able to make this clearer?

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Yes, normally a stimulant would make a person hyperactive and over-alert (think amphetamine abuse.) However, in persons with ADHD, it has the opposite effect. This is known as the paradoxic effect of stimulants in persons with ADHD. -WH

-- −− First id like to say that i used to be very heavy into CNS stimulants and they dragged me down the wrong path. also I am hoping to become a pshyichiatrist, however i get tired of doing research and reading the same thing over and over so Ive been logging down my own expierences (seeing as im perscribed concerta)and using logic and research to figure out missing pieces to puzzles im trying to solve. Ill try to explain this as best i can. when you get bored its because whatever you are doing is no longer stimulating your mind. drugs like methylphenidate effect the CNS and basically makes your brain really easy to stimulate, resulting in incresed motivation, focus, sped up thoughts and logic, and it also gets your mind off of things like food and sleep which are probably two major factors in abilitys to function in school/work wtc. it also causes your muscle to tense and it dehydrates you and helps you forget fatigue... stimulant. People like me(really bad ADHD) when they take these drugs it takes all that unfocused energy and makes it so you can sit down and focus on one thing at a time giving a relaxing clear-minded feeling of euphoria. however it is by no means a depressent. the depressent like effects are just the calming sensation of being focused and able to productivly channel the need for mental stimulation -JDD −− The way my doctor explained it is this: ADD/ADHD is probably an effect of an imbalance in dompamine levels in the brain. This imbalance is a condition the brain does not "want" to be in. Stimulation increases dompamine levels, and works to mitigate the imbalance. Hyperactivity is stimulating, and works to correct the imbalance. In non-hyperactive ADD we see other forms of self-stimulation: stimulant drug use, high-risk behavior, impulsivity, day-dreaming, frequent sexual activity/masturbation and so on. When the need to provide external stimulation is removed (i.e. because of stimulant medication) the stimulation-seeking behavior disappears, or is mitigated. So, stimulent medications have a calming effect because they remove the need for external stimulation. Regarding the zombie-effect of over-medication, the analogy that works for me is this: imagine a machine where a drive pulley is connected to the machine with a belt. Everything works fine, but when the wheel is driven far too fast, the pulley slips, and the machine appears to slow down -JPS

Of course, that explanation is about as likely as any other. "God makes kids hyperactive" would be just as valid. There is no evidence that there exists a chemical imbalance the brain "does not want" to be in. I'm wondering how it is that evolution allows for 5% of kids brains to be imbalanced. Neurodiversity, in fact, appears far more reasonable. Neurodivergent 16:09, 7 December 2005 (UTC)

In the case of the doctor's explanation, he/she qualifies with "probably". That's the humililty of a scientist when something is not known for sure. "God makes kids hyperactive" is a statement without qualification, making reference to an entity that could possibly "make kids hyperactive." Evolution "allows" because it's a messy process involving mutation. If you mean that a chemical imbalance could be the first step to an eventual adaptation, it would be a hard sell, but science is a tough crowd. —The preceding unsigned comment was added by 74.114.221.41 (talk) 16:24, 4 April 2007 (UTC).

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"the effect of an imbalance of dompamine[sic] levels in the brain" -- caused by, I don't know, boring classrooms? the so-called "imbalance" comes about because of boredom. so you give the student pills with the effects you described. I got perscribed Ritalin, by the way, and can vouch for the harm it does, that it has done me. after having taken it for a few years and going off of it the world got very boring, very depressing. why[sic], I did not realize at the time. thank you for explaining this to me, even if inadvertantly.

Methylphenidate is definitely a stimulant drug. While it is true that it often relaxes or quiets those with ADD/ADHD, this does not change the fact that the drug is a stimulant, along with all of its close chemical relatives. There is much human and animal data supporting its classification as a stimulant. --Muugokszhiion 06:53, 27 January 2006 (UTC)

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• for some people it works as a stimulant. In others it works as a depressant. It depends on the individual.

Methylphenidate does not act as a depressant drug. It does not depress the central nervous system under any circumstance. Subjectively it may calm some people and speed up others, but it always works the same way. Furthermore, note that MPH is classified by the United States DEA as a Schedule II stimulant drug. The fact that methylphenidate is a stimulant is simply not debatable. --Muugokszhiion 07:53, 30 March 2006 (UTC)

I agree that the fact that a stimulant drug is apparently used to calm children down is a paradox, and I also think it would be good if we could find reliable sources that address this paradox.

My own understanding is that perhaps it's paradoxical that we call irritable children "overtired". But if being too tired really does cause behaviour problems in children, then using a stimulant to correct it seems logical.

Moreover, Ritalin is not used to send kids to sleep in class, but to help them concentrate better! You can't concentrate on stuff when you're half-asleep. Stimulant drugs can create extraordinary powers of concentration in non-tolerant users, and this behaviour is sometimes known as punding.

Still - don't take my word for it. I've got this half-baked understanding of how Ritalin does or doesn't work, and that's why I'd like to see if any reliable sources talk about this, which we can include in the article. I don't think they have to be scientific literature - pop culture sources are okay too, as long as they are onces which have played a major part in shaping the public's understanding of ADHD and Ritalin, rightly or otherwise. Squashy 17:52, 14 April 2006 (UTC)

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What exactly is the evidence for the "paradox"? As Muugokszhiion noted, the mechanism of action of ADHD drugs is generic. Low doses of amphetamine will improve anyone's concentration. Has a decent study ever been done on this? I tend to doubt it. --CKL

A critical piece to the puzzle is the fact that dopamine, for many parts of the brain, is actually inhibitory. This is counter intuitive to most people. So, for example, in the prefrontal cortex, the more dopamine present, the lower the neural activity. I show PET scans imaging brain activity in untreated people and people given cocaine in my class. There is dramatically LESS activity in many (but not all) parts of the brain in the person on cocaine. So, drugs like methylphenydate and cocaine increase synaptic dopamine by blocking the dopamine transporter, which recycles dopamine back into the cell. In some parts of the brain, this increased dopamine enhances brain activity. In other brain areas, the increased dopamine REDUCES neural activity. So....some people believe that increasing dopamine helps the ADD patient better ignore distracting stimuli and therefore concentrate on one thing better. To me, its an interesting idea worthy of serious consideration. I'm not willing to bet the farm on it yet though.

That's all well and good, but I'm talking about empirical evidence it affects ADHD children differently. Where is this evidence? --CKL

I wasn't specifically addressing your last question. I was trying to provide some more general insight into how the "paradox" people had been discussing since the beginning of the thread may not be so paradoxical. Have you searched using the national library of medicine's pubmed database to answer your question? You'll have access to the abstracts (I know, not the same as the paper, but a decent start) of papers from virtually every biomedical journal published. A lot of studies use "normal" controls to compare the effects of the drug in "normals" and adhd kids. So, in one example (Broyd et al., Int J of Psychophysiology, 2005) the effects of methylphenidate on a response inhibition and event-related potential are compared between adhd kids and normal kids. There are behavioral changes in adhd kids, but not normal kids. Rapoport et al. (J Atten Disord 2002) report in a brief report (which I haven't read yet, but will request) that some of the behavioral effects of methylphenidate are similar in adhd and "normal" kids. The information is out there.

If it's "out there" it most definitely belongs in here (the article). I've done a couple half-assed literature searches, and everything I saw assumed the truth of this hypothesis. I'm anxious to see anything you can come up with. Of course nothing in behavioral neuroscience is a paradox, since almost anything can be explained with minimal handwaving, given the lack of predictive models in the field. --CKL

Why me? I like the article the way it is. If you dispute it, I think the burden of proof is on you. Those of us who work in behavioral neuroscience readily admit there is a lot we do not understand and even more we simply do not know. Once we know enough, there will be no paradoxes. This is true of all fields. And perhaps the reason the papers assumed the truth of the hypothesis (I'm assuming the hypothesis that normal kids and adhd kids respond differently to methylphenidate) is because thus far its been supported. I can't given a definitive answer because I've only read a handful of papers and abstracts on the topics, but, what I read generally (but not always) shows that the behavioral responses to therapeutic doses of methylphenidate differ between normal kids and adhd kids. I fully admit I may be wrong because I haven't done exhaustive research on the topic. I'm not going to post on this anymore because I'm not willing to read more on it. I think you've made up your mind about what you want to me true and think that you'll simply discount those with different opinions. As I pointed out, the research has been done since this is an important question. You just need to read it. Sw390 14:01, 20 July 2006 (UTC)

You because I tried to find some references and couldn't, and you claim you've seen them. I'll try again, though. I haven't made up my mind at all, I just think that citations make better encyclopedia articles. It sounds to me like you're the one who's made up his mind by refusing to do anything further. --CKL

I have worked with children who 'supposedly' had ADHD (I say supposedly because apart from one or two, most of them had no problem concentrating or working on something they enjoyed e.g. spending 4 hours every evening in front of the playstation...). The few that were prescribed Ritalin (a stimulant) did have the effect of it 'knocking them out' in class. The most logical explanation I have heard for it is that these children are already hyperactive (for whatever reason), they are already in a heightened state of being, there neurotransmission are already overacting (like if they had already taken a stimulant). So when you give them Ritalin, you are basically 'overdosing' them. The transmission become so great that the body can not cope with the euphoria and they become numb - literally. −− If someone with ADHD/ADD finds something that interests them they are able to focus on it better than other things because it stimulates the mind more than other activities.-JDD −− As Muugokszhiion said, Ritalin is undeniably a stimulant. Although the drug will affect everyone differently, it does not depress the central nervous system and is definitely classified as a stimulant only in every list we have available. If you are looking for evidence showing ADHD kids reacting differently from "normals", I don't think you will ever find it. The whole point of the debate on drugging kids is that supposed disorders like ADHD are so poorly defined that any kid that misbehaves can fit the bill (according to most respectable therapists, in the overwhelming majority of cases behavioral problems result from some environmental cause and not brain chemistry). The lack of any perfect way of measuring the effect of these drugs and parents' desperation for a quick fix means that any child who behaves "better" while on the drugs will certainly be labeled as ADHD. Since the method of diagnosing these disorders is so poor, studies of these patients are never going to yeild any real results.

Are you "supposedly" a clinician licensed to diagnose ADHD? "Any kid that misbehaves" does not, in fact, fit the bill. Your comment is anecdotal, and thus extraneous to the creation of an encyclopedic article.

Firefox rendering problems

Page does not render correctly in firefox. The "edits" to be specific--K... 18:27, 28 Apr 2005 (UTC)

Could you be more specific? I use Firefox 1.0.3 on Linux/MIPS and under Windows XP, as well as IE 6.0 under Windows 98 at work, and the page appears to render similarly under all three browsers. Which edits are mis-rendered?

--Ryanaxp 21:30, Apr 28, 2005 (UTC)

If you look at the infobox on the right, over the word excretion, [edit] [edit] is displayed. --Heah 21:54, 28 Apr 2005 (UTC)

I also see this error with Firefox 1.0.4 under Wink2K, and in IE6 under the same OS there is no problem. Here is a GIF displaying where the exact problem is. This looks like something in Wiki code, though. Don't know if or how it could be fixed through simple editting of the page. Perhaps there is some obscure setting in Firefox that I have overlooked.

--Indigo 10:34, 19 July 2005 (UTC)

I have worked with children who 'supposedly' had ADHD (I say supposedly because apart from one or two, most of them had no problem concentrating or working on something they enjoyed e.g. spending 4 hours every evening in front of the playstation...). The few that were prescribed Ritalin (a stimulant) did have the effect of it 'knocking them out' in class. The most logical explanation I have heard for it is that these children are already hyperactive (for whatever reason), they are already in a heightened state of being, there neurotransmission are already overacting (like if they had already taken a stimulant). So when you give them Ritalin, you are basically 'overdosing' them. The transmission become so great that the body can not cope with the euphoria and they become numb - literally.

I must say that is an excellent theory. Me myself do use ritaline by prescription. In other words: I disagree. It does the opposite, After more or less 16 years living in chaos (add here not the hyper part) I can finally live in peace, create new norms and "destroy" the ones that where messing me up. I do not believe this comes from a minimal brain damage/deficit but is rather connected with traumas or such (but hey I am just stating my theory like yourself) I am now 23 years old an can finally behave like a human being. Mostly because I now feel like one. Tell me one thing: Your theory (again) is impressive, But have you ever tried and experienced the effects of this drug? Well I both know the theory and the basis... so well I was just wondering.193.71.156.193 21:38, 30 July 2007 (UTC)

Suicide

I've looked for the suicide study to no avail. Judging by the anonymous IP's other unverifiable content in psychiatry-related pages, I'm pulling the reference pending a citation. --JohnRDaily 06:39, 31 Jul 2004 (UTC)

No problem--I kept it in hopes that someone would be able to verify or disprove it later. Maybe we should quote it here, though, for posterity's sake:

A US study done by Professor Janice Russell of the North Western University, 2003 found that the suicide rate of ADHD children taking Ritalin increased by 28% compared to those children suffering ADHD but not taking stimulant medication.

Study needs cite before being put in the article. --Ardonik 07:29, Jul 31, 2004 (UTC)

Fake? As of 19 Oct 2004, the only Russell at Northwestern medical is Eric J. Russell, and there's no Janice Russell at Northwestern at all. (The directory page says "NO LONGER AT NU" for some names, so it would probably have any faculty from 2003.) I suppose it's possible J=Janice, but he's the chair of the department of radiology, and doesn't seem to have anything to do with ADHD drug research.

methylphenidate can't be 'smoked', it breaks down at high temperatures.

≈Methylphenidate can be smoked... amphetemines cannot... and most of the time if someone becomes suicidal on ritalin its because they've either stopped taking it our they've built up a tolerence and are going through some sort of withdrawel... I know when i get depressed after taking my concerta its because the dose needs adjusting. —Preceding unsigned comment added by 76.170.119.175 (talk) 13:11, 26 November 2007 (UTC)

Bioavailabity Data for Methylphenidate

Surely 269.77 is incorrect? Does the author mean 0.269?

Fixed. -n

Developing the disorder

Someone was telling me, "You develop the disorder if you take the drugs and you don’t have it." I.e., if you don't have ADD, but you start taking methylphenidate, you will become ADD. Is that true, and if so, is it permanent? Thanks, 205.217.105.2 14:33, 19 October 2005 (UTC) ≈ this is coming from personal expierince...I already had ADHD but when i started abusing stimulants my adhd has gotten worse, my memory doesnt always work to great, and its caused all sorts of other physical and mental ailments ≈ People who do not have ADD will exhibit the same effects as anyother person who takes stimulants such as caffine or ephedra. By the sense of the term you become attention deficit and hyper because you are on drugs, but that is the same for people who are ADD. To much ritalin and you are going to act bonkers. However the effects are no more permanent than taking caffine endlessly. Most of the hype probably comes from honor students who take ritalin to stay up to study. They are more hyper because they havn't slept than because they took ritalin.

I haven't seen any studies and I am not aware of real evidence of this. Probably just urban legend. --70.22.196.151 17:05, 19 October 2005 (UTC)

See this: "A study, led by McLean Hospital's William Carlezon and Susan Andersen, found that adult rats given Ritalin as juveniles behaved differently than their placebo-treated counterparts in a host of tests that reflect mood and attention." (Emphasis added.)

http://www.researchmatters.harvard.edu/story.php?article_id=748

No. But you'll probably get high. --Netdroid9

There is absolutely no evidence whatsoever to support the assertion that correct medical use of prescribed psychostimulants contributes to the development of ADD/ADHD. The idea itself is terribly inaccurate. --Muugokszhiion 06:49, 27 January 2006 (UTC)

certain side effects

I take concerta and it has a weird side effect when i first started it. the side effect was HORRIBLE NIGHTMARES. please anyone else thats out there tell me that im not the only one out there that suffered this. I would like to know what caused it and why!

                       ~A Methylphenidate Veteran and Psychology Student at UCF~

    Methylphenidate does in fact cause nightmares. The dreams do however become less frequent over time. With refference to
cases involving patients who do not have the condition obtaining ADHD after taking the drug, I have not heard this. I suppose 

however a subject may seem less responsive to basic rewards and seem overly extroverted, but this is essentially in response to the absence of the chemical once a dependance is formed. The drug does have an effect of dopamine leves which is the cause for the drowsiness. I don't know how creadible my information is but I hope some of this information helped.

    - Dylon Haxlor

well then shouldn't it be added to the page under neurological symptomts. The last time i had a nightmare it lead to me not sleeping for 3 days... not a road i want some one else to go down

No. The information has no credibility since it's simply anecdotal. I don't believe there's a single study out there that lists nightmares as a side-effect of the medication. Until we see one, it should not be added. --Muugokszhiion 06:46, 3 March 2006 (UTC)

I had night terrors for about 3 months after I started taking concerta in the 72 mg tablet. Before then though i was on the 36 then upped to the 54 mg tablets. I had never had problems like that until it was upped to 72 mg. What kind of things where they about? Mine usually dealt with death.

I have been taking concerta now for a while and also started dreaming the first night. They were not nightmares, however. It disappeared after about a week. Side effects I had was lightheadedness and a nausic feeling about seven hours after taking the 36mg tablet. That also disappeared after about 10 to 14 days. At 56 years of age this drug has changed my life so dramatically that I do not know how I survived half a century without it. I will rather live with the side effects than without the drug.

     - Willem Victor 2 July 2006

I took ritalin when I was younger because I was "borderline" when it came to ADHD and supposedly it made me really depressed.

I took ritalin when I was younger because I was "borderline" when it came to ADHD and supposedly it made me really depressed. Is there any other cases that his happened due to takign Ritalin that anyone would know of? I was thinking of posting something here about Ritalin perhaps making one depressed but maybe with me it was a freak accident and somethig else that I didn't know about was causing the depression or whatever.

The FDA has described some possible psychiatric adverse events. "Post-marketing reports received by FDA regarding Concerta and other methylphenidate products include psychiatric events such as visual hallucinations, suicidal ideation, psychotic behavior, as well as aggression or violent behavior." [1]

Taking higher doses of ritalin for extended periods of time can and will increase the instances of depression. This becomes complicated because it results in chicken and egg question but the overall result is the same. Depression reduces the amount of serotonin available, in turn slightly reducing the rate at which new neurons are replicated. Which is another symptom of depression. For these reasons ssri and snri drugs are usually prescribed for teenagers and many adults who take ritalin. However the side effects from ritalin are minimized if not completely removed by sleeping more, and insuring that ritalin is completly excreted before going to bed. (this will fix most of the nightmare problems too, sleeping while taking ritalin usually causes an uncomfortable sensation when waking up) The less sleep a patient gets while taking ritalin, the more noticable the side effects. For instance, 5-6 hours of sleep and 20mg of ritalin in a 140-190 lb male will result in high anxiety, maybe some tremor, elevated heart rate, and very high emotion and irritability during the "rebound" when the medication wears off. (incidentally, the symptoms of being ADD/ADHD also become less on 9 to 10 hours of sleep)

 This is good information, but somebody for the love of all that is holy, clean it up

Sounds like original research to me: neither verifiable nor substantive. --Muugokszhiion 07:34, 30 March 2006 (UTC)

mechanism of action

Muugokszhiion's recent edit removed the mechanism of action section; anybody care to [re-]create one? Or translate from the spanish wikipedia (featured) article? --moof 10:20, 26 March 2006 (UTC)

The research by Volkow N., et al. (1998) is highly informative and shows that methylphenidate's mechanism of action is fairly straightforward. I think the small paragraph in the "Effects" section speaks for it concisely, sufficiently, and understandably. I don't believe there is any reason to elaborate:

"MPH is a dopamine reuptake inhibitor, which means that it increases the level of the dopamine neurotransmitter in the brain by partially blocking the transporters that remove it from the synapses. [7] This could explain its clinical efficacy."

Interested readers can simply refer to Dopamine reuptake inhibitor to learn a little more. --Muugokszhiion 07:29, 30 March 2006 (UTC)

"Rumored" use among students?

I know for a fact that "rumored" should be removed, and fast. I've done it to help study, my friends have done it to help study...it's almost a fact for students in residences that it's going to be used. I've (and many others here) have also used it before drinking to get the rush. There's nothing "rumored" about it. IMO, this word needs to be removed. The Chief 22:46, 27 March 2006 (UTC)

Well, it's rumored that it can cause cancer, so I'd be careful with that stuff. Neurodivergent 23:34, 27 March 2006 (UTC)

Is there anything that doesn't cause cancer?

I've changed the wording. --Muugokszhiion 07:15, 30 March 2006 (UTC)

Higher usage numbers?

The CDC did a study (late 2005?) which indicates that (at least according to the parents surveyed), more than four million kids were diagnosed with ADHD and 2.5 million were taking medication. Doesn't mean that all of them were taking methylphenidate, but I gather that there aren't a lot of options for drug treatments and this drug is the most popular. -- KarlHallowell 00:54, 6 April 2006 (UTC)

There are actually a number of pharmaceutical options for the treatment of ADD/ADHD, but Ritalin (methylphenidate) is the long-time favorite. The other most common ADD drugs include Adderall, Dexedrine, and Strattera. Wellbutrin is sometimes offered, especially for comorbid depression. Desoxyn is prescribed in exceptionally rare cases--almost never. Cylert used to be an option as well, but for various reasons it was removed from the market. New research with modafinil is underway, and it will be interesting to see whether or not it proves to be effective in larger-scale studies. So, a variety of treatments exists, but there are several big favorites. --Muugokszhiion 04:04, 6 April 2006 (UTC)

ADD/ADHD is a diagnosis that is passed out like candy... ignore statistics —Preceding unsigned comment added by 76.170.119.175 (talk) 13:19, 26 November 2007 (UTC)

History

I have deleted the words "was invented in the 1930s. In 1937, scientists discovered that it could be used to treat children with severe disruptive behavior and hyperactivity problems. It"

Reasons:

• There is no source for the unlikely claim that Methylphenidate was invented in the 1930s. Given patent laws, a discovery in the 1930s would be common knowledge by the 1950s and hence not patentable in 1954.

• There is no source for the claim about "scientists" using Methylphenidate in 1937. This is almost certainly a confused reference to Charles Bradley, a pediatrician, who published the first article on the use of stimulants on children in 1937 (Bradley, C. 1937. “The behavior of children receiving Benzedrine.” American Journal of Psychiatry 94:577–581). Bradley documented experiments with a stimulant, Benzedrine, not Methylphenidate on 30 children, ages 5 to 14 with a wide variety of "behavior problems", ranging from specific educational disabilities to epilepsy. Bradley reported a “striking” effect on school performance. IanWills 20:05, 18 April 2006 (UTC)IanWills

Long term effects

To state "As long-term use of methylphenidate was relatively uncommon before the 1990s, the long-term neurological effects are not well researched. As documented for amphetamines, the potential of methylphenidate use over many years causing permanent neurological damage to dopaminergic systems exists at least in theory." is ill-informed. To maintain it is dishonest.

Central facts include: Mayo Clinic neurologists Yoss and Daly described the clinical use of methylphenidate to treat patients with narcolepsy in 1956. [1, 2] Their patients neither reported nor manifest neurologic complications from long term treatment. [3, 4, 5] These are consistent with results in other medical cultures (e.g., B Roth in then Czechoslovakia, Y Hishikawa in Japan). In Switzerland Ciba manufactured lines of daily vitamins which included methylphenidate as an active ingredient for over a decade. Wilens et al. in 2005 [6] reported no "clinically significant" effect on growth, vital signs, tics, or laboratory tests (including urinalysis, hematology/complete blood counts, electrolytes, and liver function tests) were observed after 2 years of treatment. In short, the compound has been widely used and without report of significant incident for fifty years, twenty years without and thirty years with the US Controlled Substances Act of 1976.

Mayo Foundation includes the work on narcolepsy and methylphenidate in their portfolio of medical advances and mounted an exhibit marking the 50 year anniversary of the work.

During at least the 1960s and 1970s the US-DOD maintained the largest stockpile of methylphenidate. Ciba was the supplier while patents were in force. These expired as the Controlled Substances Act was implemented. The business plan of one young generic manufacturer involved supplying DOD (assured cash flow, markedly reduced liability, and no overhead for retail placement/distribution through pharmacies). Ciba made generally discussed low margin bid, then, when the young company had submitted its slightly lower bid, withdrew. The young company was sole bidder, locked into a near zero margin contract. Ciba without patent but with a near monopoly in the lucrative public market, raised prices.

Direct and inferential evidence from civilian and military sources in medical and commercial publications. Conceivably someone in law enforcement pressed into performing as a sometimes pharmacologist might ask forbearance. No one who has three times placed/replaced false information should be allowed near patients much less train to treat them.

1. Daly, D. and Yoss, R. (1956). "Treatment of narcolepsy with methyl phenylpeperidylacetate: a preliminary report.” Proc Mayo Clin. 1956 31:620-625. 2. Daly, D. and Yoss, R. (1959). "Treatment of narcolepsy with Ritalin.” Neurology. 1959 9:171-173. 3. Yoss, R. and Daly, D. (1968). "On the treatment of narcolepsy". Med Clin N Amer. 1968 52:781-787. 4. Yoss, R. (1969). "Treatment of Narcolepsy" Modern Treatment: 6:1263-1274. 5. Daly, D. and Yoss, R. (1978). "Narcolepsy". in Viken, P. and Bruyn, G. (eds.) Handbook of Clinical Neurology. Vol 15; Chap 43:836-852. 6. Wilens, T., et al. (2005). "ADHD treatment with once-daily OROS methylphenidate: final results from a long-term open-label study". J Am Acad Child Adolesc Psychiatry. 2005 Oct;44(10):1015-23.

Please expand the "Addiction"

I'd like to hear more about both sides of this issue. I'm not an expert in pharmacology or psychology, but this issue has long intrigued me. Methamphetamine is similar to Ritalin, and the worsening of the (American) meth epidemic over the past couple decades has coincided with more and more children being put on Ritalin and similar drugs. So we clearly have correlation and a plausible method of causation. Of course this correlation is not definitive proof of causation, but it's strong circumstantial evidence of a possible connection.

methamphetamines and ritalin are very different...methylphenidate is a CNS stimulant that doesnt use amphetemines. Meth is a bunch of chemicals mixed with something like psuedophedrine. —Preceding unsigned comment added by 76.170.119.175 (talk) 13:24, 26 November 2007 (UTC)

As the article's currently written, it simply says that some people have said that this might be the case and then lists one study that purports to show otherwise. (by the way, the link to that study needs to be fixed because it gives me a cookie erro message even though I have cookies enable) This could give the casual readers the impression that that's the end of the story, but that's not the case. That was just one study, and who knows what other studies have found or will find in the future...

So please expand the coverage of this issue as much as possible. Thanks.

Correlation does not imply causation, nor is it evidence one way or the other. For example, just because the release of Pink Floyd albums has preceded stock market crashes does not necessarily mean that the two events are related. ADD is increasingly being recognized more easily these days because clinicians' detection skills are improving (naturally this parallels the increased number of prescriptions to treat the disorder). Because methamphetamine abuse is on the rise, and methamphetamine causes massive excitotoxicity to dopamine neurons which can cause epigenetic changes, perhaps it is possible that the offspring of methamphetamine abusers possess defective dopamine systems, creating symptoms similar to ADD (especially if used during pregnancy). That is just one speculative theory. However, there have not been enough published reports linking the two, because it is possible that no link exists. Until we find valid peer-reviewed scientific literature on the subject, it is only possible to speculate, and speculation does not belong in encyclopedia articles. -Muugokszhiion 15:48, 9 January 2007 (UTC)

It should be OK to post anecdotal negative drug information

I consider the official FDA research on drugs to be biased. I think that other, anecdotal stories about people with negative drug reactions SHOULD be included, as long as the source is clearly marked as such.

I mean, if you were considering taking this drug, and you looked here for information, wouldn't you WANT to see negative information, even if it is merely anecdotal?

It is true that there has been no formal study about negative drug reactions. Just because someone hasn't spent a lot of money on a research study doesn't mean it isn't valid to include other viewpoints. — Preceding unsigned comment added by Fsk (talk • contribs)

Wikipedia:Reliable sources is really quite clear about the unacceptability of anecdotal bulletin board posts as sources. This rule is not open to interpretation by anyone here. Please stop posting the link. —phh (^t/_c) 23:05, 27 May 2006 (UTC)

I am not using it as a source. I am merely posting the information for someone to read. As long as it is clear that the link is a non-scientific source, it should be acceptable. The rule I am using is "If I was a concerned parent looking on Wikipedia for information, would I want to see this information." The answer is yes, so I think it is correct to include the information. I moved it to a separate section. There is a real debate concerning the legitimacy and effectiveness of this drug. The page should include this information. I assert that you are engaging in vandalism by removing this link.

You are misinterpreting Wikipedia:Reliable sources. That document asserts what sources are acceptable for inclusion in the main body of an article. That document does not say that links to anecdotal/bulletin board sources are completely forbidden. If I took the text from that page and put in the the body of that article, you could argue that I was violating Wikipedia:Reliable sources. Merely including a link to an "unofficial" source is not a violation of that policy. — Preceding unsigned comment added by Fsk (talk • contribs)

The relevant policy is Wikipedia Talk:External links. You are citing the wrong article. The links I included are valid by the standard of that page.

WP:RS may not forbid the inclusion of personal websites, then on the other hand we also really shouldn't insinuate that anything is/isn't so by linking to what is a source of doubtful validity. Please stop. Reputable journals (Lancet, JAMA, whatnot) are fine, random websites aren't. Dr Zak 02:14, 28 May 2006 (UTC)

The correct thing to do then, is mark them as "doubtful". You are not justified removing them entirely.

From the "external links" page. . Although there are exceptions, such as when the article is about, or closely related to, the website itself, or if the website is of particularly high standard.

By this standard, the links I provided are acceptable, because they are closely related to the content of the article and the content on the link is of a high standard. — Preceding unsigned comment added by Fsk (talk • contribs)

This aspires to be an encyclopedia, so giving disclaimer with the link saying "this is someone's personal website, and it's doubtful" just doesn't cut it.

Besides, one website advertises (top-right corner) for some kind of supplement. High standard? Huh! Dr Zak 03:51, 28 May 2006 (UTC)

If this is an encyclopedia, then it should have both viewpoints pro and con to usage of a specific drug. I think you are trying to suppress negative information on these drugs. I think we should appeal to some sort of formal resolution process. Other people have also violated the "3 reverts" rule on this page.

Someone else answered my question on the "Reliable Sources" page, and they said that information in the "external links" section of a page does not need to follow the same rigorous standard that information in the main body of an article is required to have. Therefore, I assert that Dr Zak and PHenry are engaging in vandalism by removing these links. — Preceding unsigned comment added by Fsk (talk • contribs)

No one is squashing any information here. If you want to assert that methylphenidate has a bad press or that people believe that is has unacceptable side effects then linking to someone's website isn't enough to back that up.

Also, please don't to forum shopping. At best the discussion over at WP:RS is undecided. Dr Zak 04:55, 28 May 2006 (UTC)

So how would this be resolved then? I can put the links back in as often as other people remove them.

I think if you filed a formal complaint against me for violating Wikipedia's usage guidelines, the ruling would be in my favor. Anyway, you haven't convinced me that those links violate Wikipedia's standard for inclusion in the "external links" section of an article. All the information I saw on the guidelines pages said that is acceptable.

My concern is that many of the 'scientific' studies supporting these drugs are in fact biased. Most of the scientific studies are sponsored by drug companies, which can hardly be considered unbaised. I know that I should find better sources for the "these drugs are harmful" viewpoint, but until someone does a proper scientific study, that's all that's available. My argument for including the links is "If I were a concerned parent looking up information on Wikipedia, would I appreciate the presence of those links?" I believe the answer is "yes".

Following your reasoning, I should remove all links to the FDA website, because I consider that information to be biased.

As far as the silly reverting goes, there is the three-revert rule to prevent people from undoing each others edits indefinitely. Please don't go there!

At Wikipedia we are not concerned with truth but peoples' perception of it. So if the FDA states that methylphenidate is safe, that's a fact. On the other hand, if many people believe that isn isn't safe, then that's a fact too, and of course needs backing up (for example with an article from a decent newspaper like the NY Times or Washington Post).

(As far as scientific studies go, I actually agree – there are conflicts of interest and not all studies of efficacy out in the literature are trustworthy. The legal exposure from falsified safety assessments would be far too great, so those are likely credible.) Dr Zak 05:22, 28 May 2006 (UTC)

Who appointed you to be Wikipedia's offical censor anyway? — Preceding unsigned comment added by Fsk (talk • contribs)

What compels you to add exactly these links? I have already stated why I want them out. Looking over the article again you are actually right on one point - the drug is controversial and what is missing is one or two paragraphs on peoples' perception of the stuff. However, I don't think that the external links you are pushing are the right way to go about it (and one of them uses a person's death to sell stuff). Dr Zak 01:42, 2 June 2006 (UTC)

Well, you could find different links that tell the same story. I'll look for better ones. You could also. People have died from using this drug, so it should be pretty clear about that from reading the page. If you're that concerned, why don't you call the parents and ask them if their child really did die from Ritalin? I'm sure they'd appreciate the call. — Preceding unsigned comment added by Fsk (talk • contribs)

I'd rather know why they see fit to advertise quack pills supplements in conjunction with their son's death. Pass the bucket, I'm going to be sick.

The latest link isn't great either, it is to a the website of a totally un-noteworthy organization. Dr Zak 06:19, 4 June 2006 (UTC)

Well, so far we seem to be the only 2 people interested in this issue. You seem to be arguing in favor of censorship, but I seem to be arguing in favor of including more information. You could make some effort into helping me find replacement links that tell the same story, rather than censoring mine.

I assert that the official scientific publications on this issue are extremely lacking in quality. If scientific sources are the *ONLY* acceptable sources, then it is impossible to create a balanced article on this subject. I don't have the time and resources to conduct my own scientific study on this issue. However, I have researched it, and there is a lot of negative (but not scientifically proven) information out there. It should be represented on the page.

Do you assert that NOBODY has died with the "official cause of death" listed as Ritalin?

Fact is that the drug has a poor press. There is also the odd report of hypertensive cardiomyopathy out there. Dr Zak 07:02, 4 June 2006 (UTC)

ADD, Creativity, and Stimulants

I am an art student in college, and I was diagnosed with depression and ADD in high school, I was put on Concerta in high school (36 mg daily), but I took it sporadically ( would not take it for a week or so, then take it in larger amounts and with things to destroy time release for about a week or less) so I was not consistantly on it til the very end of my senior year when I cleaned up my messing around. anyway, when I got to college, my doctor upped my dosage to 54 mg (also in conjunction with 300 mg of wellbutrin xl, risperidall (forget dosage) and lamictal (again, forget dosage)). I found that while I was on concerta, I found myself incapable of free associating effectively, which essentially meant my creative thought abillities were cut off. I eventually switched doctors, and he suggested that I try going off of the medication (which included a significant withdrawl period for the concerta). My new doctor explained to me that the concerta increased my focus so much that I was too focused to be creative. might this be considered for the side effects? It doesn't really affect anyone who is not in a creative industry, but it made my first year at college hell (think about spending 7 hours straight brainstorming for an idea, but not being able to free-associate in order to branch out ideas). also has anyone else had this experience? --Wasdeadthenalive 13:21, 2 August 2006 (UTC)

all of those medications are used as anti-deprssants... i dont think mixing that many ssri's and ritalin is very good for the old liver and kidneys

Criticism by Non-experts and Scientology

This section is very much so in violation of NPOV. For this reason I am removing it from the article. William conway bcc 23:25, 13 August 2006 (UTC)

That is Lame. Admit it-- You are a censor who simply want to promote the drugging of un-developed kids. It is criminal what you are doing. At least be honest. There are MANY valid arguments against the use of Ritalin. Valid arguments with medical fact behind them. You KNOW that is true but you do not want to present the other side of the story. At least have some backbone and admit it. Funny, the Ritalin article, as of 2006-Aug-28, does not show a single one "anti-Ritalin" stance. My that's odd. It is you and your ilk that have ruined Wikipedia. I hope you are happy. You will have your race of zombie kids ready to vote for you social agenda very soon. Good luck. --mkamoski

Are you joking? Sometimes irony doesn't come across well in print. The article is about a chemical. Facts about its action, etc. are appropriate; a brief mention of the controversy surrounding its use is appropriate. A detailed outline of every group's opinion of its social impact? That isn't very "encyclopedic", is it? If you're just pulling a fast one, you suckered me in. —The preceding unsigned comment was added by 74.114.221.41 (talk) 16:40, 4 April 2007 (UTC).

mkamoski: How disguisting I do not think that wikipedia nor it`s users has any reason to accept insults and comments like yours. While I have not signed in for reasons personal, I assure you that this kind of comment(s) will not be tolerated by anyone or under any circumstances as they are little more than pure abuse. "the non registered one"

Redirected from Vitamin R

Hey everybody, I was just wondering why this redirects from vitamin R, because I don't think it's explained in the article...

Vitamin R is a slang term for ritalin. -- Vertigo

proof that Wikipedia is a propaganda machine

Well, I now have proof that Wikipedia is a propaganda machine.

I had long suspected this was the case; but, I now have proof.

As of now, the current Ritalin artilce is obviously VERY "pro-Ritalin" slanted.

A while ago, I posted some "anti-Ritalin" evidence, with citations, and VERY softly placed, with no heavy-handed rhetoric. Just stating the facts--- like teen violence cases (such as Columbine) conspicuously involve Ritalin and some have drawn a causal relation Via medical research. I put links. I padded my writing to avoid offence and bias. But, those facts were not good enough for the "have you drugged your kid today?" crowd. Big surprise.

Check the history. The censors left GIANT footprints.

Well, that's it. Wikipedia is certainly no longer a credible source. It probably never was. Another piece of junk on the internet.

That's what happens to most of the "open source", feel-good, communistic, relativistic endeavors.

Where there is no distinction between right and wrong, no objective reality, no ethical assessment, where "make your own truth" and "choose your own truth" is the order of the day... there is no truth.

It is VERY funny how the "tolerance" and "diversity" crowd is so quick to censor as soon as someone opposes their view.

It is also VERY funny (and a downright contradiction) when relativist liberals need an absolute answer (such as directions to the store) they have NO problem with an absolute answer.

Typical.

This is why Wikipedia will NEVER be on par with Britannica et al.

Are you saying the Britannica article on Ritalin is less pro-Ritalin than this one? I find that hard to believe. If you find the article or contributors have violated Wikipedia policy, you should document that. If you have problems with Wikipedia policy, you should discuss that in the appropriate pages. Neurodivergent 17:01, 28 August 2006 (UTC)

This is really funny, because I came to this talk page to say the article seems a little too ANTI-RITALIN! hahah. Maybe. The criticism is very important to include, but it seems like a fuller discussion might be good. For example, despite some of its similiarities to cocaine, Ritalin is very, very different from cocaine in some very huge ways-- but that's not really reflected in the article. I was going to put up a POV-check, but.. since people are already talking about POV issues, i won't. :) --Alecmconroy 21:39, 30 August 2006 (UTC)

Hmm... I do not believe comments slandering and ranting about wikipedia has any place here whatsoever, I suppose it will stop now. Or else I suggest that it best be deleted because of it`s lack of informative value and abuse. "the non registered one"

Featured article

Seems to me a very good article, what about featuring it? Shandris^{the azylean} 09:27, 14 September 2006 (UTC)

• I don't think the article's there yet. I recently acted as an advocate for a user involved in a content dispute on this page. One requirement for FA is that the article in question must be stable. We might be there soon, but for now I'd hold off. A peer review is always welcome however! →Bobby← 18:45, 20 November 2006 (UTC)

Neither I think it is ready. Sadly information about such a controversial "case" (personally I would call it medication) is not bound to be settled or completed any time soon. Still I too would like to see this as a featured article one day. But the discussion to make it as feature would be a long one. (unless someone bother to set this articles neutrality to disputed I suppose...)

Daytrana should not redirect here

I suggest that Daytrana (Ritalin in a patch) should not redirect here. I needs it own page in that it is a patch and its half-life is dependant on how long the patch is worn. Daytrana is the first patch approved for ADD/ADHD treatment, more-so for people with difficaulty taking pills or with a history of abuse. It is worn on the left or right thigh or butt, and has almost no potental for abuse. If then the person does not want to feel the effects of the patch, they simply take it off and the drug expells in ~2 hours.

Fair enough, but a redirect makes sense until someone decides to turn it into an article. You seem to have done some research on the topic... --Eloil 21:26, 27 March 2007 (UTC)

Done —The preceding unsigned comment was added by GregoryCJohnson (talk • contribs) 05:36, 29 April 2007 (UTC).

"Ritalin is a tragedy" from the front lines

I am an independent researcher where I talk to 1000's of parents and relatives ond grandparents of kids who are, were or are thinking about putting their kids on Ritalin, Concerta and Adderall. Adderall is an amphetamine where Ritalin and Concerta have similar properties. All are addictive in pill form, not just slightly. Ritalin is a harder drug to come off of than heroin and the pharmaceuticals know this. Just like adding nicotine to cigarettes. I have met hundreds of parents who had a rough time when they abruptly took their kids off them. They went through hell as the kids became emotional wrecks without the drugs. While on the drugs, their kids became zombielike, and withdrawn and they weren't going to drug their kids anymore. These aren't isolated incidences. The newspapers and this internet site will have you believe they have rare side effects. The side effects are the main effect of the drug. Only the insufficiently responsible parent who is looking for a kid to get straight A's in class or to be less rambunctious (you know, be a kid) so they can have less parenting responsibility are the 2 kinds of people who will keep their kids on these drugs KNOWING they have toxic side effects. That's called child abuse. I have met parents, friends, and relatives of 5 suicide victims of these drugs and one 7 year old who attempted it twice. 7 years old! I have met parents whose kids were used as guinea pigs to test the effects of the drugs and the kids are pyschotic and have many emotional prioblems. I have met nurses who have parents come in and demand the doctor give them a prescription for Ritalin and some doctors will tell them no way and most will write it and collect their blood money from the pharmaceutical at the end of the month when it gets kicked back to them. Bottom line is these drugs are like giving your kid cocaine every day and telling them it is like vitamins and is good for them. The FDA is the agency with no conscience and no sense of right and wrong, only profits, and more profits and more research money and the drug comapnies are the pushers and the psychiatrists are the ones who make it legal with their DSM code book amd their pretense of being the authority on mental illness in Washington, and the uneducated public are the victims with the 2 classes above being the most willing. The kids are the big losers and that makes me cry and makes me so god damn mad so I sit at my computer and write this stuff so maybe one person will read it and realize that they may be causing their child great harm. There are so many better ways to treat a child who bounces of the wall all day and you can find these methods at www.alternativementalhealth.com and www.theroadback.org. Mostly, the best thing to do for your child is to feed them REAL food, not fast, processed food (fruit roll ups is not real food, hamburger helper is not real food, mac and cheese in the box is not real food, cheetos is not real food and of course cola products with caffeine and high fructose corn syrup are poisons to the body and cause many maladies when taken in excess). Stop eating the crap and you will see a HUGE difference. Our kids are our future but not when they are drug addicts. Drug addicts can not accomplish goals other than getting their next dose. Drug addicts can not fight back when they are threatened or their family is threatened. Drug addicts don't care about their rights being taken away little by little. Drug addicts will sell their guns for their next prescription, or use their house payment money for their drugs. This is some serious shit folks. This is what this whole drugging program is all about. Free people are tough, focused people that can fight back. Drug addicts can not. And the Scientologists are a percentage of the people fighting this. There are hundreds of groups and hundreds of thousands of individuals in those groups fighting to protect your kids. They just happen to be the most effective and are responsible for more legislation to save the kids from being drugged to death.

Cult, cult, AND CULT! Well let me just say that you better start finding reliable sources to your comments whoever you are, and do NOT forget: sometimes the side-effects can be so much more acceptable that the untreated symptoms themselves. (Oh please what is drugged to death thing?) If I started writing down what I personally think about this group of yours in... let us say in the scientology article, I would probably never get finished. But truth is that I have no reason whatsoever (or right I personally think) to tell this cult of yours how to live. Neither do we need your... comments. Please at the future keep this away from non-scientology discussions hmm? "The non registered"

If you have a problem with the artical and have sources to back it up. MAKE A CHANGE. Otherwise you are just another loud mouth that is convinced they are right. Scientology by the way is a cult. 68.167.250.138 03:26, 26 November 2006 (UTC)

Wikipedia is not the place for such opinionated crusader-like hogwash. Go write (or read) a book. And don't forget to cite your legitimate scientific sources; I wish you the best in that endeavor, for it will be a challenging one. Muugokszhiion 05:54, 9 January 2007 (UTC)

I know way to well that this comment has little use (as many others around here) but... Well said Muugokszhiion

"The non registered"

"While on the drugs, their kids became zombielike, and withdrawn" - Absolutely true. I was on Ritalin for 5 years when I was a child, so I would know. "I have met hundreds of parents who had a rough time when they abruptly took their kids off them. They went through hell as the kids became emotional wrecks without the drugs." This part is true too. The really sad thing is when these kids have depression or anger problems from being off the Ritalin doctors will just put them on different drugs like Zoloft or Prozac. Now I don't support crazy Tom Cruise-like Scientologists or anything like that, but Ritalin is a real problem and in my opinion should be made illegal immediately. —The preceding unsigned comment was added by 70.104.206.99 (talk) 19:23, August 20, 2007 (UTC)

Controversial?

In a book that I read called "From Chocolate to Morphine" written by Andrew Weil and Winifred Rosen, the small section on Methylphenidate states, "One of the more controversial uses still permitted is the control of of attention deficit hyperacticity disorder (ADHD) in children." I didn't realize it WAS controversial. Based on the data given in the article as well as the prevalence of children in schools taking the medication, it doesn't seem to me at all like the drug is controversial. It seems like parents put faith in it, and obviously the doctors must as well since they are the ones prescribing it. I personally don't put too much trust in medications used to treat psychiactric disorders, but it seems to me that the information I've seen never says anything bad about methylphenidate. (1, 2) I know obviously that information on drugs is bound to be biased based on who's maintaining the webpage and that more than likely the pages are tied to the distributors of the drug, so they're bound to emphasize the positive aspects and ignore the negative side effects. The only negative things I've read all seem to deal with people not prescribed the drug abusing it, which is not a problem that anyone really has control over should the person in question decide to abuse it. It's the same with any other drug legal or illegal. Anyways, my point is that until definitive research is obtained, methylphenidate will continue to be overprescribed, and I fail to see how the drug is considered controversial if it's so accepted by doctors and parents giving it to their children.

(1) http://www.nida.nih.gov/Infofacts/Ritalin.html (2)htpp://www.adhdinfo.com/info/start/treating/start_treatment.jsp

Target Audience/ Symptoms

After doing a little bit of research on Ritalin LA, I was able to determine the makers of Ritalin are targeting boys and girls children over six. Ritalin.com has a detailed symptom list, a child is diagnosed with the hyperactivity-impulsivity form of ADHD if the child talks too much, has difficulty playing quietly in areas where quiet play is expected, fidgets with hands or feet, squirms in seat, runs around and often climbs on large objects, acts before they think, shouts obscenities, and is unwilling to take turns. A child is diagnosed with the inattention form of ADHD if the child has a hard time focusing on one thing, can be distracted easily, becomes bored easily, has difficulty organizing and completing tasks, loses or forgets things, makes frequent careless mistakes and does not seem to listen when spoken to directly. In other portions of their page Ritalin mentions on how recent studies have found young boys suffer from the hyperactivity-impulsivity form of ADHD, and young girl suffer from the Inattention form of ADHD. Before this apparent study it was believed that ADHD only affects boys, but now the marketers for Ritalin and other drugs of its type can go after an entirely different gender.

Novartis Pharmaceuticals Corporation. Ritalin LA® and ADHD Medication. 2006 25 Oct. 2006 <http://www.ritalinla.com/index.jsp>.

The issue here is not that they've artificially expanded the symptoms so that they can "target" females as well as males, but that in the past, only the hyperactive form was recognized. Males are more likely to exhibit symptoms of the hyperactive form, while females are more likely to exhibit syptoms of the inattentive form. Non-recognition of the inattentive form led to a lack of diagnosis in females (I'm talking about children, teenagers, and adults - it's not just a childhood disorder, but "the children" is all anyone ever seems to talk about). I'm 20, and only just recently started therapy with Concerta for the inattentive form, and so far the lower dose has made an incredible improvement in my focusing and work-finishing abilities, in conjunction with therapy and time-management skills (things which I had tried before without medication, but which only worked for a few weeks, tops, and then it was back to flailing around an falling behind as usual). Obviously, this is only anecdotal evidence, but based on this, I'm a strong proponent of controlled, monitored dosing with stimulants for patients who fit the DSM qualifications for AD(H)D. (But you definitely need to pay attention, and keep in touch with you doctor, which is something I think people tend to not do. My doctor recent decided to double my dose, and I was pretty miserable, and so went back down to my original dose, which still seems to be working just fine.) 71.202.124.98

Does ritalin attack the muscles? could muscle tissue decrease by taking ritalin? Since it causes abdominal pains and muscle pains...

To say that the company is "targetting" young boys and girls implies unwarranted value judgment. Anyone who has worked in psychiatry will know that it is easier to recognize and treat ADD in older children than in much younger ones. You have listed some of the diagnostic criteria for inattentive- and hyperactive- ADD but it seems that your comment pertains to whether or not women can be affected by ADD. While the disorder is much more prevalent in men, it is a fact that women may also be affected. Please refer to the following sources: [2] [3] [4] [5] -Muugokszhiion 06:12, 9 January 2007 (UTC)

is this really true?

i have had add and been on ritalin since i was about 8, im now 19... i have suffered many of the side affects but i never knew what to make of them, they were just side affects to me, i never knew it was like cocaine, i didnt even know all these symptoms that existed from the drug. i often get nearly all the symptoms and i cant believe the doc never told me about this! But what is ritalin in comparison to cocaine?

Ritalin and cocaine are both stimulant drugs which, it seems, act on some of the same chemicals in the brain. This does not mean that Ritalin is "like cocaine," anymore than caffeine(another common stimulant you may be familiar with) is "like cocaine." Ritalin is generally neither addictive nor dangerous, and has been shown to be highly effective in treating ADHD. The same cannot be said of cocaine, although I admit I don't know of any studies that have evaluated the efficacy of cocaine in the treatment of ADHD. Some people do have side effects serious enough that they have to switch to another medication, but that is fairly uncommon, and has nothing to do with any similarity to cocaine. - Jpstead 17:23, 29 November 2006 (UTC)

Addiction

I noticed that the addiction paragraph looked to have been written by a Novartis rep. I've never posted anything here before, but I have a paragraph that I think is a little more accurate(I have no idea how to make my citations into footnotes, so any help would be cool).

While ADHD info sites argue that prescribing medications like Ritalin can decrease the likelihood of drug abuse later in life (Mannuzza, S., Klein, R.G., Moulton, J.L. (2003). "Does Stimulant Treatment Place Children at Risk for Adult Substance Abuse? A Controlled, Prospective Follow-up Study". Journal of Child and Adolescent Psychopharmacology, Sep 2003, Vol. 13, No. 3: 273-282.), many psychiatrists disagree. Those who use MPH recreationally have been known to abuse it (Williams, R., Goodale, L., Shay-Fiddler, M., Gloster, S., Chang, S. (July-Sep 04) “Methylphenidate and Dextroamphetamine Abuse in Substance-Abusing Adolescents”. American Journal on Addictions, Vol. 13, No. 4 381-389), and due to the wide documentation, there are rehab programs available specifically for ritalin (http://www.drug-rehabs.com/ritalin-rehab.htm). Many doctors argue that not only is Ritalin itself addictive, it can act as a gateway drug even at a prescription dose (http://www.breggin.com/congress.html). Ritalin given to adolescent rats has been shown to mimic addictive brain behavior as well (Brandon, C.L., Marinelli, M., White, F.J. (Dec 2003) “Adolescent exposure to methylphenidate alters the activity of rat midbrain dopamine neurons”. Biological Psychiatry, Vol. 54, No. 12, 1338-1344). -- — Preceding unsigned comment added by 71.198.177.138 (talk • contribs) go for it! Misou 00:10, 10 November 2006 (UTC)

CITATIONS NEEDED

Under the Effects section this statement is made. "It is claimed to have a "calming" effect on many children who have ADHD..."

It then says in brackets that a citation is needed. I completely agree with the statement, and I've found a source of evidence. I'm just not sure how to update the citation section.

[6]

In the second paragraph it says a use of ritalin is to "stabilize" children with attention deficit disorders.

Ritalin with Chronic Pain ==

  After reading most of the information on Ritalin, I now have several questions. I was prescribed Ritalin to
counter react the affects of Lyrica. ( after, worse side affects from the use of high levels of Neurontin)
  The use of Lyrica is helping with the nerve pain, allowing me for the first time to use my hands for simple
things, even like typing. Lyrica makes me feel dense(not alert) and if I sit idol for just a few minutes I fall
asleep. Making even simple tasks impossible. I Burnt down my Kitchen, and fell asleep driving on the freeway.
This is when they started the use of Ritalin. I also am suffering from severe depression, from chronic pain.
With the use of Ritalin, I feel like there is hope, more like myself before the pain. I was a type "A" personality
and an overachiever before I was hurt. With the combination of Nortriptyline a (anti depressant),Lyrica and
Ritalin I feel like I can get up in the morning and do things(live life). I use to just lay around hurting and
doing very little. I no longer use pain medications due to many reasons. I am now starting bio-feedback
sessions.  I feel the best I felt in years.
 Is there any medical advice anyone can offer? If more of my history is needed, Please feel free to e-mail me.
  Can you explain the affects of both Lyrica and Ritalin on mood, and central nervous system? Do they clinically work together?What risks do I face using any of the medications long term?
  Thank you for your attention and time.

After reading most of the information on Ritalin, I now have several questions. I was prescribed Ritalin to

counter react the affects of Lyrica. ( after, worse side affects from the use of high levels of Neurontin)
  The use of Lyrica is helping with the nerve pain, allowing me for the first time to use my hands for simple
things, even like typing. Lyrica makes me feel dense(not alert) and if I sit idol for just a few minutes I fall
asleep. Making even simple tasks impossible. I Burnt down my Kitchen, and fell asleep driving on the freeway.
This is when they started the use of Ritalin. I also am suffering from severe depression, from chronic pain.
With the use of Ritalin, I feel like there is hope, more like myself before the pain. I was a type "A" personality
and an overachiever before I was hurt. With the combination of Nortriptyline a (anti depressant),Lyrica and
Ritalin I feel like I can get up in the morning and do things(live life). I use to just lay around hurting and
doing very little. I no longer use pain medications due to many reasons. I am now starting bio-feedback
sessions.  I feel the best I felt in years.
 Is there any medical advice anyone can offer? If more of my history is needed, Please feel free to e-mail me.
  Can you explain the affects of both Lyrica and Ritalin on mood, and central nervous system? Do they clinically work together?What risks do I face using any of the medications long term?
  Thank you for your attention and time.

NPOV-section dispute - Criticism

One user tries to create the impression, that criticism of Ritalin is inherently related to scientology. I cannot name the subsection, since he prevents me from creating one. (80.109.194.224 on nov 27)

Let's start with the portion of your statements that is correct. I have indeed opposed your attempts to restrict all mention of the influence Scientology has had on the debate over methylphenidate to a single subsection. If it was somehow determined that the uproar over methylphenidate was triggered almost single-handedly by Nobel Prize-winning scientists, would you want that isolated in a sub-section called "Criticism by Nobel Prize winners"? No? Then why do you think we should marginalize the fact that the debate has been greatly influenced by a group which believes that aspirin works by "impeding the electrical conductivity of nerve channels" and has the effect of making a person "stupid, blank, forgetful, delusive and irresponsible ... [putting him] into a 'wooden' sort of state, unfeeling, insensitive, unable and definitely not trustworthy, a menace to his fellows actually"?[7]

It's not even as if it could be confidently said "well, while there is criticism from this Scientology group, there's still plenty of criticism that isn't from or influenced by Scientology groups." I will remind you that we are talking about an organization, Scientology, which has frequently used groups it itself termed "Secret PR Front Groups".[8] Even if we assume that Scientology is not directly behind a particular anti-Ritalin group, where is that anti-Ritalin group getting their information from? Are they using accurate statistics, or are they using dubious figures which they accepted in good faith from fellow 'fighters against Big Pharma' who are in reality another Scientology 'secret PR front group'?

Your accusation that I am "[trying] to create the impression, that criticism of Ritalin is inherently related to scientology" is false, just as your edit summary claiming that "you now stated clearly, that you wanted to discredit all critics as scientology affiliates"[9] was false. I do not believe that all critics are Scientology affiliates, nor do I want to portray all critics as Scientology affiliates, and needless to say, your false accusation that I actually "stated clearly" that I wanted to "discredit" all critics as Scientology affiliates, is not only wrong but rude and highly un-CIVIL. I think mention should be made under the criticism section, for instance, of Peter Breggin, who opposes Ritalin but also opposes Scientology quite publicly. That would clarify that criticism of Ritalin is not inherently related to Scientology. But the approach you would have us take is not to clarify anything -- it's to hide information which might lead people to conclusions that you don't want them to reach. Sorry, that's not the way it works. The evidence is that Scientology has very strongly influenced the debate over Ritalin, and readers deserve to be alerted that this is the case. -- Antaeus Feldspar 02:03, 28 November 2006 (UTC)

to the hypothetical prizewinners: I would never use or even quote the phrase "almost single handedly started" for an opinion. Those guys would probably be quoted in the section, that corresponds to their arguments. I admit, that the main reason, why i did not write quotes from sources here, is, that i have difficulties filtering Scientology sources out. Thank you for naming me a clean one, although Breggins website looks odd to me for other reasons. Someone linked him from the links section, and i may sometime bring him into the criticism section. Where is the anti Ritalin group getting information from? From the DSM perhaps. Try walking up to random people, telling them the DSM criteria of ADHD and asking them what they would think of a pill, that would eliminate or diminish those traits in children. You will get a feeling, how big the anti-crowd is. About civility: Point taken, i was emotional, but, on the other hand, so were you. Maybe you didn't want to put a Scientology stink on all criticism, but it somewhat looked like that. It is as if above a collection of psychiatrist opinions i made a statement, that some psychiatrists are on the payroll of Novartis. That would probably be a factually true statement, but in the context it would create a wrong and unfair impression and qualify as FUD spreading. (80.109.194.224 on nov 28)

Cherry-picking and misrepresentation

What is it about this article that attracts so many editors willing to misrepresent their sources? Blatant examples we've seen recently include a claim made about a study showing, purportedly, that "children treated with Ritalin are three times more likely to develop a taste for cocaine". The only problem is that the cited reference shows no such thing. The reference only touches on one study which even had human subjects involved; the results of that study said nothing about the figure of "three times more likely", and due to the structure of the study, it couldn't have made a meaningful statement about how much more likely a "taste for cocaine" became. Why? Because the subjects in the study were all selected because they had taken cocaine at least once. That means that if only 0.1% of the people who were treated with methylphenidate for childhood ADHD ever sampled cocaine, that fact would not be reflected by the study, because the study is ignoring the 999 who didn't try cocaine and examining only the one who did.

And now let's consider this text:

Why, then, aren't the 4 million to 6 million kids who take Ritalin daily acting more like the Studio 54 crowd, circa 1977? One important difference is that Ritalin, administered as directed, acts much more slowly than cocaine. Nora Volkow, a senior scientist at Brookhaven National Laboratory who has done extensive research on methylphenidate, found in a 2001 study that Ritalin takes upward of an hour to raise dopamine levels; cocaine, a mere seconds. The exact reason why the uptake speed matters is unknown, but it seems to account for the different effects.

Now we are using the source that text comes from as a reference in the article -- but are we citing it to clarify for the reader that methylphenidate correctly administered has different effects from cocaine? No, we are not. This, instead, is the statement that uses that source as a reference:

The similarities between methylphenidate and cocaine have prompted concern that the unknown dangers of methylphenidate could be similar to the known dangers of cocaine.

The article says nothing about "the unknown dangers of methylphenidate". At best -- at best -- we could possibly infer from the article that someone is concerned by the chemical similarities between methylphenidate and cocaine. However, it is hard to imagine how anyone could have in good faith read that article and decide to cite it just for what it implies about "concern" about similarities, and not a single bit of the factual information it provides about the differences. -- Antaeus Feldspar 17:44, 27 November 2006 (UTC)

See my comment here for a small conversation about the differences. Cocaine and methylphenidate are two very different molecules with little in common structurally. A mention in the article regarding the differences really isn't necessary. -Muugokszhiion 22:54, 9 January 2007 (UTC)

cocaine similarity section misleading

A discussion of similarities between ritalin and cocaine that ends with a mention of amphetamine as a third common stimulant implies that ritalin and cocaine are more similiar to each other than to amphetamine. It is my understanding that methylphenidate is in the same class of drugs as amphetamines. Additionally, the statement that ritalin is like low dosage long acting cocaine suggests that taking a small dose of cocaine regularly would have the same effects as ritalin. This statement is either patently false, or from a study that is not widely accepted(or known) by experts. - Jpstead 17:09, 29 November 2006 (UTC)

Methylpheniate is pretty much a substituted amphetamine and is thus much more similar to dextroamphetamine than it is to cocaine, a tropane alkaloid. In a comparison between MPH and d-AMP, the only differenes I can see are found at the R_ß, R_N and R_α positions (the latter two of which close to form a piperidyl-like ring; the molecule is clearly related to phenethylamine. Cocaine is a much more complicated and different story. Some similarities include the carboxylate and phenyl groups, but they're in much different positions and it would take an organic chemist to be able to draw accurate comparisons. Even without a knowledge of chemistry, one could see the similarities between MPH and d-AMP just by looking at the molecules. Cocaine is more similar to atropine than it is to MPH or d-AMP.

Because cocaine and methylphenidate are both stimulant drugs, and stimulant drugs may increase focus, I can see where one might make the assumption that cocaine would be effective. It has in the past been tested experimentally for this reason, but has been found to be much less effective than MPH in clinical and experimental trails, not to mention more addictive by an enormous magnitude; thus, it is never used. I've made a couple of changes that I hope should clear up the confusion. -Muugokszhiion 22:52, 9 January 2007 (UTC)

overprescription inclusion

The heading "overprescription" is followed by studies which suggest ritalin is underprescribed. I edited the section by adding the "some have asserted" part, but really there seems no reason for the section to be there absent any evidence of overprescription. The section would be very long indeed if someone asserting something was enough to warrant a section. Research, which I don't have the time to collect and include right now, suggests that among certain demographics ritalin may well be overprescribed, but among others is underprescribed. The section would make sense if it discussed these issues. - Jpstead 17:08, 29 November 2006 (UTC)

TBI and Methylphenidate

I had a moderate frontal-temporal closed head injury several years ago, and all of my ADD-like symptoms began just after it. Some experts do say that true ADD is impossible if the symptoms appear after age 7 (which they certainly did.) However, I can now say from personal experience that for this type of head injury, stimulant medications work exactly the way they are supposed to for ADD patients. I can calm down, concentrate, and focus for the first time in MANY years. I'd really like to see some information about the effects of this medication for TBI survivors-- as of now, I think there's only a brief mention with no details.

-- Anise 71.228.235.161 01:21, 7 December 2006 (UTC)

In fact, the ADD symptoms were historically first linked to brain injury, due to the effects of encephalitis caused by the Spanish flu around 1920. Check out the History section on the ADHD page. --IanOsgood 16:12, 23 May 2007 (UTC)

Risk of death

Edited to more accurately represent the work of FDA advisory committees. More to come, if I have time. YeahIKnow 20:32, 18 December 2006 (UTC)

Um... is that a trustworthy article? I am not by any means challenging your statement, I am simply asking is it not possible that these deaths could be random? I mean if we started noting how many people died of wearing slippers we would surely find numbers. Is it really necessary to keep that part? I am sorry for my doubts but I would really like to hear opinions regarding this. "The non registered one"

Balance needed in a few sections

Overall, this article is well-written, especially given its inherently polarizing subject. Kudos to those involved.

I'm a 44 year old male and take Concerta daily. And as a physical scientist, I researched the so-called "controversy" before I began taking it 3 years ago. I apologize for not providing citations, but I just stumbled across this and wanted to weigh in on two points, in particular.

First, the stimulant/"my kid's a zombie" paradox is far better understood these days. Brain scans (PET, I think) of people with ADHD/ADD show they typically have decreased baseline activity in their pre-fontal cortex. This region of the brain is associated with Executive Function, thought to be responsible for e.g. "future consequences of current activities,...prediction of outcomes, expectation based on actions,...the ability to suppress urges."

MPH is an amphetamine; but the net effect is to stimulate that specific area of the brain responsible for impulse control. Children and adults with ADHD/ADD benefit from a psycho-stimulant because it makes them more able to consider the consequences of their actions, control impulsive behavior, and focus their energy towards long-range goals. In short, a "hyperactive" ADHD child is not disruptive simply due to the natural surfeit of youthful energy, but because the brain function that allows them to control -- and learn to control -- that energy, is under-active.

Lastly, the "addiction" section neglects the important "chicken and the egg" relationship between cocaine use and undiagnosed ADD in adults -- not to mention their often heroic caffeine consumption. Because of the similarities between MPH and cocaine, many adults first diagnosed with ADD as adults have a history of cocaine use, myself included. It's been postulated that undiagnosed ADD may result in cocaine use, as adults intuitively prefer --and sadly become addicted to -- the drug that initially best resolves years of struggling to succeed. Todd Johnston 10:48, 27 December 2006 (UTC)

Excellent comment! I've tried to balance the section further in recent edits by raising the point you made in your last paragraph. In my experience in psychiatry, I've noticed that some ADD/ADHD adolescents and adults consciously or unconsciously attempt to manage their symptoms with illicit stimulant drugs such as cocaine. This is especially prevalent in those with a family history of drug abuse, suggesting a genetic connection. Typically I've observed that the drug use is indeed a result of poor impulse control and an attempt to return to a state of "normality" by jacking up a dopamine system that may be structurally deficient in some ADD sufferers in the first place (this can indeed be seen in some PET scans).

Methylphenidate, like other ADD drugs, works in a relatively gentle, controlled manner, and relieves symptoms when taken appropriately and at the right dose. Some people try to use illicit drugs as their medication of choice, and the result is often a dangerous and damaging addiction that generates and further exacerbates damage. Of course, heavy stimulant use (such as cocaine, methamphetamine, MDMA, etc) as seen in addiction, causes excitotoxicity to the dopamine system and damages neurons. Thus, many users often try to self-medicate the impulsivity and inattentiveness produced by the substance abuse by taking more of the drug, further precipitating the damage; such is the tragety of addiction.

Fortunately, treatment of ADD usually does improve symptom control, reducing hyperactivity, the need to "act out," the impulsivity that often leads people into trouble, etc. That is why it has been found that with most individuals suffering from ADD, especially those with an underlying predisposition to substance abuse, treatment with methylphenidate reduces the future risk. -Muugokszhiion 22:33, 9 January 2007 (UTC)

study removed from Potential Carcinogen section

The following three sentences have been removed from the Wiki article for the reasons listed below.

"A recent study concluded that human hepatic enzymes have the capacity to convert methylphenidate to a mutagenic metabolite(s) that can induce mutations in exposed lymphocytes. [29] This would explain why tests on rats did not reveal the carcinogenic potential of methylphenidate. Because rats perhaps do not have these enzymes that humans have. Therefore, rats did not develop tumors when methylphenidate was tested on rats".

The link goes to www.toxicology.org/AI/FA/SOT_Toxicologist2006.pdf. The website is hosted by the "The Society of Toxicology". This is not a scientific organization. The folks at ADDF went to great lengths to critic this study and they did a far better job then I ever could. [[10]] The major critism (and there were many) of the article was that it had never been posted in a peer review journal and consequently had no scientific validity. --Scuro 06:39, 31 December 2006 (UTC)

I am removing the study's mentioned in the section now as well as they may not be proper scientific investigations, but they are mentioned here as if they are.--82.69.113.120 00:56, 7 January 2007 (UTC)

Changes

I made several edits chiefly affecting the "Criticisms" section. Many of the purported criticisms were not actually criticisms at all, but rather citations of studies reinforcing methylphenidate's efficacy, tolerability, or safety. So several paragraphs within were moved to other sections.

For instance, "Risk of death" was moved to a new "Long-term effects" section, which is a more appropriate choice, because the risk of death is not necessarily a criticism, but rather a statistical occurrence in susceptible individuals. A "Brain and body" section was created to better house the information on the dopamine system and clastinogenicity. The "Stature" section was also moved to "Long-term effects."

A number of sentences were confusing or incompletely written, so several minor changes were also made to those to facilitate readability and clarify ambiguity. -Muugokszhiion 07:41, 9 January 2007 (UTC)

Muugokszhiion, please explain this reasoning from your recent edit->"acute and chronic adm occur w/ all regular timed med regimens; does not change fact of target receptor system; study provides valuable information re receptor types". The words "acute" and "chronic" in the study refer to long term drug abuse. I fail to see how that sort of drug abuse occurs, "with all regualr timed med regimens". Are you stating that those who take theraputic levels of Ritalin are all drug abusers? I'm lost, that doesn't seem to make sense at all. The second point that you seem to be trying to make is that there is something important going on with the "target receptor system" and receptor types. Look, the study is about chronic and acute drug abuse, plain and simple. This means that the dose was abnormally high and that it was administered over a period of time. Drug abuse has nothing to do with the theraputic use of Ritalin. It's a red herring, the two issues are seperate and do not relate to each other. Why is this in the article? --Scuro 04:33, 10 January 2007 (UTC)

There is nothing political in my edit and I certainly do not believe that people treated with MPH are drug abusers (if I did, I certainly wouldn't be a health professional). I left the study in the article because, upon reading the full text, I couldn't find evidence of 'drug abuse doses' (though it can be difficult to determine what dose constitutes drug abuse in an F-344 rat). Regardless, even if the doses were extremely high, the results still demonstrate which receptor systems were involved in signaling, which may help other users understand how the drug acts on the body, especially if they are already familiar with other stimulants. Like MPH and d-AMP, psilocybin and LSD share a cross-tolerance as well, and one who has never taken psilocybin may be able to conjecture as to the effects or method of action of LSD, with the knowledge of which receptors are involved. While the comparison is not entirely accurate and must be taken with a grain of salt, there are still of course great similarities, many of which can be found to be correct. A further note: the acute effect of a drug is the result of a single dose, and a chronic effect is the result of repeated doses over time. This does not necessarily imply drug abuse, because people who use antidepressants, antipsychotics, blood pressure medication, and so forth, are experiencing the chronic effect of their drug (which is therapeutic).

The bottom line is, while I think the information is valuable, there is already a moderate amount of information in the article regarding the neurochemical patheway involved, and I don't think it's worth fighting over. I'm fine with leaving it out of the article if you prefer. However, I can't help but feel that you were misunderstanding my intention of leaving it in the article: it seems that you thought I was criticising MPH users rather than clarifying the method of action (which is data independent of judgment), and I don't want to make it seem that way. I do not believe that this study represents a bias either way, because I treat it simply as scientific data pertaining to brain signaling, nothing more. Nonetheless, if you prefer to excise the study, feel free to do so. -Muugokszhiion 17:43, 10 January 2007 (UTC)

Glad you responded Muugokszhiion. It nice to have a conversation. Perhaps I simply misunderstood because of the phrasing ie ->"acute and chronic adm occur w/ all regular timed med regimens; does not change fact of target receptor system". As I read that, it indicates that all who take meds, take it over a long time and at a very high dose. Regardless, when I see those two words and it's a rat study, immediatly I think they are examining some facet of addiction. My guess was they were looking to see if abused methylphenidate and/or amphetamine created cross tolerance to cocaine through the target receptors. I'd put money on the fact that these rats probably got huge doses of stimulants for their body size.

Back to the article.

So the effect section was talking about synapses and how Ritalin is a dopamine reuptake inhibitor when WHAMO...we are talking about cross tolerance to cocaine. Why? The ideas don't logically fit together. Nor does theraputic levels of Ritalin have anything to do with cross-tolerance and subtance abuse. And even if it did, what is it doing in this section of the article? I have no problem accepting the idea that cocaine and Ritalin could be working on the same receptor systems, after all they are both stimulants...but then again other noted stimulant like caffine probably also work on those receptors...so what's the point?

So, I wasn't reading into your intentions. All I knew was that this particular sentence did not fit in that paragraph. --Scuro 04:49, 11 January 2007 (UTC)

I belive the study belongs in the article, and I also believe that I can address your concerns. You're not criticising, you simply want more of the facts, so let me explain what I've found upon reading the full text. First, the study was not designed to demonstrate drug addiction, but rather drug tolerance. Second, it doesn't seem that the doses were all at extremely high levels. In fact, the scientists were not only able to establish a maximum tolerable dose, but a threshold dose, the minimal dose required to achieve a response (0.5mg/kg, see PDF file p.2,¶6). In a 150lb human, that is approximately 34mg d-AMP, which is a reasonable dose when taken B.I.D. (most immediate-release psychostimulants for ADD are in fact taken twice a day). I've worked in a number of clinics in which higher doses of Adderall-IR have been prescribed, with generally positive results. Third, the study challenges the notion of "reverse-tolerance" that may occur with d-AMP, and that is an important finding worthy of greater investigation (see p.5,¶1 for mention of norepinephrine sensitization).

In the context of the MPH article, the study does not appear misleading or judgmental. The fact that MPH expresses cross-tolerance with other psychostimulants is important (see p.5,¶3 in Discussion). For instance, it shows that methylphenidate treatment probably should not be augmented with dextroamphetamine treatment, due to the added buildup of tolerance, which would reduce the clinical effectiveness of both drugs, thereby exacerbating the patient's symptoms and increasing side-effects. Not only that, but it also shows that in cocaine users, methylphenidate may be less effective, thus warranting the use of a different medication.

I feel that I've exhausted the subject, but if the study were biased or misrepresentative I, too, would demand its removal. However, I do believe that it is valuable to the article and that its science is sound, and that is why I have spent some time advocating its inclusion. If you're accustomed to science writing, I would encourage you to read the full text if you still have questions regarding the methodology—the researchers themselves can explain their own study far more descriptively than I can theirs. Finally, thanks for being willing to discuss the matter. I wasn't clear enough in my comments on the revert so I really appreciate your patience and thought. -Muugokszhiion 06:44, 11 January 2007 (UTC)

passage should be moved or removed

Lets look at the passage one more time. In the effects section of the article, we have this passage.

"There have also been some medical reports showing a cross-tolerance between cocaine, methylphenidate, amphetamine, which are known to act on similar receptor systems[11]. Pharmacokinetic researchers have found Methylphenidate is absorbed into the body at a much slower rate than cocaine. These researchers concluded that the fact the drug stays in the body for a long period, preventing additional 'highs' until it is absorbed by the body, may prevent addiction.[12] This conclusion is supported by a recent study that found no link between Methylphenidate and later substance abuse.[13]"

The first sentence - speaks to tolerance and addiction. Can you really isolate the two? Without tolerance where is the addiction cycle? This sentence has nothing to do with the section of the article in which is inserted.

The second sentence - is a confusing one in it's context. What are we to draw from it? How was the cocaine and Ritalin administered? Did they take cocaine pills? The point here is that Ritalin has a different delivery system then cocaine which is typically snorted or injected, and that makes all the difference in the world. The slow absorption rate does not create the instantaneous high that snorting or injecting does. With those two methods a large dose of the drug reaches the brain in seconds to create that high and then it leaves as suddenly to create the crash. This is where tolerance comes in and the addiction cycle. Conversely, Ritalin is ingested and slowly absorbed by the stomach lining. The drug gradually builds in the brain and then tappers off. Hence with Ritalin we have no addiction or tolerance.

The third sentence - basically reiterates what I have just stated. Both sentences contrast therapeutic drugs vrs. abusing drugs. Both sentences are not relavant to the passage.

The forth sentence - This conclusion may not be supported by this study. There are many possible reasons that children who take Ritalin may not have an increased rate of substance abuse. The obvious one that comes to mind is that when a student is on Ritalin they may not attract other dysfunctional peers who are drug abusers.

So, this passage definitely doesn't belong where it is now. It may be helpful for drug addicts to know that they shouldn't take Ritalin while using. Perhaps another section in the article should be created and the passage should go there with modifications.

--Scuro 07:19, 12 January 2007 (UTC)

This is going to be a long one, so bear with me. Listen, I don't mean any offense, but I must be perfectly frank with you. From your most recent entry (and the few preceding it), I get the impression that you are very sensitive about how methylphenidate is represented, and you would rather excise immportant facts rather than risk a potential misrepresentation of what your mental image of methylphenidate is. Facts are facts. It seems that you cannot be impartial in this matter, not because you don't want to be, but rather because you do not understand neuropharmacology or scientific publications. Unfortunately, eiter you lack the foundation to be able to read and understand the studies yourself, or you are unwilling to. This is not a fault, it is simply a matter of specialty in life, and science is clearly not your specialty. Let me address your concerns piece by piece:

Sentence 1. Obviously you completely ignored my last post located here. It was not a study of drug addiction, but a study of drug tolerance. Please be able to distinguish the two, and please read my response and follow along. As you don't understand the study, I don't know if I can be any more help than I already have, because if you don't understand the scientific method or research techniques, you won't be able to make sense of the publication.

Sentence 2. You can trust that the research was conducted reproducibly, and that the drugs were administered in the same manner each time (the study has been held up to peer review). It would not be a scientific study without consistency. Also note that the study has been cited by other scientific publications over thirty times. Also see this source for more information. Since you probably won't read it, let me quote some of it for you:

"...methylphenidate (MPH) acts primarily by blocking the dopamine (DA) transporter (DAT) and increasing extracellular DA in the striatum. This is strikingly similar to the mechanism of action of cocaine, a primary stimulant drug of abuse. When administered intravenously, MPH like cocaine has reinforcing effects (euphoria) at doses that exceed a DAT blockade threshold of 60%. When administered orally at clinical doses, the pharmacological effects of MPH also exceed this threshold, but reinforcing effects rarely occur." [11]

What this means is that methylphenidate and cocaine act have very similar effects in the human brain, but methylphenidate use does not typically lead to repeated use like cocaine does. You are correct in asserting that methylphenidate, when used properly, does not typically cause the same kind of addiction as cocaine (this study provides more interesting data).

However, you are completely wrong to believe that tolerance doesn't develop. Almost any drug used frequently causes neurochemical adaptation (drug tolerance). If you knew anything about neuropharmacology, you would know this. This indicates to me that you are not qualified to make the statements you have, possibly for a lack of scientific knowledge. Here are some publications regarding methylphenidate tolerance: Treatment of ADHD when tolerance to methylphenidate develops, Acute tolerance to methylphenidate in the treatment of attention deficit hyperactivity disorder in children, Pharmacodynamic modeling for change of locomotor activity by methylphenidate in rats, Discriminative stimulus effects of caffeine: tolerance and cross-tolerance with methylphenidate, and finally A comparison of the motor-activating effects of acute and chronic exposure to amphetamine and methylphenidate, which states:

"These findings suggest that, although sensitization develops with chronic amphetamine treatment, the consequence of chronic exposure to methylphenidate is tolerance." [emphasis added]

Sentence 3. We have already found that tolerance in a clinical setting has nothing to do with abuse, and that the neurochemical effects of cocaine and methylphenidate are similar. Since your third argument parallels your second argument, I have already addressed it in the above paragraph.

Sentence 4. Of course, there are may reasons why methylphenidate treatment may reduce future addiction in patients, but that is just one finding that scientists have posited, and it is absolutely important, relevant, and has been observed. All of science is theory based on observation and experimentation. Technically, our knowledge of cellular biology is collectively referred to as the cell theory, despite the fact that we know cells exist and we can observe them directly (nobody would reasonably doubt that life is made of cells).

You still make the assumption that a value judgment is implied in a comparison between the effects of methylphenidate and cocaine. That is absolutely not the case. Scientific studies are not there to judge, they are there to supply information. Methylphenidate treatment has helped and continues to help millions of people, and I would never doubt or question the validity of helping people. I have worked under numerous doctors who regularly prescribe MPH to ADD patients, and I have seen how much it has benefitted them. I also have experience treating patients with methylphenidate and have learned a great deal through research, clinical experience, and observation. I have no agenda against the drug at all, so for that very reason I want to represent it farily and impartially.

I have given you a wealth of scientific literature supporting everything I have said, yet I fear that despite my efforts you may not be convinced. Hopefully this won't be the case, and you will understand my points. If not, it would greatly help to have an outside opinion in this issue, especially from someone qualified in neuropharmacology and scientific research. Again, let me reiterate that I am not trying to say anything negative about you or your opinions, I am merely showing that scientific data on the matter says something different. -Muugokszhiion 19:34, 12 January 2007 (UTC)

"From your most recent entry (and the few preceding it), I get the impression that you are very sensitive about how methylphenidate is represented, and you would rather excise immportant facts rather than risk a potential misrepresentation of what your mental image of methylphenidate is. Facts are facts. It seems that you cannot be impartial in this matter, not because you don't want to be, but rather because you do not understand neuropharmacology or scientific publications. Unfortunately, eiter you lack the foundation to be able to read and understand the studies yourself, or you are unwilling to. This is not a fault, it is simply a matter of specialty in life, and science is clearly not your specialty".

Wow, you have subjectively inferred my abilities, intentions, and my interpretations...to begin and frame your response. That speaks volumes. Me thinks you have a greater bias then I. "Facts are facts"? Your scientific abilities come into question also. What researcher would state, "facts are facts"? More later as I chew on the lengthy response. --Scuro 13:00, 13 January 2007 (UTC)

I'd like to butt in here and make a few points that seem to be missing.

Before I do that, however, let me first point out that both Scuro and Muugokszhiion seem to share the goal of accuracy. Since this is my goal as well, I'd like to backtrack a little bit to the original question of the inclusion of specific references.

I'd also like to remind Muugokszhiion that not everyone has access to the full text of every study cited. Abstracts do not contain the information needed to examine methodology. Questioning a study that one has not read is, IMO, reasonable and even necessary. It certainly is difficult to criticize what one is unable to evaluate, however, that does not make the question invalid or the questioner incompetent.

Since this is my first time commenting on a talk page, let me provide a few important pieces of information to consider when reading my posts:

1) I am a scientist by trade. I do not focus on psychopharmacology, but it is not outside my content area. My specialty, however, is scientific research methods.

2) I have not looked into the "wealth of scientific literature" that Muugokszhiion refers to in the above post, but I have scrutinized the Leith & Barrett paper.

3) While I am a skeptic, I am not a cynic. Please to not accuse me of dismissing evidence without examining it; I will not do so without good reason.

4) Like every scientist, I reserve the right to be wrong.

Muugokszhiion: Even with access to the full text, I would never assume that someone having difficulty understanding the Leith & Barrett paper was lacking in scientific understanding. This is a VERY convoluted paper.

It took me 2 hours to get a grasp of what the authors were trying to say and this paper is not long and not outside my area of expertise. The problem? It's very poorly written. The authors use multiple vague terms for all of their important components and the statistical evidence they report does not match the inferences they make. More on that below. These problems do not make for a very readable research report.

Scuro: Your gut is on the right track, but you won't get there by following this path. You are trying to discuss the generalizability (external validity) of work that has no internal validity. That's a bit like trying to fit a hat on the headless horseman. It's mute. Also, the use of terms like "facts" in casual conversation (especially with someone presumed to be a layperson) is usually acceptable. If we don't accept a certain amount of "I know what you really mean", we'd all be walking on eggs everywhere, afraid to open our mouths. I knew a mental health professional once with a stronger-than-average understanding of scientific literature who used the word "prove" quite often. I ignored it because I understood that his definition of "prove" in this context was "there is a great deal of strong evidence to support".

OKAY, back to the work. My opinion:

While this study has a number of serious problems, most are not worth discussing because the lack of internal validity makes this paper worthless. It's silly to discuss whether cross-tolerance in laboratory rats suggests cross-tolerance in humans because there is no evidence here of cross-tolerance in rats. What's more, the inference that cocaine & methylphenidate act on similar receptor systems could not be made using this study even if it were valid (the study, I mean). The authors make a number of VERY VERY serious errors in their reasoning. Their conclusions do not follow from their argument.

I would be happy to provide anyone interested with a pretty long-winded set of notes, but I don't see the point unless someone truly wants to read it. So, I'll only do so by request. The most troublesome problems, however, are: the use of what amounts to a series of one-group pretest/posttest designs. This is the absolute worst type of study one can conduct. It is NOT a true experiment and cannot lead to causal conclusions. In addition, the methods employed in this study do not and cannot provide information to support the hypotheses the researchers set out to test. They make some very serious errors in interpreting their test results.

The authors present sloppy work that is a waste of time, money, and publishing space.

It's relevant, also, to address these comments by Muugokszhiion:

Sentence 2. You can trust that the research was conducted reproducibly, and that the drugs were administered in the same manner each time (the study has been held up to peer review). It would not be a scientific study without consistency. Also note that the study has been cited by other scientific publications over thirty times

These comments would be valid and true in a perfect world, but in the real world this process doesn't fulfill its intentions.

Peer review is a necessary first step in the scrutiny of scientific study, but it does not ensure that research was conducted reproducibly, well, or consistently by any stretch. In fact, I would estimate that at least 50% of the research reports published in respected scientific journals are worthless.

These points are important because an argument based only on authority cannot move forward. Carl Sagan said, "In science, there are no authorities." He meant that heresay and opinion are not evidence. Evidence is in the method and premises, not in whether the report was peer-reviewed.

Science is a body of work completed by scientists. Scientists are, of course, human. Humans are not designed to think critically (for several reasons), and few find this kind of reasoning easy. Like in every profession, mistakes are missed every day and often by many people (sometimes for years) before they are "caught". In addition, like in every profession, a large proportion of scientists are simply BAD at their job.

The result is that one cannot blindly accept that a study published in a peer-reviewed journal is valuable. Peer review is simply the first step in a long series of examinations (including replication) that are needed before a conclusion can be "trusted". I'M NOT KNOCKING SCIENCE. IT'S STILL THE BEST WAY TO UNCOVER KNOWLEDGE. But, we have to be VERY careful about how we go about evaluating it.

You cannot trust that the research is consistent. A quick read of the study shows that there are a number of both vague and direct references to differences in methods among the animals. Given the small sample size, these differences are not trivial. In fact, I am a bit shocked (although I shouldn't be) that Psychopharmacology published this paper. The definition of scientific study is not consistency. Science is simply a systematic way to uncover knowledge and, like everything else, there are "right" ways and "wrong" ways to go about it. While we do not always agree on which methods are best, I can't imagine anyone that truly understands methodology would argue that the methods used here are acceptable. For example, and the thing that REALLY shocks me about this paper, they were somehow allowed to justify their lack of control group with a casual reference to "pilot" work. This is completely unacceptable.

Another important point - Thirty citations in 25 years is nothing to brag about, especially since there's no indication of what those citations involve. I routinely cite studies that are very poor in order to point out methodolical issues. Citations are not the gold standard of a study's value.

The bottom line here is that a statement such as "There have also been some medical reports showing a cross-tolerance between cocaine, methylphenidate, amphetamine, which are known to act on similar receptor systems." requires support AND a clear description of what is meant by "similar". The study cited DOES NOT SUPPORT THIS STATEMENT. Since the rest of the paragraph relies on this statement, I propose that all of the references to tolerance and cross-tolerance be removed.

Barbyma 01:22, 14 January 2007 (UTC)

Thanks for your reply. Based on your discussion of the study, I'd accept the removal of: "There have also been some medical reports showing a cross-tolerance between cocaine, methylphenidate, amphetamine, which are known to act on similar receptor systems," since it appears that the study itself was flawed. -Muugokszhiion 18:03, 14 January 2007 (UTC)

My issue with the study was on a much simpler level. How could inferences be made about the therapeutic effects of Ritalin, based on a rat study where the rats were INJECTED with Ritalin? How can you compare injected dosages per kilogram with a rat and ingested dosages for humans per kilogram? You are comparing apples and oranges and any inferences made from this comparison about the therapeutic use of Ritalin would be bogus. If the authors of the study wanted to look at cross tolerance between the therapeutic use of Ritalin with Cocaine, then they should have used an ingestable form of the drug for the rats. The different delivery system of the drug changes everything. They used to put cocaine in Coca-Cola yet we had no Coke houses. Turn that cocaine into crack which is snorted and the drug becomes highly addictive. The difference in delivery systems is immediate entry ( high then crash ) into the brain vrs gradual entry into the brain. --Scuro 22:13, 15 January 2007 (UTC)

I didn't read everything that was posted here. IV MPH isn't insanely different than oral if you measure the amount in the blood (which people do). I mean, its not the same, but on a similar note not taking an IV study into consideration is almost splitting hairs.

Yes, Cocaine is similar to MPH in the sense that they both effect dopamine. The main difference is that MPH only affects the DAT (dopamine transporter) and keeps it open. This is even different than amphatamine which is assumed to create more DA to be released. What you don't say is that MPH has been shown to be VERY specific in its binding whereas cocaine binds many more receptors. Lastly, and MOST IMPORTANTLY (for those who skim.. like me) after cessation of MPH there was no compensatory increase in the DAT whereas with cocaine there is a large compensatory increase. People on ritalin have a regular amount of DAT and cocaine users have TONS, so without the drug MPH people are fine and cocaine users undergo withdrawl.

Calling MPH cocaine is like calling a VW bug similar to a porsche. I mean, they both are cars and they both drive. But, it is VERY different. Its not just that MPH is slower, its the fact its DIFFERENT. The "reward response" for taking a dose is very different - yet the stimulatory effect is similar. The specificity of the drug is why its so different. Cocaine is a lot more general and effects serotonin and much more. I mean, seriously. Look at a kid or adult on ritalin and take it away from them, or see the lengths they go to to get their hands on it. Then compare that to a cocaine addict. I know my last point isn't a scientific study so don't harp on me for saying it. I made much better points.

If someone is actually interested in learning about the drug and wants to read a scientific paper read the one I site below (I posted about GH also, its where I got all the above info). Its much better than most of the crap out there about ritalin. There are MANY worse drugs out there that are much more dangerous. Anybody who says it is a bad horrible drug is just misinformed and needs to read the literature themselves rather than listen to what a celebrity or nightime news stations says to get people to listen to them. Rjkd12 02:17, 20 January 2007 (UTC)

Growth Hormone?

I was reading up on the scientific literature about methypheindate and came to the conclusion that ritalin increases growth hormone levels. Joyce et al (1986) and Brown (1977) both show an increase in serum levels of GH with MPH, with a larger increase in males compared to females. I assume this literature is up to date considering a recent review of the drug (Leonard 2004) cites these studies and also concludes (after "reviewing all the literature" that methylphenidate does in fact increase GH output.

So, why after googling ritalin and GH I get people touting like mad that it DECREASES GH output and that it is a concern for growing children? Also, if it does increase GH, any hypothesis about why it may stunt the stature of a growing person? Rjkd12 23:40, 16 January 2007 (UTC)

Scientology and Anti-Psychiatry criticism of Ritalin

When it comes to Ritalin both movements have been highly vocal and have played a major role in the public's perception of the drug. Consequently it is appropriate to accurately discuss each entities viewpoint in this article and compare them to each other. With regards to Ritalin and Psychiatrists there appears to be little difference in opinion between the two groups.

80.109.194.224 decided to edit the section stating that" Nevertheless Scientologists, unlike others do view "hyperactivity" as a problem, that needs treatment (they advocate a change of diet, so their "solution" is also chemical in the broad sense of the word)". Yet Breggin who is an Anti-psych offers the same solution in his Ritalin Fact book in "chapter 11 entitled "do alternative treatments help with ADHD?". This is the part of the anti-psych and Scientology viewpoint that appears to be illogical. On the one hand they can state that ADHD is bogus, a fraud, a collection of symptoms...yet on the other hand they offer solutions to this "nonexistent" problem. ADHD skeptics come up with discriptive terms like "wildcolts" or describe the behaviour as "boys being boys". But if this is normal behaviour why do they need fish oil, magnesium, or some other "catalyst" to change behaviour?

Both the CCHR and Scientology believe the disorder is bogus. Both offer alternative solutions to hyperactive behaviour. For this reason I am reverting the section back to it's original format which correctly makes note of this. --Scuro 13:46, 20 January 2007 (UTC)

Here is another tortured edit from 80.109.194.224. "Nevertheless Scientologists, unlike others do view "hyperactivity" as a problem, that needs treatment (they advocate a change of diet, so their "solution" is also chemical in the broad sense of the word) (Breggin also advocates a change in diet against "hyperactivity", so his viewpoint is similar in this respect)". So I take it that they and different but the same?

Isn't this passage so much cleaner and closer to the truth? -> "The viewpoint of Baughman and Breggin with regard to Ritalin is almost identical to the CCHR's viewpoint on this issue". Readers need to know that. If they are looking for a critic of Ritalin, and the CCHR and Breggin have the same viewpoint, why research both? The statement gives information and while it is a generalization, I wait to see any example where the two parties differ in opinion with regards to ADHD and Ritalin. The generalization has not been challenged with facts.

I can be wrong user 80.109.194.224. But take the time to point out to me errors in this information, instead of deleting out my contributions without sufficient justification. If not I will simply have to contact an administrator.

--Scuro 18:00, 20 January 2007 (UTC)

Odd phrasing

"It is also important to note that while ADHD is a condition that includes hyperactivity, problems holding still, and following directions, this is also typical of a child under the age of 6. This causes difficulty in diagnosing children under this age and should probably not be studied." -- I had assumed that this was vandalism, but took a quick look at the page history and apparently it isn't. Therefore: What is this supposed to mean? Can we phrase this more clearly? -- 201.50.248.179 20:13, 28 January 2007 (UTC)

I am not sure, but I'll give my 2 cents. Maybe instead of should not be studied, it should say, "This causes difficulty in diagnosing children under this age and therefore should not be used as critera in diagnosing someone with ADHD." Or elude to how it can cause a false positive diagnosis in children under the age of 6. And, are children only hyperactive until 6? That seems like a young age, especially for boys. Rjkd12 20:30, 28 January 2007 (UTC)

Side Effects And Effects Like Other Psychomotor Stimulants?

Does methylphenidate produce similar effects as other psychomotor stimulants? Since methylphenidate is a psychomotor stimulant, doesn't it have side effects very similar to that of cocaine and the amphetamines? Coke and amphetamines such as meth cause similar side effects and are equally as addicting. Since all three are closely related I assume they produce very similar effects and side effects. If this is so, wouldn't it be just as dangerous to use methylphenidate as any other psychomotor stimulant? It doesn't seem like coke or meth has as much medical uses as this drug though. Zachorious 13:01, 1 February 2007 (UTC)

It's all in the delivery system. Snort or inject stimulants and pow, instant high and then major crash. The therapeutic level of stimulants used in Ritalin are ingested. These meds have been shown to be one of the safest and most effective classes of drugs when taken as prescribed. --scuro 05:24, 9 March 2007 (UTC)

Effects

Holy heck, I had no idea there was going to be so much talk. I'm sure my little comment will get lost in the crowd. Under "effects", the article states "It is claimed to have a 'calming' effect on many children who have ADHD,[9]". The article cited is not specifically referencing methylphenidate. If this is a statement on CNS stimulants in general, maybe the comment should be on a CNS stimulants page. If it is about MPH specifically, then a different source should be cited. I'm not taking issue with the statement, merely how it is supported. If I knew how to fix it I would.

The Letter J 04:28, 9 March 2007 (UTC)

I agree, the content of the reference was misrepresented. Removed the reference from the article; here it is if someone thinks of a way to re-integrate it:

<ref>{{cite web |url=http://psychiatry.jwatch.org/cgi/content/full/1999/301/1 |title=Hyperactivity Paradox Resolved? |accessdate=2006-11-11 |work=Journal Watch }}</ref>

I'll put the ref at Talk:Attention-deficit hyperactivity disorder and Talk:Stimulant as well for use in those articles.--Eloil 22:01, 27 March 2007 (UTC)

Is a citation *really* needed when listing tachycardia as common side-effect of a CNS stimulant? Really? Is there a doctor in the house?

Yes a Dr. would be nice, ignorance can show it's face anywhere. THERAPUTIC levels of stimulants do not cause the same side effects as stimulants that are abused. For instance, coffee is a CNS stimulant and can cause a rapid beating of the heart. Yet if you stay under a certain level it won't have that side effect for the vast majority of drinkers. For instance, if you started at a quarter cup of coffee and then the next week raised it to a 1/2 a cup of coffee, that side effect would not be seen in a significant population of the controls. In fact you would see positive attributes from consumption. Same holds true for theraputic levels of stimulants.--scuro 21:49, 4 April 2007 (UTC)

Similarity to Cocaine

Look, hell, I take Concerta (legitimately) and even I know that it's both structurally and functionally similar to Cocaine. I really do think that should be expanded on, and IIRC there used to be a section on it. Where'd it go? Klosterdev 16:26, 2 April 2007 (UTC)

I don't think it's responsible or appropriate to compare the subjective effects of methylphenidate to cocaine in this article. The two drugs have a similar receptor profile, which might be worth mentioning, but even then, this article is about MPH, not cocaine. Furthermore, cocaine and MPH are not structurally similar. MPH is a substituted phenethylamine while cocaine is much more similar to tropane. -Muugokszhiion 00:05, 3 April 2007 (UTC)

I agree whole heartedly with Mugg...to top it off one drug is abused the other is therapeutic and they have two TOTALLY different delivery systems. One having potentially disastrous outcomes while the other is clinically proven to improve symptoms for 9/10ths of the users. This a red herring idea . --scuro 03:04, 3 April 2007 (UTC)

This whole talk section reads strangely, with one side actively pursuing anecdotal "this one time at band camp I took Ritalin and I died" and the other side begging for a decent article with references to solid sources. Is there an adequate set of criteria for "structurally similar" that could clarify this? It seems like people are looking at molecular diagrams and returning to the argument with, "yeah, but the hexagon in this diagram and the hexagon in this diagram are really similar." I applaud Muugokszhiion's patience. —The preceding unsigned comment was added by 74.114.221.41 (talk) 17:02, 4 April 2007 (UTC).

IIRC, people with ADHD have a higher tendency to abuse cocaine due to it having similar effects as Ritalin. Am I missing something else? Klosterdev 02:33, 4 April 2007 (UTC)

Scuro's characterization of cocaine as solely a drug of abuse is factually unsound - The difference between Schedule I & II drugs is a recognized medical purpose. MPT, cocaine & methamphetamine are all Schedule II and they are indisputably related to each other either by pharmacology or use in disorder therapy. To deliberately redact this information based on moral judgements of appropriate use seems subjective and not NPOV. GregoryCJohnson 23:08, 27 April 2007 (UTC)-

Cocaine is a stimulant and they have some similarities. How closely are they related? Someone else could give you a better answer. Now imagine if someone took a very small dose of cocaine and instead of snorting it or smoking it, they ingested the drug. I'd hazard to guess that those with ADHD may see some positive outcomes with their symptoms. And conversely if you took the caffeine from coffee beans and refined it into a pure substance and then injected it, it would be highly harmful over time.

But why bring up the question? ...and the answer is simply to make the association in this readers mind. For some people it's not about the truth but rather about trying to get people to accept their belief system. It's not like they will enlighten you with knowledge but rather they will attempt to influence you to create a bias in you. Anyone who knows anything about this subject sees this as a non-issue. That is because it is an apples and oranges comparison. One stimulant is abused and instantly reaches the brain. The purpose is to get high and the drug reaches it's maximum effect almost instantly. The downside to drug abuse is the crash and possible addiction. On the other hand, theraputic stimulants are taken at a very small dose that has been tested to clinically reduce symptoms in over 90% of those who have ADHD. The dose is swallowed and slowly enters the bloodstream through the stomach. There is no withdrawal or addiction.

This issue is all about creating "smoke" and confusion in your mind. --scuro 22:26, 4 April 2007 (UTC)

Gentlemen, I don't mean to be combative, but your position here simply untenable - Studies dating back to at least 1995 show identical receptor binding and posit clearance time differentials proportional to abuse potential. The link may not be proven, but it cannot be credibly dismissed out of hand. GregoryCJohnson 23:08, 27 April 2007 (UTC)

Heck the effects are damn alike those of caffeine as well. But I neither see the need to post something like that, as it would have very little (if any) informative value.(And in my opinion it sounds like a very bad idea to make such comparisons until more can be proven?) "the non registered one" (Ill be registered again soon do not start whining eh?)

[I don't again have my papers on this computer to reference but I have seen that rats will substitute methylphenidate for cocaine. This is surely not in debate. They are pharmacologically similar in action and though as a chemist I agree that cocaine is very structurally different that is irrelevant in this case - the end effect is very similar due to a very similar mode of action - thus I would give it to the pharmacists on this one that they are closely related drugs, even if not so closely related molecules. The method of delivery for cocaine is generally different, but both can be taken in the same ways - you just don't take methylphenidate by insufflation when using legitimately because it is a faster absorbance profile - and thus more akin to cocaine consumption. Anecdotally I have to say that a leading UK specialist I saw asked me (after all the other doctors, including an assisstant of his had asked the "Have you ever taken an illegal substance?" question) if I had ever tried cocaine as many patients of his who have ADD or ADHD say they found it calmed them down. Thus the close tie is strongly regarded by leading professionals - to deny this is wrong - whether you think it is an inconvenient truth for sceptics to take up it is still a truth when left undistorted.] [Sorry. Not sure how to indent.] [Oh and MPH is - as much as I dislike the fact as a pro-MPH legitimate user - addictive and has withdrawal effects (see my Titre discussion below)]

Addiction Study

The beginning of the Addiction section mentions a study in which MPH users have a higher tendency to use cocaine 'at least once' in their lifetime. I think this belongs in another section; Someone's willingness to experiment with new drugs is separate from their ability to get addicted to them. If there's a study which shows that MPH users become addicted more quickly, that would be more appropriate. GarconDansLeNoir 19:06, 3 April 2007 (UTC)

chop chop

The criticism section was taking over the article. The information within this section is neither majority viewpoint or minority viewpoint. It is controversial and as such was moved to the ADHD controversy article. --scuro 04:33, 9 April 2007 (UTC)

There are no negative sides to giving amphetamines to children

Military looks to drugs for battle readiness As combat flights get longer, pilot use of amphetamines grows, as do side effects.

By Brad Knickerbocker | Staff writer of The Christian Science Monitor

When Navy fighter pilot "Maverick" and his sidekick "Goose" declare "I feel the need – the need for speed!" in the box-office hit "Top Gun," they're speaking about the capabilities of their fast and furious F-14 Tomcat. In the air war over Afghanistan, "the need for speed" may have taken on quite a different meaning.

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"Speed" is the well-known nickname for amphetamines, the controversial and potentially harmful drug some American pilots are taking in order to enhance their performance. Despite the possibility of addiction and potential side effects that include hypertension and depression, such drugs are needed, military officials believe, in order to stay alert and focused – especially on long-range bombing missions. Such flights can mean nine hours or more alone in expensive, high-performance aircraft. Their lethal weapons are aimed at an elusive enemy that can be (and has been) confused with civilians or friendly troops.

According to military sources, the use of such drugs (commonly Dexedrine) is part of a cycle that includes the amphetamines to fight fatigue, and then sedatives to induce sleep between missions. Pilots call them "go pills" and "no-go pills." For most Air Force pilots in the Gulf War (and nearly all pilots in some squadrons), this was the pattern as well.

The drugs are legal, and pilots are not required to take them – although their careers may suffer if they refuse.

Amphetamines follow a pattern that goes back at least 40 years to the early days of the Vietnam War – further back if one counts strong military coffee as a stimulant. But they're also part of a new trend that foresees "performance enhancements" designed to produce "iron bodied and iron willed personnel," as outlined in one document of the US Special Operations Command, which oversees the elite special-operations troops that are part of all the military services.

Indeed, the ability to keep fighting for days at a time without normal periods of rest, to perform in ways that may seem almost superhuman (at least well beyond the level of most people in today's armed services), is seen by military officials as the key to success in future conflicts.

"The capability to resist the mental and physiological effects of sleep deprivation will fundamentally change current military concepts of 'operational tempo' and contemporary orders of battle for the military services," states a document from the Pentagon's Defense Advanced Research Projects Agency (DARPA). "In short, the capability to operate effectively, without sleep, is no less than a 21st Century revolution in military affairs that results in operational dominance across the whole range of potential U.S. military employments."

A 'radical approach'

What's called for, according to DARPA, is a "radical approach" to achieve "continuous assisted performance" for up to seven days. This would actually involve much more than the "linear, incremental and ... limited" approaches of stimulants like caffeine and amphetamines.

"Futurists say that if anything's going to happen in the way of leaps in technology, it'll be in the field of medicine," says retired Rear Adm. Stephen Baker, the Navy's former chief of operational testing and evaluation, who is now at the Center for Defense Information in Washington. "This 'better warrior through chemistry' field is being looked at very closely," says Admiral Baker, whose career includes more than 1,000 aircraft-carrier landings as a naval aviator. "It's part of the research going on that is very aggressive and wide open."

In a memo outlining technology objectives, the US Special Operations Command notes that the special-forces "operator" of the future can expect to rely on "ergogenic substances" (such as drugs used by some athletes) "to manage environmental and mentally induced stress and to enhance the strength and aerobic endurance of the operator."

The memo continues: "Other physiological enhancements might include ways to overcome sleep deprivation, ways to adjust the circadian rhythms to reduce jet lag, as well as ways to significantly reduce high altitude/under water acclimatization time by the use of blood doping or other methods."

Although the Air Force Surgeon General's office recently acknowledged that "prescribed drugs are sometimes made available to counter the effects of fatigue," it is not publicly known how widespread the practice is or whether special-operations forces on the ground in Afghanistan are taking such drugs.

But it is certainly widely talked about among combat veterans and military experts.

"Given the extent of recreational drug use within the military, and the use of performance-enhancing drugs among athletes, it is very easy to imagine that warriors would consider using any manner of drug they thought would increase their chance of returning home alive," says John Pike, a defense expert with GlobalSecurity.org in Alexandria, Va.

During the Gulf War, according to one military study, "pilots quickly learned the characteristics of the stimulant [Dexedrine] and used it efficiently." Pilots were issued the pills and took them if and when they felt the need.

Some people have defended that practice. "If you can't trust them with the medication, then you can't trust them with a $50 million airplane to try and kill someone," says one squadron commander whose unit had the fewest pilots but flew more hours and shot down more Iraqi MIGs than any other squadron.

But military officials, as well as medical experts, warn that the use of amphetamines can clearly have its bad side.

The flight surgeon's guide to "Performance Maintenance During Continuous Flight Operations" (written by the Naval Aerospace Medical Research Laboratory in Pensacola, Fla.) mentions such possible side effects as euphoria, depression, hypertension, and addiction. There's also the possibility of "idiosyncratic reactions" (amphetamines can be associated with feelings of aggression and paranoia) as well as getting hooked on the "cyclic use of a stimulant/sedative combination."

"The risk of drug accumulation from repetitive dosing warrants serious consideration," the guide notes. The "informed consent" form that military pilots must sign notes that "the US Food and Drug Administration has not approved the use of Dexedrine to manage fatigue."

Amnesia on the job?

It's not just the "go pills" that can cause problems in certain individuals. "No-go pills," used to induce sleep, can have dangerous side effects as well – including the possibility of what's called "anterograde amnesia ... amnesia of events during the time the medication has an effect."

"For the military aviator, this raises the possibility of taking the medication, going to a brief, taking off, and then not remembering what he was told to do," according to the lab's report.

But researchers say suchsymptoms "are primarily dose related and are not expected with 5-10 mgs of dextro-amphetamine (Dexedrine)" – the amounts given to pilots in the Gulf War and in Afghanistan.

For the most part, the issue of prescribed drug use by US pilots has gone unreported in the United States. But in England and Canada, it has been raised recently – especially in a possible connection with errant bombings.

In April, four Canadian soldiers were killed and another eight injured when an American F-16 pilot on a long-range mission, thinking he was under attack, dropped a 500-pound laser-guided bomb on an allied military exercise.

"The initial version of the Canadian incident portrayed the pilot as behaving with inexplicable aggression tinged with paranoia, and my first thought was that the poor guy had been eating too much speed," says Mr. Pike of GlobalSecurity.org. Officials are still investigating that accident, and the pilot has been questioned, among other things, about the possibility of drug use.

More recently, concerns have been raised about aggression and violence among soldiers returning from Afghanistan. In three of four cases in which men killed their wives, the accused husbands were in special-forces units based at Fort Bragg, N.C.

"It is quite obvious that someone needs to pose this question in the context of the business at Fort Bragg," says Pike. "This sort of hyper-aggressive behavior is just what one would associate with excessive use of such drugs or from withdrawal from using them."

As the US moves into an era in which national security is likely to mean wars fought from the air – using attack aircraft and small, specially trained units flown long distances to the battlefield – the issue of performance-enhancing drug use by US military personnel is likely to escalate. "The real story here is the ever-extending reach of air power," says Daniel Goure, a military specialist at the Lexington Institute in Arlington, Va. "We were flying F-15s out of Lakeheath [a Royal Air Force base] in the United Kingdom during Kosovo. Why? Because we had used up the available landing space everywhere else."

"As asymmetric threats such as ballistic missiles become more available to our adversaries, we are going to stand even farther back," adds Dr. Goure. "That means that this problem [i.e., the need to combat pilot fatigue] can only grow." —The preceding unsigned comment was added by 70.189.0.225 (talk) 04:42, 18 April 2007 (UTC).

...and the point of the cut and paste antipsych article and totally unrelated title is ....? --scuro 10:51, 18 April 2007 (UTC)

How about removing this? Just asking... "the non registered one" (soon to be)

Criticism of Methylphenidate based on relation to taboo drugs, specifically cocaine & methamphetamine

Scuro,

I apologize for the inconvenience of having to revert my addition, especially one characterized as a "rambling collection of facts, and ideas not related to the topic". I was trying to formulate a concise, accessible description of the underlying basis of MPT criticisms. The only apparent distinguishing criticism consistent with a section linking to "ADHD controversy" is the belief that MPT use is equivalent to cocaine/methamphetamine abuse. I attempted to define the scope of the discussion, exclude ADHD related criticisms, and state the summary of my analysis. After defining the structural concerns and the mechanisms thereof, I address them in relation to both comparative drugs with particular attention to maintaining NPOV.

Could you please detail the basis for your characterization?

Thanks, GregoryCJohnson 23:21, 27 April 2007 (UTC)

Methylphenidate (MPT) is a CNS stimulant with broad and controversial distribution, as are cocaine and methamphetamine. All three are "Schedule II" drugs, all three are considered "medically useful". Your paediatrician could prescribe any of them, including cocaine and methamphetamine. All three act primarily on dopamine, but so do food, sex, and most other things, as discussed extensively under that entry,

Leaving aside the emotionally charged issue of medicating children to treat a vaguely defined condition (ADHD), the considerations are mainly the chance of abuse, dependence, and injury. The first is a moral issue, the second societal, while the third is self preservation. As regards MPT, it either ties or compares quite favorably to both cocaine and methamphetamine. This is not an accident, but rather it is the reason MPT is used.

Unfortunately, elevated levels of anything with a receptor can cause downregulation, wherein the receptor's sensitivity decreases. This risk of downregulation exists with any elevation, regardless of how elevation is achieved, and increases with exposure. A common example of downregulation is diabetes. High carbohydrate intake increases insulin levels, which can damage insulin receptors, leading to diabetes, possibly requiring injecting supplemental insulin for life. It is not unreasonable to say obecity-induced diabetes is just another form of drug addiction

Turning strictly to neurotransmitters, how you achieve increased levels is important. Increased levels can result from either reuptake inhibitors or agonists. Inhibitors stop the destruction of the neurotransmitter, while agonists actively release any available neurotransmitter they affect. Using a bathtub analogy, inhibitors close the drain while agonists turn the hot water on full blast. Eventually you will either run out of hot water (dopamine) or overflow the tub (receptors).

MPT is a very poor substitute for cocaine - both are dopamine reuptake inhibitors, but cocaine is a dopamine agonist as well. The "high" from increased dopamine is more related to the speed than the amount of increase. A inhibiting agonist increases it's effect by flooding the brain faster with more dopamine, thus depleting the dopamine reserve. Further, cocaine is short acting, clearing from the receptors in about 20 minutes. Fast clearance means frequent cycles leading to rapid exhaustion. In contrast, MPT clears in about 90 minutes without affecting dopamine reserves - too long and too low for an abuser.

Turning to methamphetamine, it is a truly powerful drug - like cocaine it is an inhibiting agonist, but in addition to dopamine it targets norepinephrine and seratonin as well. It's clearance rate is nearly half a day, making it substantially more powerful on an equal weight basis, giving it longer effect but still depleting three neurotransmitters in the end. Unlike cocaine, in 2007 methamphetamine still used to treat ADHD, among other things. (See Desoxyn) For various reasons it is usually used after the other treatments are shown to be ineffective.

In conclusion, as the toxicologists point out, "the dose make the poison", thus the debate eventually resolves to the question of physician judgment in the selection of drugs. All three are clearly powerful drugs, but even methamphetamine is clinically useful in limited situations and at appropriate doses.

Gregory,

Don't apologize.

You wouldn't have taken the effort you did to post unless you have something important to say. For improvements I'd recommend either creating a new article entitled, "Criticism of Methylphenidate" and linking it back to this article or I'd find ways to integrate your ideas into the article. If you choose the second option, start with the what you feel are the most important and most obvious points. Make sure that the ideas inserted into the article in such a way that they don't interfere with the flow. Be clear and concise and above all cite your ideas...especially those ideas that stray from the majority viewpoint.

Personally I'd want to know if you are making reference to the therapeutic effects of the drug or drug abuse.--scuro 03:00, 28 April 2007 (UTC)

Recrational Uses Miss Leading.

Ridalin is NOT Speed, or Uppers or any of those things. Speed is usually a mix of several weak stimulants that causes nervousness and euphoria, Ridalin is just Ridalin, Adderal is commonly know as Speed. And don't quote me on this but I've read somewhere that snorting Ridalin is becoming less common because of its extreme effects when snorted. —The preceding unsigned comment was added by 70.177.220.1 (talk) 00:29, 1 May 2007 (UTC).

Methylphenidate is a stimulant and is used as one. Btd-no 01:41, 1 May 2007 (UTC)

Comparison to Cocaine

I don't understand the controversy here. I posted about this higher up, and it didn't seem to be recognized. Just because two drugs are similar doesn't make them the same. Cocaine is not only a dopamine reuptake inhibitor, its a dopamine agonist - and a very fast acting one at that. MPH is only a dopamine reuptake inhibitor that is localized to a certain part of the brain. Because of its relatively mild effects and its specificity it is nowhere nearly as potent as cocaine. If it was, we'd have MPH junkies like we have crack heads and that obviously isn't true. Morphine is VERY similar to opium, and we do have both morphine and opium addicts. Look at oxycontin and heroine, both very similar and we have addicts of both. You see some students selling ritalin, and you see some snorting it, but its not an epidemic like the other drugs I mentioned. Two main things separate it from other stimulants. One is, it doesn't appear to give the 'reward response' that is so addicting. Even adderal gives that response more than MPH, and cocaine and meth give that response a lot, hence their addiction. Also, (FOR THOSE SKIMMING, READ THIS) a study on rats showed that there was no upregulation of the dopamine transporter after cessation of heavy IV MPH administration, meaning there was no compensation which would give withdrawal upon discontinuation of the drug. Part of the reason cocaine is so addicting is that when you are off it you have a ton of empty dopamine receptors (which are highly upregulated) and the cells don't have any to release, so you get very depressed. Plus, IIRC regarding future drug use, it was kids on ritalin who had less future drug use due being more accepted in school and doing better grade-wise.

With the main drugs out there (cocaine, opium, heroine etc) science has had a difficult time to extract the good things from them (stimulation, relaxation/anti-anxiety, pain relieving) and get rid of the addictive and "bad" qualities. Sometimes it works to a degree (vicodin, xanax, MPH, dextroamphetamine) and other times not as well (oxycontin, morphine, methadone). This drug has been around since the 60's and at one point was even in some european multivitamins, which is indicative of how well tolerated it is.

This is point of view, but out of all the stuff that is out there, this is one of the most mild and well tolerated drugs around. I'd prefer my kid pop MPH over alcohol, pot, even aspirin. Granted, kids can crush the extended release tablets or snort it, but obviously that isn't as "good" as other drugs or like I said we'd have more of a demand on the street for it. As far as pharmaceuticals that have a negative effect on the public, there are MUCH bigger fish to fry and much better ways to spend you internet searching.Rjkd12 22:03, 23 May 2007 (UTC)

[Heroin is much more "powerful" than morphine, and in turn codeine etc. etc. They are natural drugs or derivatives produced due to the massive increase in desired activity/utility (when used legally or otherwise). MPH is not available like cocaine as it is a full synthetic (or as close as from what I have seen). To make it would take much more effort for a non-chemist than getting hold of cocaine instead to abuse. It would involve several synthetic steps from some interesting starting materials that I doubt you can just buy as an individual, especially given the last few years of anti-terrorism crackdowns limiting even some legitimate chemical purchases. At the end you would have something very close to cocaine when snorted, though maybe not quite as "good".

Thus: Why bother? If you want an illegal high it is easier to get cocaine. This is a chemical/natural product sourcing difference and nothing to do with the drug effects. And people abuse codeine, even though it isn't as "good", so it is more down to availiability. Even MPH is abused by insufflation or injection - the delivery method is not determined by the molecule - cocaine could be taken orally (I believe - I don't think it will be destroyed).

Also crack and cocaine are different - you say we would have MPH-junkies; well we have cocaine addicts seperate to crack addicts - they are different drugs. What it was in is irrelevant - cocaine was in coca-cola at one time. Elemental phosphorus was in health tonics. Dextro-rotatory amphetamine doesn't have bad qualities 'cos science made it that way?! (Though I realise you qualified this somewhat, but methadone has pros surely, and amphetamine cons.) I agree that MPH ranks low in the recent Lancet article about 20 drugs of abuse and their real impact (D. Nutt, et al., about March 2007) and there are bigger fish to fry but the truth should be stated, bias can come from either side.]

New pic from article "phenidate"

Focalin

Focalin

The article "phenidate" contains little information pertaining to methylphenidate. In fact, it only mentions ADHD. It has a good rotating pic though. I've turned it into a redirect to this article. Fuzzform 23:36, 1 June 2007 (UTC)

Um... nice! Should be on the front if you ask me (the rotating pic at least) Then again I guess style and methylphenidate does not match. (not that the choice is mine to make just wanted to comment on this rather nice rotating pic) "the non registered one"

You might want to read this discussion from the Wikiproject on chemistry where most people decided that they don't want rotating images of molecules in articles.

Although it's not an official policy, it is the de facto guideline that chemists on Wikipedia tend to follow.

Ben 15:53, 9 July 2007 (UTC)

Inappropriate Footnotes

Just thought I'd mention that I removed four footnotes from the main article that seemed to have merely been tacked on to promote a controversial viewpoint, not to further the article. They were the last four footnotes listed, and unlike all the other footnotes none of these were referenced within the article. All of them pointed to sites with pronounced anti-methylphenidate viewpoints claiming that the medication is dangerous and leads to brain damage. The questionable validity of the claims made in the referenced articles seems somewhat besides the point - my main reason for removing them was that they seemed more relevant to the Controversy_about_ADHD article, and that their presence seemed intended mainly to inject an inappropriately strong POV into this article. Anyone have any qualms with the removal? -- 01:57, 12 June 2007 (UTC)

None here... "The non registered one"

Is it possible that Ritalin does not work on everybody suffering ADHD?

Or is this a sign of wrong diagnosed ADHD? Are there people with ADHD not responding on Ritalin but on Amphetamine? Thank you for your answer. --134.155.99.41 14:45, 24 June 2007 (UTC)

The short answer is yes to q#1, possibly for q#2, and yes to q#3. --scuro 03:35, 25 June 2007 (UTC)

Thank you for your answer. Too bad that amphetamine is forbidden in Germany so I have to keep on suffering from ADHD. --134.155.99.41 02:15, 26 June 2007 (UTC)

Germany has blinders on, they are backwards when it comes to a general understanding of disorders and how to treat them. --scuro 03:59, 26 June 2007 (UTC)

That's true. Weird they don't have any inhibitions prescribing downers but are very biased against amphetamines. Double weird as Germany invented amphetamines! Maybe it has something to do with the fact that in Nazi Germany the Wehrmacht gave soldiers amphetamines? And it seems to me typical for the mentality of Germans, even German doctors to look rather after the law than after how to help. --134.155.99.41 15:25, 27 June 2007 (UTC)

I believe that most if not all medications can fail to provide the desired effect at less than way too rare cases. The mentality of Germans? why does that sound so... discriminating? Well one thing is for sure. That is no fact and contains no informative value whatsoever. "The non registered one"

This isn't the only drug possible to use as treatment. New options include modafinil, and better yet, atomoxetine --user:guruclef —Preceding unsigned comment added by 200.7.17.84 (talk) 01:56, 28 September 2007 (UTC)

Taper/Titration of Dosage

Apologies for not having yet created an account; though I hope the credibility of this point is self-evident.

I have seen no reference to any mention of beginning/ceasing MPH medications. Anecdotally I have seen (generally) US ADHD-support sites that make reference to the ability to use these medications on “only the days you feel you need them” (Not a true quote; I have not currently got the URL's noted for this information).

However from experience of the UK system, and specialist psychopharmacology documents such as http://jop.sagepub.com/cgi/content/abstract/21/1/10 (DOI: 10.1177/0269881106073219; which mentions titrated doses - though at this moment I am unable to access the reference which it specifies contains some mention of this material), I can say that it seems to be the practice in the UK that doses are usually (?) titred up/down so that the body has time to become used to the changes in dopamine metabolism/concentrations (whether they also be up or down).

Given the "interesting" issues raised above by at least one un-logged individual, that the removal abruptly of methylphenidate treatments is physiologically stressful (although the degree mentioned is somewhat questionable) I think it is important that the article should detail the fact that at least in some prescribing jurisdictions there are practices in place that limit the potential for depressive/adverse/addictive behaviours upon initiation or cessation of treatment, appropriately.

It also informs potential users that it may not be feasible to use the compound as-and-when, and that the fluctuation of the dose has effects which can be harmful. Though I am not on a crusade this is one reason why recreational use poses more significant hazards – tolerance and depression are more likely due to “spiked” levels of medication.

Apologies for lack of documentary sources at this moment – I am not on my usual computer. I am not a pharmacist, but a reasonably well read chemist, so apologies if I have made errors in the use of pharmacology terms.

I have also edited the Equasym dosage to show 20 mg tablets, at least available in the UK: http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=7288

Removed problem quote (unreferenced) from controversy section

I cut out a line of the controversy bit. It was an unreferenced quote supposedly from an NIH article, and I had originally decided to leave a "needs a reference" tag, but then went ahead and checked the document1998 NIH Consensus statement on ADHD in question, finding that the line in the wiki was not in fact a direct quote but a misleading paraphrase of one cherry-picked ½ sentence and another fact without any context.

The actual article noted that there was no perfect test for ADHD and no absolute evidence of brain problems (the word “malfunction” appears only in a true or false quiz at the end of the document”, not as it was quoted in the wiki). The article also noted, however, that Schitzophrenia and other mental illnesses were similarly lacking perfect tests or absolute proof of actual brain problems, but this made them no less real or relevent conditions. The most recent release by the same institution, with more recent research, actually says “Most substantiated causes appear to fall in the realm of neurobiology and genetics” (8 years more recent).

All in all, it seemed to me the line in question was sloppy, outdated, poorly documented and I suspect written with an ideological bent and a desire to mislead.

Oh, and as a disclaimer I’m an adult with ADHD who does not currently choose to take medication for my condition, but have in the past. I'm neither a shill for drug companies nor rabidly anti-meds or anti-psychiatry.

Wilsonstark 16:04, 14 August 2007 (UTC)

I also fixed the "risk of death" section. Whether intentionally or not, the author again cherry-picked words from the referenced government article and left out a key qualifier. This medication will not cause otherwise-healthy children to fall over dead, and the issue in the actual article referenced is strictly for those children with significant cardiovascular defects. The only real concern health-wise is that some children might have undiagnosed defects of this type. I therefore felt the information was important enough to keep in the article, so parents are aware that a check of the child's cardio system would be wise before starting medication (not all family doctors would automatically do this) but it needed to be re-written so as not to give the erroneous impression that Ritalin will cause heart problems, or lead to a fatal cardiac arrest.

Wilsonstark 16:42, 14 August 2007 (UTC)

[Agreed on the first point - the document even has this nice line just before the part you quote: "There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods." Given common rebutals of the condition, due to varying levels of prevalence/diagnosis in different societal settings, this might be nice to put in the Article too. Nothing against your second point but I haven't checked any docs to quote so I'm going to remain officially neutral (and anecdotally agree; and I'm in the same situation as you, but currently taking MPH.)]

References

1. [12] might help to get rid of need reference for over 75 are boys.
2. [13] for the trachecardia
3. [14] for Arterial hypertension
4. [15] for the D/L-amphetamine discussion
5. [[16]] blured vision
6. [17] abdominal pain
7. [18] muscle twitches
8. [19] dizziness
9. [20] euphoria

additional Abuse and toxicity of methylphenidate. Therapeutics and toxicology Current Opinion in Pediatrics. 14(2):219-223, April 2002 -Stone 09:34, 17 August 2007 (UTC)

Wilsonstark 18:41, 20 August 2007 (UTC)

help please

I put in the reference for "This is not a documented side effect in medical literature" in the side effects section, but the link doesn't show right. Also, references after that seem hideosly bjorked and I'm afraid I don't know how to hunt things down well enough to see who broke them (for the record, wasn't me)

Wilsonstark 18:41, 20 August 2007 (UTC)

WP:CITET should help you here --lucid 18:43, 20 August 2007 (UTC)

Lucid, do you mind fixing the overall reference list? It appears it was your edit that messed up the references (looking through the history).

Wilsonstark 18:48, 20 August 2007 (UTC)

"not used in medical literature"

Please find a reference that says that. As it is, it's merely a listing of side effects, it does not say that the subject has not been discussed professionally --lucid 19:09, 20 August 2007 (UTC)

It is very hard to prove a negative. I frankly agree with the earlier editor who removed that "zombie" bit entirely. At best, it should probably be placed in the "controversy" section, as it is hardly medical information and the 'references' are anecdotal. That being said, I've put enough work into this one today I think. I'm not really sure why there's a side effects section when there's a side bar for side effects, but who knows.

Wilsonstark 19:33, 20 August 2007 (UTC)

Given it's such a well spread and well known negative, it should be easy to prove it. Putting it in controversy would be wrong, as it is blatantly something that is unintentionally caused by the drug, not a controversy over it's use or such. --lucid 19:37, 20 August 2007 (UTC)

I think you miss my point, I should have been clearer. The negative that is hard to prove is "not used in the medical literature". Regardless, I've just dumped what I wrote and fixed the sentence I objected to so that it makes the point the original author intended (I think) without being so sloppy and controversial in choice of words. I hope that is acceptable (see below)

Wilsonstark 19:59, 20 August 2007 (UTC)

A reasonable compromise?

I think i've fixed that side effects bit about zombies to look better, used the quotes accurately and thus I've removed my quibble about the 'zombie' bit. You will note that I have not attempted to eliminate the claim, which I admit is certainly out there, but I've helped to define the terms and used two of the supplied references to do it.

I quite intentionally removed the link to http://www.drday.com/attentiondeficit.htm If you would go check that site out, you will note that it is a part of a promotional web page, and adds nothing either to the claim re. being a zombie (other than referencing that others have used it) and certainly doesn't have anything to add. In my opinion it's inclusion adds nothing and violates the standards [21] for self-published content.

Wilsonstark 19:56, 20 August 2007 (UTC)

1- However 'out there' you think the claim is, it is very, very common, again as a quick google search will show. 2-I won't edit war with you, since there are more than enough RS out there, but you should read WP:RS before you remove things like that again. Just because a website sells things doesn't mean it isn't reliable. -lucid 20:05, 20 August 2007 (UTC)

1. I agree, it common,although of the many people I have known whose kids have been on Ritalin, very few complained of this, and of the few that did 2 of 3 were on inappropriate doses (one much too high, the other well below recommended doseage).

2. I have read WP:RS carefully. Thank you for pointing it out earlier. "Self-published material may, in some circumstances, be acceptable when produced by an established expert on the topic of the article whose work in the relevant field has previously been published by reliable third-party publications. However, caution should be exercised when using such sources: if the information in question is really worth reporting, someone else is likely to have done so."

Dr. Day is hardly an established expert in this field. Honestly, did you read that page?

Look at the bottom under "Prevention and Treatment:

"13. Trust in God and teach your child to trust in God. Study the Bible and pray with your child every day. Read Bible stories to your child. Children (and adults) become like those they admire. If they learn about Jesus, they will admire Him and want to be like Him. This has the most calming influence of all. For more information on the harmful effects to the brain and nervous system from the problems of modern life, watch my video "Turn on the Light."

So in the last bit she implies that Jesus will cure your ADHD (I'm a Christian, but that's not a really scientific point) and then that "Turn on the Light" is a hyperlink to http://www.drday.com/light.htm which DOES, in fact, sell you that video for $19.95 USD. The video promises to explain "Why drugs never cure depression or anxiety". Seriously, this Dr. Day is a crackpot at worst, and a cynical opportunist at best.

Honestly, that reference had no merrit, and removing it was the correct thing to do. Wilsonstark 20:15, 20 August 2007 (UTC)

cancer risk

I looked into that article on cancer risk, and TBH it was pretty dodgy (sample size too small, etc), but in my never-ending search to be fair, I left it pretty much alone and checked for related research. I found that there was rather a ton of scientific comment on the 2005, most of it quite critical of methods, lack of information, etc. But I did find this nice, professionally written, peer-reviewed AND public domain article that sought to take the 2005 findings and do the ultimate scientific job of replicating his results. That study just didn't find the same results at all, despite using a good methodology, etc. Regardless, though, the genie is out of the bottle and some people have heard of the supposed cancer risk, so it seemed to me wise to leave the reference to the 2005 article and just add in the published refutation.

From what I read of the 2007 article, there is no evidence that Ritalin causes cancer. On the other hand, they can't actually prove that it doesn't (not can we prove Fritos don't cause cancer) so I guess everyone is back to square one. Anyway, it is that 2007 article that I included with my edit, as an additional paragraph after the discussion of the 2005 article.

I swear there is more work on the controversial sides of this article than on the factual side.

Wilsonstark 20:54, 30 August 2007 (UTC)

Focalin?

What is the differance betwean Focalin and Focalin XR? My son age 9 has been on both, reacts well to focalin but not the XR. I'm trying to undersand why.The doctor says they are the same thing. (74.170.235.57 21:26, 14 September 2007 (UTC))

Consult a different doctor. We can't give medical advice Nil Einne 07:46, 27 September 2007 (UTC)

Help With History Ritalin

I and trying to remember an article which stated Ritalin was a drug designed for the VA for WWII veterans in VA hospitals. From what I recall it was to improve mood and increase energy.

Anyone remember anything about this??

Dennis —Preceding unsigned comment added by 70.104.173.185 (talk) 03:08, 16 September 2007 (UTC)

The theraputic effects of the drug were accidentally discovered in 1937. It was first used in 60's and was approved for ADHD by the FDA in 1975. See Wikipedia-adhd-history. I don't remember reading anything about ww2 veterans but it may be true.--scuro 12:50, 16 September 2007 (UTC)

Cite 17

Citation 17 fails to come up with anything (I'm on Firefox if it matters), could it be fixed? --66.67.187.203 01:00, 24 September 2007 (UTC)

Do we drink Ritalin?

Please visit this website for more information. Never Trusted 03:39, 27 September 2007 (UTC)

effects of it on people who dont have ADHD

what happens when people who dont have ADHD take the drug for short and extended periods of time. —Preceding unsigned comment added by 86.161.33.131 (talk) 16:49, 27 September 2007 (UTC)

Well, it's a stimulant that enhances focus, so I'd assume that they'd get improved focus and be hype for a good deal of the day, and would probably also get the side-effects --66.67.187.203 00:05, 28 September 2007 (UTC)

ryetalin from star trek??

I think that's VERY obscure. It's many times more possible that the name comes from ritalinic acid! (Or is this comment just an in-joke?) user:guruclef —Preceding unsigned comment added by 200.7.17.84 (talk) 02:00, 28 September 2007 (UTC)

Effects controversy

Made some more changes to better reflect the somewhat fringe nature of the comparison between cocaine, illegal ampehetamines (speed, crystal meth) and ritalin. In fact there is quite a bit of research that contests these sorts of theories, and the quoted study is not available to read full-text. I also noted the researchers in question seem to be using mice for test subjects, and I am not clear on how mouse trials could indicate causes of schitzophrenia (which can't actually be diagnosed in rodents and I doubt is even possible in the rat brain). The addiction research for Ritalin is pretty clear. It is NOT habit forming when taken as prescribed, although it can be abused by the stupid/demented who will crush it and snort it or inject it.

On the other hand, it is research and all, so I felt deleting it would be inappropriate given the collaborative nature of wikipedia, etc. I noted from reading the original post and the posting history of the individual a pretty strong anti-medication/anti-psychatiry bias. I myself am not pro or anti medication, and I'm interested in the views of other neutral parties as well. —Preceding unsigned comment added by Wilsonstark (talk • contribs) 17:07, 15 October 2007 (UTC)

ADHD, not ADD

The first line of the wiki article says that Methylphenidate is used as treatment for ADD... there is no such disorder. According to DSM-IV, there is only ADHD (of varying types). —Preceding unsigned comment added by 70.62.102.158 (talk) 02:23, 16 October 2007 (UTC)

It's a tad complicated. Basically the issue is that many folks, including doctors and workers in the field, still prefer the "ADD" label simply because the 'H' in ADHD is a bit of a red herring, hyperactivity being less common and a lot of cases being "without hyperactivity". That being said, quite correct about the definition in the DSM. On the other hand, I believe Europe uses a completely different standard, and I think they still call it ADD (although admittedly I'm talking out of my, um, ear.

Wilsonstark 13:21, 16 October 2007 (UTC)

Safety on the developing brain?

The second paragraph under 'Known or suspected risks to health' starts like this, "A 2006 review assessing the safety of methylphenidate on the developing brain found that in animals with psychomotor impairments, structural and functional parameters of the dopamine system were improved with treatment."

This paragraph shows a possible benefit of the drug, therefor shouldn't it be under the main part of effects? I'm not a Wiki-Pro, so I'll let somebody else make the decision, I just thought I'd put it out there. —Preceding unsigned comment added by 130.17.62.245 (talk) 20:55, 18 October 2007 (UTC)

Where is research from Joseph Biedermann?!

If you are going to talk about the psychopharmacology of methylphenidate to treat ADHD, it will not be taken seriously in academia without a citation from J. Biedermann! He is the foremost psychiatrist on biological interventions for ADHD. —Preceding unsigned comment added by 71.138.139.146 (talk) 05:55, 27 October 2007 (UTC)

Article needs restructuring and additional sections

http://en.wikipedia.org/wiki/WP:MEDMOS#Drugs --scuro (talk) 13:00, 20 November 2007 (UTC)