Should I be worried about using an ADD drug (specifically Concerta)?

Concerta is actually time-release Ritalin. Ritalin clears the body very quickly (within a matter of four hours; within 8 hours in the time release forms) and so does not build up to toxic levels as long as you are taking your prescribed dose.

The side-effects of Concerta/Ritalin are more involved with difficulties in eating (no appetite, stomach pains, etc.) and sleeping, and sometimes headaches or irritability when it wears off. However, 18 mg. is quite a low dose so the unwanted side effects should be minimal. For more detail see http://www.ncpamd.com/Stimulant_Side_Effects.htm

If you have certain problems Concerta/Ritalin needs to be monitored closely. These include having a history of tics, diabetes, or high blood pressure.

The more important question is does it help you focus? If yes, then continue to take it.

Are you able to pass your classes without it? If no, then continue to take it.

The biggest concern I would have is that it is a Schedule II drug with a potential for abuse and that has street value – take it exactly as prescribed and don’t let anyone else have access to your pills.

I say all this because my son takes Metadate, another time-release form of Ritalin, but at a considerably higher dose. However, when he does not take it he does not succeed in school, with friends or at home. That leads him to major self-esteem problems and even suicide attempts.

I am also assuming that you are under a doctor’s care and this has been prescribed for you. If not, then you have no business taking it and would be breaking federal law to do so since it is a controlled substance.

@Darwin Thanks, I took it for the first time this morning at about 7:54AM Its now 10:41 AM I was told that it would last about 10Hrs. I do feel like I can focus but considering that the next quarter of school is an experiment we shall see.

yes, you should worry.

as an aside I would ’‘not’’ depend on Fluther for something this serious. do a thorough research on any drug you take, Googling phrases like Concerta, +dangers, or +“side effects”.

having said that, methylphenidate, the active ingreident of Ritalin and Concerta, affects dopamine levels. this has a couple of permanent side-effects. one, withdrawal symptoms. two, it can reduce your brain’s regular level of dopamine levels.

see: http://www.sciencedaily.com/releases/2004/12/041220013546.htm

I strongly suggest not taking any drug with methylphenidate. I did and I wish I never did.

@Ria777 What did you take? How much?

I took Ritalin. years and years ago when as a minor I had no right to refuse. so I don’t know how much I took at the time, exactly.

though I won’t pretend that I know (I don’t) I can kind of feel like you want to reassure yourself of the safety of this so you can go on taking it. at the same time I really truly worry about the effect that going off of methylphenidate will have on you.

have you taken a look at the link I provided?

@Ria777 – If you read your link carefully what it actually says is that early (ie childhood) use of Ritalin over a long time by people misdiagnosed as having ADD or ADHD but who actually have normal brain function will affect brain development.

It words it this way: that recent research ”...suggests that the misdiagnosis of attention-deficit hyperactivity disorder (ADHD) combined with prescription drug use in children may lead to a higher risk of developing depressive symptoms in adulthood.” Please note the terms “misdiagnosis” and “in children.”

It does not say that a low dose taken by an adult properly diagnosed as ADD for a short period causes permanent brain dysfunction.

It also notes that “Children with ADHD are also likely to have other disorders, such as a learning disability, oppositional defiant disorder, conduct disorder, depression, or anxiety.” This is seen long before any Ritalin is ever taken and is a further sign that brain chemicals are off kilter, so the person does not have a “normal” brain.

It goes on to say about the results of the study that “These findings are critical because they suggest that Ritalin can have long-term consequences on normal-functioning brains.”

The question that really needs to be answered is whether the asker has been properly diagnosed with ADD or ADHD and has thus been prescribed Concerta in order to keep his life from being damaged by his inability to function or is simply scoring some pills off the street to help him get better grades.

If the asker does indeed have a level of ADD that interferes with his life then his brain chemicals are already screwed up and the Concerta will bring them closer to normal levels. If the asker has a normal brain then he shouldn’t take any medications to mess with his brain chemistry at all but instead work on study habits.

As I said in my earlier post ”I am also assuming that you are under a doctor’s care and this has been prescribed for you. If not, then you have no business taking it and would be breaking federal law to do so since it is a controlled substance.”

It is quite possible that you were misdiagnosed as ADD and should not have been taking Ritalin. However, it is also possible that without the Ritalin other problems you have related to brain chemistry are coming to the fore.

@Darwin, did they do a controlled study where they gave methylphenidate to one group of people diagnosed with ADD and to another group without? no, they didn’t. (and ethics rulings would prohibit it.) therefore, the disclaimer remains only conjectural and in order to not state the obvious.

put another way, would you give a child caffeine pills, regardless of whether they had a diagnosis of ADD? or any other stimulants?

finally, I had the most jumpy, excitable, distractable personality you can imagine, and Ritalin had the effect I mentioned above. so at least anecdotal evidence (which I attacked someone else for using in another thread) as far as me disproves your statement. by the way, I still have a jumpy, etc. personality and I don’t know how much of that to attribute to having taken Ritalin in the first place.

@Ria777 – You still aren’t reading your own link. You offer it as support for your contention that Ritalin is bad for people. The link says that Ritalin is bad for rats and may be bad for people with normal brains but not for people who are actually ADD.

And actually, there have been many, many double-blind placebo controlled studies using people, both ADD and not – folks have to give permission to be included, that’s all. Such studies are carried out as part of the system for getting pharmaceuticals approved for use as well as in continuing information gathering about them.

People who are truly ADD cannot function without medication that alters their personal dopamine system because their dopamine levels are not right. They end up failing school, losing jobs, friendless, depressed, and suicidal. However, when they take Ritalin or one of the other stimulant drugs they can function fine. People with milder versions of ADD can get by with behavioral management techniques, and through self-medicating with adrenalin – many of the X-Games stars are ADD and their sport serves as their medication. The contrast is almost like magic when someone who is really ADD takes Ritalin.

People who are not ADD but are put on Ritalin will not function normally but will have all sorts of problems. You sound as if you either were not actually ADD but put on ADD meds anyway (a very common problem where teachers demand that all children conform), or you are deluded about how well you actually function. Also be aware that the foul up in the dopamine levels that produces ADD can and very often does result in other problems, such as learning disabilities, depression, and inability to control anger.

And actually, caffeine pills (and in some cases caffeinated sodas) are a good emergency medication for kids who are truly ADD and whose inability to focus can be dangerous at times.

You say “I had the most jumpy, excitable, distractable personality you can imagine” but you still haven’t shown whether or not your diagnosis was correct. And even in the link you provided there is absolutely no mention of Ritalin causing a jumpy personality. Did your personality make it completely impossible to learn in school, keep a job, make and keep friends, and fail to function at home? If you could succeed in at least one of these settings you probably were not ADD.

And actually, people with ADD show certain specific brain patterns when examined by imaging methods that look at brain functioning, so there is a definite organic difference between an ADD brain and a normal brain. Specifically areas of the frontal lobes and sometimes the temporal lobes do not function the same way as those of “normal” people and this can be seen on a brain scan.

My son had such a scan, after being diagnosed as ADD, and after attempting to commit suicide for the first time at the age of 7. He has detectable damage to his frontal lobe and to his right temporal lobe that dates to birth. Without Ritalin he literally explodes. He cannot comprehend what is going on around him, and he cannot focus at all on anyone’s words. He would not be able to sit still long enough to type a post on Fluther, and his spelling would make whatever he posted all but illegible (the temporal lobe problem is involved in that). He is nonfunctional without Ritalin or Concerta or Metadate, which are different delivery systems for the methylphenidate.

Please do not blame your personal problems on a drug that has been proven helpful to many people, allowing them to function in the real world.

However, if the asker is taking the medication simply to make his brain sharper, or give him a competitive edge, then he should be aware that is illegal and an inappropriate use of an otherwise helpful medication.

@Darwin, The link says that Ritalin is bad for rats and may be bad for people with normal brains but not for people who are actually ADD.

the study does not actually quote other studies that say this.

Please do not blame your personal problems on a drug that has been proven helpful to many people, allowing them to function in the real world.

and then they go off it and then what?

you seem to have parsed this in terms of conventional morality and not in terms of science. biochemistry doesn’t care about whether you use drugs with a prescription or not, or why.

BTW, I have temporal and frontal lobe abnormalities, too. as far as how I described my personality, I meant before going on Ritalin. (and also now.)

I went through bad withdrawal symptoms and when I went off, went through everything they mentioned in the article. (apart from the severe symptoms I went through while taking Ritalin which I won’t go into apart from saying that I had them.)

@Darwin, Without Ritalin he literally explodes.

you mean he figuratively explodes.

@Darwin, And actually, there have been many, many double-blind placebo controlled studies using people, both ADD and not – folks have to give permission to be included, that’s all. Such studies are carried out as part of the system for getting pharmaceuticals approved for use as well as in continuing information gathering about them.

show me the double-blind placebo studies relative to Ritalin, then. I mean one with so-called normal or neurotypical people. I tried Googling and uncovered nothing.

I want to also mention the possibility that perhaps Ritalin got approved by the FDA before the modern policies came into being. actually, you know, that the diagnoses ADD and ADHD did not even exist when Ritalin came into use.

@Ria777 -

“prohibited experiments”

These experiments are only prohibited if the participants are not fully informed and do not grant permission to participate. You can’t do it the way they studied syphilis in black men, but you certainly can do it with full consent.

“and then they go off it and then what?”

So you figure diabetics should go off their insulin? Schizophrenics should go off their lithium? Ritalin does not cure ADD – there is no cure for it. It is a physical condition, and you do not grow out of it. If you do then you were immature, not ADD.

“as far as how I described my personality”

Did your personality make it impossible for you to function in all areas of your life, at home, at school, and socially? If so then you were ADD and needed help. If not, then you may be at an extreme of normal, but normal all the same and not ADD.

You say you have temporal and frontal lobe abnormalities. Have these been documented by neurologists? Or do you just assume it because of your personality?

“you seem to have parsed this in terms of conventional morality and not in terms of science. biochemistry doesn’t care about whether you use drugs with a prescription or not”

Actually science and biochemistry is what has determined that the drug needs to be a prescription drug. It does have potential for addiction in people who do not need it to function. However, for those with true ADD it is essential for normal function.

And quite frankly, if you saw my son and his surroundings in the aftermath of one of his explosions, you would be looking for shrapnel. There are holes in the walls, broken furniture tossed every which way, and blood and feces on most surfaces.

As to the history of Ritalin and ADD – The first testing was done using Benzedrine on children with behavioral problems back in 1937. Then testing was done with amphetamines. Ritalin itself was patented in 1954 as a potential cure for Mohr’s disease but as a derivative of amphetamine it was considered to replace Benzedrine and amphetamines in control of minimal brain dysfunction, which is what ADD and ADHD was called at the time.

Beginning in the 1960s, it was used to treat children with ADHD or ADD, known at the time as hyperactivity or minimal brain dysfunction (MBD).

As to studies, here are a few:

Ahmann, P A, Waltonen, S J, Olson, K A, Theye, F W, Van Erem, A J & LaPlant, R J (1993). Placebo-controlled evaluation of Ritalin side effects. Pediatrics, 91, 6, 101–1106.

Barkley, R A, McMurray, M B, Edelbrock, C S & Robbins, K (1990). Side effects of
methylphenidate in children with attention deficit hyperactivity disorder: a systematic,
placebo-controlled evaluation. Pediatrics, 86, 2, 184–192.

Charles, L & Schain, R (1981). A four-year follow up study of the effects of methylphenidate on the behavior and academic achievement of hyperactive children. Journal of Abnormal Child Psychology, 9, 495–505.

Feldman, S, Denhoff, E & Denhoff J (1979). Attention disorders and related syndromes
outcome in adolescence and young adult life in minimal brain dysfunction: A evelopmental approach. In: Denhoff, E & Stern, L (eds.), Minimal brain dysfunction: A developmental approach . New York: Masson Publishing Co. pp. 144–148.

Funk, J B, Chessare, J B, Weaver, M T & Exley, A R (1993). Attention deficit hyperactivity disorder, creativity, and the effects of methylphenidate. Pediatrics, 91,
4, 816–819.

Garfinkel, B D, Webster, C D & Sloman, L (1975). Methylphenidate and caffeine in the
treatment of children with minimal brain dysfunction. American Journal of Psychiatry, 21, 237–242.

Hechtman, L (1985). Adolescent outcome of hyperactive children treated with timulants in childhood: a review. Psychopharmacology Bulletin, 21, 2, 178–191.

McBride, M (1988). An individual double-blind crossover trial for assessing methylphenidate response in children with attention deficit disorder. Pediatric Pharmacology and Therapeutics, 113, 1, 137–145.

Murray, J B (1987). Psychophysiological effects of methylphenidate (Ritalin). Psychological Reports, 61, 315–336.

Rapport, M D, Stoner, G, DuPaul, G J, Birmingham, B K & Tucker, S (1985). Methylphenidate in hyperactive children: differential effects of dose on academic learning, and social behavior. Journal of Abnormal Child Psychology, 13, 227–243.

Reid, M K & Borkowski, J G (1984). Effects of methylphenidate (Ritalin) on information
processing in hyperactive children. Journal of Abnormal Child Psychology, 12, 1, 169–186.

Rie, H, Rie, S, Stewart, I H & Ambuel, J (1976). Effects of methylphenidate on underachieving children. Journal of Consulting Clinical Psychology, 44, 250–263.

Weiss, G, Kruger, E, Danielson, U & Elman, M (1975). Effect of long term treatment of
hyperactive children with methylphenidate . Canadian Medical Association Journal, 112, 159–165.

Schachter HM, Pham B, King J, Langford S, Moher D (November 2001). “How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis”. CMAJ 165 (11):1475–88. PMID 11762571. PMC: 8166

Volkow N., et al. (1998). “Dopamine Transporter Occupancies in the Human Brain Induced by Therapeutic Doses of Oral Methylphenidate”. Am J Psychiatry 155:1325–1331, October 1998.

Markowitz JS, DeVane CL, Boulton DW, Nahas Z, Risch SC, Diamond F, Patrick KS. Ethylphenidate formation in human subjects after the administration of a single dose of methylphenidate and ethanol. Drug Metabolism and Disposition. 2000 Jun;28(6):620–4.

Williard RL, Middaugh LD, Zhu HJ, Patrick KS. Methylphenidate and its ethanol transesterification metabolite ethylphenidate: brain disposition, monoamine transporters and motor activity. Behavioural Pharmacology. 2007 Feb;18(1):39–51.

I can’t help with the scientific bases for use of these stimulants but I will state that I have been using Ritalin in one form or another since 1995 when I was diagnosed with Adult ADD.
The difference in functioning in a structured workplace was amazing. I started reading business related documents with so much more clarity. I stayed on task, something I had a great deal of difficulty doing in the office.
It did not make me jumpy. It did not get me to be better organized. What it did do was somehow allow me to focus on doing what I needed to do in the timeeframen required to finish the task.

I recently had an examination by a professional (I can’t say more) for a specific issue and her first comment when I returned for my evaluation was that if I had been able to try methylphenidate in some form when I was in school, (I graduated high school in 1967) my life would have been completely different. It would have addressed in some way, all of the problems I had in education. It would not have made me valedictorian or automatically sent me to Princeton but I certainly would not have graduated in the bottom third of my class and managed to only maintain a 2.4 in college. At least that’s her opinion.

I have adapted to life with ADD. I earned my MBA at night, slowly, and nearly flunked out (for a lot of reasons) but disorganization and pure study habits and lack of discipline and concentration were important factors.

Early on, my physician told me that people with ADD react well and utilize the stimulants to improve themselves but that people without ADD end up like anyone taking any kind of stimulant. That is why there is a black market and lots of abuse for prescription medications like Ritalin, Concerta, Adderall and Vyvanse.

And it is a stimulant. On the rare occasions where I have a very late night out on a weekend and end up sleeping late, I will skip the Vyvanse and frankly I am tired during the day because I guess I am, in a manner of speaking, on speed.

But on the one day in two years that I ran out and could not get a refill before work, I was a mess. I got nothing done. I kept starting doing ten things at once and accomplished little.

I don’t advocate Ritalin as a catch-all solution to kids who might just be more ebullient than other kids. There seems to be overdosing of younger kids with ritalin at too young an age, but at this point in my life and my professional career I could not imagine surviving the daily grind without it.

SRM

@srmorgan – When someone truly has ADD their results are exactly what you experience. I am glad you found help even at this late date. My cousin was first put on Ritalin at age 61 and it has made a huge difference in his life. For the first time he can actually stay married, and he is doing such good work as an attorney that we wonder where he might have gone in his career if only he had been diagnosed earlier.

When someone needs it, Ritalin and similar medications are a God send.

@Darwin, You say you have temporal and frontal lobe abnormalities. Have these been documented by neurologists? Or do you just assume it because of your personality?

yes, neurologists have documented it. I will get to the other parts of your reply tomorrow.