Ritalin for adults reviews

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  • The use of stimulant medications for the treatment of Adult ADHD has increased tremendously. I now see many psychiatrists in the community prescribing them along with antidepressants in those without ADHD. Before you commit to the use of stimulant medications here are ten things you need to now—some reassuring and some not.

    1. They’re popular: Adults now receive one third of all prescriptions for ADHD medications in the US, a pattern that is not seen in other countries.

    2. Kids only? The bulk of the available data on the treatment of ADHD come from studies in children, which limits the ability to make evidence-based recommendations for adults.

    3. Legit for adults? It surprises many of my patients to learn that only some of the stimulants, like Adderall XR, Concerta, Vyvanse, and Focalin XR, are FDA-approved for use in adults. Adderall XR and Concerta are available in generic form so will be much cheaper for you.

    4. Warnings for women: The warnings issued along with Adderall, Ritalin, and Vyvanse acknowledge that women of reproductive age should not take these stimulant medications. Use of stimulant medications during pregnancy may lead to increased risk of premature delivery and low birth weight, infants may experience symptoms of withdrawal, and birth defects have been reported with women taking Adderall during the first trimester. So any woman on these meds who plans on conceiving will have to be weaned off of them.

    5. The heart: While stimulants can increase heart rate and blood pressure a large study published in JAMA in December 2011 (http://jama.jamanetwork.com/article.aspx?articleid=1104778) showed there was no increased cardiovascular risk in middle-aged adults taking stimulant medications. This was reassuring.

    6. Use and abuse: Abuse potential exists, and this is different for adults who require larger doses of stimulants than those prescribed to children.

    7. The energy pill: Many people feel better on stimulants and have difficulty weaning off them and feeling the “normal” periods of fatigue during the day, along with the possibility they may not feel as productive as they did while on them. Stimulants improve cognitive function in most people. As an example, methylphenidate (Ritalin) has been found in studies to reduce driving errors in all adults, not just adults with ADHD. Thus, a person’s response cannot be used to confirm or exclude the diagnosis of ADHD.

    8. The downsides: If you find yourself experiencing insomnia, anxiety, weight loss or elevated heart rate or blood pressure from your stimulant, ask your doctor about non-stimulant options.

    9. Finally cheaper: There has been a run on the generic options for ADHD medications like Adderall XR (amphetamine salt combination XR) and Concerta (methylphenidate ER), so many pharmacies were experiencing a shortage. This was due to increased demand and a decrease in supply and is not expected to end anytime soon.

    10. Heat: During exercise know that stimulants may potentially increase your risk of developing heat illness. During the hot months watch out for heat illness and stay hydrated.

    Dr O.

    • Contents

      Benefits and harms of methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)

      Review question

      We reviewed the evidence of the effects of methylphenidate on the behaviour of children and adolescents with ADHD.

      Background

      ADHD is one of the most commonly diagnosed and treated childhood psychiatric disorders. Children diagnosed with ADHD find it hard to concentrate. They are often hyperactive (fidgety, unable to sit still for long periods) and impulsive (doing things without stopping to think). ADHD can make it difficult for children to do well at school, because they find it hard to follow instructions and to concentrate. Their behavioural problems can interfere with their ability to get on well with family and friends, and they often get into more trouble than other children. Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD.

      Study characteristics

      We found 185 randomised controlled trials (RCTs; studies in which participants are randomly assigned to one of two or more treatment groups), involving 12,245 children or adolescents with a diagnosis of ADHD. Most of the trials compared methylphenidate to a placebo – something designed to look and taste the same as methylphenidate but with no active ingredient. Most trials were small and of low quality. Treatment generally lasted an average of 75 days (range 1 to 425 days), making it impossible to assess the long-term effects of methylphenidate. Seventy-two of the 185 included trials (40%) were funded by industry.

      The evidence is current to February 2015.

      Key results

      Findings suggest that methylphenidate might improve some of the core symptoms of ADHD – reducing hyperactivity and impulsivity, and helping children to concentrate. Methylphenidate might also help to improve the general behaviour and quality of life of children with ADHD. However, we cannot be confident that the results accurately reflect the size of the benefit of methylphenidate.

      The evidence in this review of RCTs suggests that methylphenidate does not increase the risk of serious (life threatening) harms when used for periods of up to six months. However, taking methylphenidate is associated with an increased risk of non-serious harms such as sleeping problems and decreased appetite.

      Quality of the evidence

      The quality of the evidence was very low for all outcomes. It was possible for people in the trials to know which treatment the children were taking, the reporting of the results was not complete in many trials and for some outcomes the results varied across trials. These considerations limit our confidence in the overall results of the review.

      Conclusions

      At the moment, the quality of the available evidence means that we cannot say for sure whether taking methylphenidate will improve the lives of children and adolescents with ADHD. Methylphenidiate is associated with a number of non-serious adverse events such as problems with sleeping and decreased appetite. Although we did not find evidence that there is an increased risk of serious adverse events, we need trials with longer follow-up to better assess the risk of serious adverse events in people who take methylphenidate over a long period of time.

      Given that methylphenidate is associated with adverse events, designing high quality trials is challenging. It can be easy for clinicians, researchers and participants to work out whether a child is in the experimental group (receiving methylphenidate) or in the control group (receiving the placebo). This is a serious risk of bias that can make us less confident in the results of a trial. One way to avoid this is to design trials that compare methylphenidate with a placebo that can produce similar adverse events, but which has no other active ingredient. These trials are known as ‘nocebo trials’. For ethical reasons, nocebo trials should first be undertaken with adults. Only if the results suggest that methylphenidate is effective for adults, should researchers consider recruiting children to trials with this design.

      What is Ritalin?

      Ritalin is a stimulant used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. It affects the parts of the brain and central nervous system that control hyperactivity and impulses. Ritalin is one of the trade names for the drug known as methylphenidate. Other brand names can include Concerta, Methylin, and Metadate.

      When did the U.S. Food and Drug Administration approve Ritalin in the United States?

      Methylphenidate was first approved by the U.S. Food and Drug Administration in 1955 for treating what was then referred to as hyperactivity.

      Is there a generic version of Ritalin available?

      Yes, the generic name for Ritalin is methylphenidate and is for purchase in the United States. Some users have argued that the generic version may be weaker than the brand name version.

      Are there any major differences between Ritalin and Adderall?

      There are a lot of similarities between the two medications. Both drugs are stimulants used to treat ADHD, and both are habit-forming and classified as Schedule II controlled substances. Therefore, if you have a history of substance use problems, you should talk to your doctor about this before taking either medication. As far as differences, Ritalin comes in three formats: instant release (lasting 3-4 hours), sustained release (lasting 6-8 hours), and long-acting (lasting 8 hours). Adderall comes in two formats: instant release (lasting 4-6 hours) and extended release (lasting 12 hours).

      Can children take Ritalin?

      Children over the age of 6 may be prescribed Ritalin for ADHD. They should take the medication in the exact amount prescribed by their doctor. It’s also important to tell your child’s doctor about other medication complications or past substance use history.

      Article continues below

      Concerned about ADHD?

      Take our 2-minute Attention Deficit Hyperactivity Disorder quiz to see if you may benefit from further diagnosis and treatment.

      Take ADHD Quiz

      How do you initiate Ritalin therapy?

      Talk to your doctor about whether you are a good fit for the medication. Also, always take medication in the exact amount prescribed by your doctor. There are many different dosage strengths, depending on whether you are taking immediate release tablets, sustained release tablets, or extended release capsules.

      Are there potential interaction issues for people taking Ritalin and any other drugs?

      Do not take Ritalin if you have taken an MAO inhibitor in the past two weeks, as a dangerous interaction effect could occur. There are also hundreds of drugs which are known to interact with Ritalin in major, moderate, or mild ways, so let your doctor know what other medications you are taking before you begin Ritalin therapy.

      Are there any other medical conditions that would make someone ineligible for Ritalin therapy?

      You should not take Ritalin if you are allergic to the medication. Also if you have glaucoma, Tourette’s symptoms, a history of muscle tics, you should not take Ritalin. The drug can also make symptoms of severe anxiety or agitation even worse. Also talk to your doctor if you have heart problems, high blood pressure, seizures, circulation problems, a history of mental illness such as depression or bipolar disorder, or a history of substance use problems.

      What is the typical dose that would be prescribed to someone taking Ritalin?

      Dosage varies depending on the type of tablet (instant, sustained, or long-acting) as well as the age of the recipient and the condition being treated (ADHD or narcolepsy).

      How long does it usually take for Ritalin to work?

      Timing of effects depends on the type of tablet (instant, sustained, or long-acting) as well as the dosage. The quick release version takes typically 30 to 45 minutes for the effects to begin, and effects can last for up to eight hours.

      What do I do if I miss a dose?

      If it’s later than 6 p.m., skip the dose. If it’s before 6 p.m., take the dose when you remember. However, you should never take extra doses of the medication to make up for missed doses.

      What are Ritalin’s side effects?

      These are the most common side effects reported by people who take Ritalin:

      • headache
      • nausea
      • vomiting
      • insomnia
      • decreased appetite
      • dry mouth.

      Major side effects should be reported to your doctor immediately, and can include fast heartbeat, joint pain, rash, fever, black stool, blood in urine, blurred vision, muscle cramps, vocal outbursts, unusual bruising, or flaking of the skin. You can also report them to the FDA at 1-800-FDA-1088 or online.

      Are there any psychiatric side effects that come from taking Ritalin?

      People who take Ritalin may experience anxiety and irritability.

      Is it safe for a woman who is pregnant, trying to become pregnant, or nursing, to take Ritalin?

      There are no controlled studies on human pregnancy and Ritalin, and the drug is only recommended during pregnancy when the benefits outweigh the risks. The drug can also be transferred via breast milk in small amounts. Therefore talk to your doctor if you are pregnant, planning to become pregnant, or are nursing before you take Ritalin.

      Can symptoms occur if Ritalin is discontinued?

      Ritalin withdrawal symptoms can start a few hours after stopping the medication and last for up to several months. Symptoms can include changes in heart rate, depressed mood, fatigue, nausea, nervousness, nightmares, and agitation. Talk to your doctor if symptoms persist.

      If taken in overdose, is Ritalin toxic?

      An overdose of Ritalin could be fatal, so seek immediately help or call the Poison Help Line at 1-800-222-1222 if you overdose. Overdose symptoms can include vomiting, muscle twitches, flushing, dry mouth, fever, seizures, wide pupils, uncontrollable shaking, confusion, agitation, sweating, hallucinating, headaches, toxic psychosis, and loss of consciousness,

      Is Ritalin habit-forming?

      Ritalin can be habit-forming as users may develop a tolerance to the drug over time. Sometimes the drug is abused by students to concentrate for longer periods of time. Make sure that you keep track of the medication and never take more than prescribed. It is illegal to give or sell the medication to others. Talk to your doctor if you have a past history of substance dependence before you begin Ritalin Therapy.

      How much does Ritalin cost?

      According to drugs.com, one hundred 5 mg Ritalin tablets costs approximately $76.

      Are there any disadvantages to Ritalin?

      Disadvantages include the observation that 25% of people who take the mediation may respond to the drug. Also, because the drug is habit-forming, there is risk for abuse and overdose.

      DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings. Last Updated: Feb 21, 2018

      Adult ADHD (Attention Deficit Hyperactive Disorder)

      Attention deficit hyperactive disorder, or ADHD, is a condition characterized by inattention, hyperactivity, impulsiveness, or a combination.

      About 60 percent of children with ADHD in the United States become adults with ADHD; that’s about 4 percent of the adult population, or 8 million adults.*

      Less than 20 percent of adults with ADHD have been diagnosed or treated, and only about one-quarter of those adults seek help.*

      Thought to be biological and most often genetic, ADHD takes place very early in brain development. Adults with ADHD may exhibit the same symptoms they had as children, and although hyperactivity often diminishes by adulthood, inattentiveness and impulsivity may persist.

      Symptoms

      ADHD symptoms often include an inability to focus, disorganization, and restlessness. Adults with ADHD may have a hard time organizing things, listening to instructions, remembering details, or difficulty completing tasks, which can affect their relationships at home, school, and work.

      People who have ADHD may exhibit different symptoms, and they may experience them at different levels of severity, ranging from mild to significant impairment.

      ADHD and mental health disorders

      Adults with ADHD are likely to have an anxiety disorder, depression, bipolar disorder, or other comorbid psychiatric disorder. (The term “comorbid” refers to a condition that exists with another.)

      About 50 percent of adults with ADHD also suffer from an anxiety disorder. Adult ADHD symptoms that coexist with an anxiety disorder or other disorders may significantly impair the ability to function.

      Diagnosis

      Proper diagnosis relies on a comprehensive clinical evaluation by a health professional, who will take into account personal history, self-reported symptoms, and mental-status testing, as well as early development problems and symptoms of inattention, distractibility, impulsivity, and emotional instability.

      Overlapping symptoms of comorbid psychiatric conditions often complicate getting an accurate diagnosis.

      A health professional will ask questions like these during a consultation:

      • Do your behaviors and feelings show that you have problems with attention and hyperactivity?
      • Do you have a hard time keeping your temper or staying in a good mood?
      • Do these problems happen to you at work and at home?
      • Do family members and friends see that you have these problems?
      • Have you had these problems since you were a child?
      • Do you have any physical or mental health problems that might affect your behavior?

      Treatment

      Medication is a cornerstone of treatment for adults with ADHD. Research has shown that stimulants and some nonstimulants can improve the symptoms of ADHD, helping people pay attention, concentrate, and control their impulses.

      Most people also benefit from behavioral, psychological, educational, and coaching interventions. A helpful resource for locating support groups or professionals with appropriate expertise is CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder).

      Anxiety disorders and other comorbid conditions may come about as a result of living with ADHD. Having a comorbid anxiety disorder can make treatment more complicated. A health professional will define the areas of impairment (such as problems relating to attention or impulsivity at work or school, sleeping, or family life) and help select the most favorable treatment option.

      In addition to prescribing medication for ADHD, a health professional may recommend CBT (cognitive-behavior therapy) for comorbid anxiety. Some stimulant-drug treatments for ADHD may worsen anxiety symptoms in patients with comorbid anxiety disorders.

      A health professional should focus on the disorder associated with the highest degree of impairment. If ADHD is the cause of anxiety, treating the ADHD may reduce the anxiety. If anxiety is independent of ADHD, however, a doctor will determine the proper medication. One health professional may decide to treat the anxiety first; another may treat both conditions simultaneously.

      *Reference information:

      • Among those with ADHD persisting into adulthood, only about one-quarter report having received treatment for their symptoms in the past year” 18. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry. 2006;163:716–723.
      • In terms of treatment-seeking – First Treatment Contact for ADHD: Predictors of and Gender Differences in Treatment Seeking Elias Dakwar, M.D, Frances R. Levin, M.D, , and Carlos Blanco, M.D., Ph.D http://ps.psychiatryonline.org/doi/ref/10.1176/appi.ps.201300298
      • ADHD symptoms were found in 20.3% of the sample, but only 7.3% of these subjects had ever received a formal diagnosis. https://www.ncbi.nlm.nih.gov/pubmed/27680974

      Getting Help

      Find a Therapist
      Professional support directory for ADHD

      Find Out More

      Attention Deficit Disorder Association
      Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
      ADHD in Adults (WebMD)

      Other Resources

      Learn more about ADHD at the free BetterHelp.com resource.

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