For children and adolescents with attention deficit hyperactivity (ADHD), Ritalin (methylphenidate) is typically the medication of choice. As a psychostimulant drug, Ritalin increases the concentration of the neurotransmitters dopamine and noradrenalin in the brain. These neurotransmitters are partly responsible for impulse control and attention, among other things.
Studies in both rats and humans have verified that Ritalin effectively controls the three primary symptoms of ADHD: inattention, hyperactivity, and impulsivity. When ADHD goes into remission, the person’s quality of life and performance in work or school measurably improve.
Despite these benefits, critics have wondered about the potential negative effects of this heavily prescribed medication. For one thing, no one fully understands how Ritalin functions in the brain. More importantly, little information exists as to the long-term effects of a psychostimulant drug on the developing brain. A recent study with rats highlighted a possibly adverse effect of Ritalin that had previously been overlooked.
Adolescent play behavior is important in terms of both mental and social development. Through play, children learn the basic “rules†of social interaction and receive the rewards of companionship. Isolated children often have difficulty adjusting to adult life and navigating social situations. Researchers investigating Ritalin’s effect on social play found that the medication significantly reduces the behavior in rats.
Adolescent rats treated with low doses of Ritalin were apt to ignore invitation to play, instead remaining focused on their general environment. The effect was surprisingly specific. Rats demonstrated the same overall activity levels as untreated counterparts, but less overt play behavior and social interaction. Some rats were isolated for up to 24 hours before release into a play area. Researchers believed a long period of isolation would enhance play despite the effects of Ritalin, but they were mistaken. Regardless of isolation period, Ritalin proved to be a powerful blocker of normal, social play behavior.
The beneficial effects of Ritalin for people with ADHD are inseparable from the possibly negative effects of inhibited play. By its very nature, play is a complex, dynamic, but not necessarily focused activity. One of the primary aspects of Ritalin’s overall effect is to inhibit “unfocused,†freewheeling behaviors—including play, apparently. This calls for more research and possibly long-term studies of the potential consequences of Ritalin prescription throughout childhood and adolescence. It’s possible that this medication poses more risks than previously believed.
References:
- Attention deficit hyperactivity disorder (ADHD) – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/
- Vandershuren, L., Trezza, V., Griffioen-Roose, S., Schiepers, O., Van Leeuwen, N., De Vries, T.J., and Schoffelmeer, A. (2008). Methylphenidate disrupts social play behavior in adolescent rats. Neuropsychopharmacology, 33, (12), 2946-2956.
People battling cancer often experience fatigue and low energy levels, despite getting adequate rest. Fatigue is one of the largest negative impacts on a cancer patient’s quality of life. In fact, in some surveys, patients identify fatigue as a more bothersome effect of cancer than pain. Treating the secondary effects of advanced disease, including fatigue, is one of the main goals of modern cancer research. Lifestyle interventions, such as physical exercise or group therapy, have yet to demonstrate significant improvement in terms of patient fatigue levels. Pharmaceutical approaches may be most effective in reducing cancer-related fatigue.
Ritalin (methylphenidate) is generally prescribed for attention deficit disorder in children and narcolepsy in children and adults, and it’s available in both immediate and sustained release formulations. There is conflicting evidence as to whether Ritalin might be useful in reducing cancer-related fatigue. While some studies have shown significant improvement in cancer patients’ quality of life after taking this medication, others have produced negative or insignificant results.
With cancer, researchers sometimes have difficulty separating the effects of an experimental treatment from a patient’s routine treatment. The most recent study of Ritalin and cancer fatigue, conducted in part by the Mayo Clinic, showed no significant improvement for all but the most serious cases of tiredness. Participants were placed into drug or placebo groups and administered identical tablets for three weeks. Fatigue and quality of life surveys were conducted at regular intervals. As with all drug research, however, primary effect is not the only consideration; adverse effects must be considered and carefully weighed against the desired outcome.
In the Mayo Clinic study, participants receiving daily sustained-release Ritalin reported nervousness and loss of appetite at a rate far greater than the placebo group. Patients with Stage III or IV cancer and severe fatigue showed the most significant improvement, but they also experienced the most adverse events. Whether or not the potential benefits outweigh risks must be decided on a case-by-case basis. Researchers acknowledged that perhaps immediate release Ritalin could offer greater benefit, and future investigations may take up this line of reasoning. As for now, a non-pharmaceutical approach to managing cancer-related fatigue may still be the safest alternative in most instances.
Fatigue, sleepiness, and even depression often linger for months or years after cancer has gone into remission. In many cases, the effects of cancer treatments are so damaging to healthy cells that full recovery is an uphill struggle. Currently, there is no overwhelmingly effective approach to reducing fatigue in cancer patients and survivors. Ritalin might be useful in advanced stages of the disease, but more study is needed to be certain.
References
- Methylphenidate – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 16, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000606/
- Moraska, A.R., Sood, A., Dakhil, S.R., Sloan, J.A., Barton, D., Atherton, P.J., Suh, J.J. et al. (2010). Phase III, Randomized, Double-Blind, Placebo-Controlled Study of Long-Acting Methylphenidate for Cancer-Related Fatigue: North Central Cancer Treatment Group NCCTG-N05C7 Trial. Journal of Clinical Oncology, 28, (23), 3673-3679.
Amphetamine abuse and addiction is a serious and growing public health issue throughout the United States. Addiction inevitably leads to rising health costs, lost productivity, broken families, and progressively declining quality of life for drug users. Medical science has yet to formulate a satisfactory answer to this problem. Rehabilitating users is clearly one of the primary objectives, but there are numerous stumbling blocks along the way. Typical users deny the seriousness of their addiction unless and until dire consequences arise. Withdrawal effects from amphetamine are profound, and recovering addicts experience relapse at alarmingly high rates. The current best practices for addiction treatment include supportive individual therapy, group therapy, and profound lifestyle changes. In severe cases of withdrawal, anti-anxiety medications are often prescribed to ease feelings of fear and discomfort.
Ironically, amphetamines serve a therapeutic purpose in the treatment of both attention deficit hyperactivity disorder (ADHD) and narcolepsy. Dexedrine (dextroamphetamine), Adderall (dextroamphetamine and amphetamine), and Ritalin (methylphenidate) are the three primary stimulant drugs prescribed for these purposes. Recently, a nonstimulant medication, Strattera (atomoxetine) has received attention both as an alternative treatment for ADHD and as a possible therapy for recovering amphetamine addicts. Researchers in Connecticut discovered that Strattera, when taken over the course of several days, actually suppresses the effects of Dexedrine. Participants in a study group pretreated with Strattera reported fewer positive drug feelings when given a single dose of Dexedrine. Similarly, blood plasma levels showed fewer chemical markers of the heightened mood state typically associated with Dexedrine and other amphetamines.
The mechanics of amphetamine addiction are still something of a mystery. Researchers know that several chemicals in the brain are important to building and maintaining a state of dependence. Dopamine is one of these chemicals, and it plays a major role in the so-called “reward system.†Norepinephrine is thought to be responsible for the feelings of energy and euphoria experienced by users. Effective pharmaceutical interventions will need to disrupt some of the patterns that amphetamines establish within the brain. The most recent experiments have shown that norepinephrine is at least as important as dopamine in generating the stimulating physical and psychological effects of amphetamines. By altering the levels of norepinephrine with Strattera, the positive drug feelings of Dexedrine are greatly reduced.
References
- PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Atomoxetine. Retrieved April 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000222/
- PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Dextroamphetamine. Retrieved April 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000310/
- Sofuoglu, M., Hill, K., Kosten, T., Poling, J. (2009). Atomoxetine attenuates dextroamphetamine effects in humans. American Journal of Drug and Alcohol Abuse, 35(6), 412-416.