From: dyer@spdcc.com (Steve Dyer)
Newsgroups: sci.med
Subject: Re: How does Ritalin work?
Date: 1 Sep 92 14:55:26 GMT
Article-I.D.: spdcc.1992Sep1.145526.4327
Organization: S.P. Dyer Computer Consulting, Cambridge MA

In article <1992Sep1.140805.1353@chpc.utexas.edu> jbyrd@chpc.utexas.edu (Jan Byrd) writes:
>I'm wondering now if anyone can explain to me, a layperson, how 
>Ritalin works.  We're just beginning the process of dealing with ADD,
>and I'm sure I'll be learning a lot more, but since they started the
>drug first, I'd like to understand how something that is a stimulant
>(giving a stimulant to a hyper-active child? no way!), that is not 
>addictive, that is completely gone from the body in 4-5 hours can make 
>such an incredible difference.

Stimulants like amphetamine and methylphenidate (Ritalin) seem to
have a general beneficial effect on attention, and act non-specifically
to improve the ability to stay focused on a task.  This is very noticable
in children diagnosed with attention-deficit disorder (ADD), but it's not
unique to such children.

Using the word "addictive" or "non-addictive" is a bit of a red herring
here.  Both the amphetamines and methylphenidate can be used for their
euphoric effects, and there are documented cases of Ritalin abuse and
dependence (that is, someone taking the drug for non-medical purposes
and escalating the dose.)  However, the incidence of such abuse in
children with ADD is vanishingly low.  Even when Ritalin used to be
prescribed as a general pick-me-up drug for fatigue and so-called "mild
depression", the absolute number of cases of misuse was quite low.
It was rescheduled as a C-II controlled substance in the early 70's
primarily because the amphetamines were rescheduled at that time
and the DEA expected a lot of amphetamine users "crossing over" to
Ritalin if it were not also rescheduled.

Actually, its short duration of action is sometimes problematic in
treating some kids with ADD.  Some require multiple doses during the
day, which is sometimes difficult in a classroom setting.  There is
a sustained-release form of the drug as well, Ritalin SR, and that
_may_ work better for some kids, but not necessarily.

>This drug is apparently so safe that they started him on it before we
>started the diagnostic workup and told us to give it to him as needed
>up to 3 times per day.  The prescription has to be handled differently
>from other prescriptions (I have to call the doctor every time we need
>to get a refill (not the pharmacy), and then go pick it up from the doctor
>before taking it to the pharmacy; I was told the reason was because it
>can be mis-used as an appetite-suppressant), but there was no attempt to
>restrict our use of it "as needed".

Schedule II drugs like Ritalin have no refills--you need a new prescription
each time.  I'm sure you're going to get a few people commenting that
the circumstances of its prescription in your case sounded a bit lax.
Most experts involved in the diagnosis of ADD try to avoid drug treatment
unless there is something close to a clear diagnosis.  On the other hand,
the drug really isn't very dangerous.  It can cause insomnia if the last
dose is given too late in the day, it can cause irritability in some kids,
and it can sometimes depress appetite and slow their growth (however, it
doesn't seem to affect their final height.)

>Anyway, I'm curious about how it works.

Hope this helps.

-- 
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer