Friday, April 20, 2007

The safety and efficacy of Ritalin

Another article reiterating the peculiar longterm efficacy and safety of Ritalin (methylphenidate). The side-effect data is based on chart review, so it's particularly meaningful (22%). The primary value of the study is to show that ritalin works as well in the real world as in clinical trials.
J Dev Behav Pediatr. 2006 Feb;27(1):1-10.
Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study

* Barbaresi WJ, et al

Department of Pediatric and Adolescent Medicine, Division of Developmental and Behavioral Pediatrics, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. barbaresi.william@mayo.edu

The purpose of this study was to offer detailed information about stimulant medication treatment provided throughout childhood to 379 children with research-identified attention-deficit hyperactivity disorder (ADHD) in the 1976-1982 Rochester, MN, birth cohort. Subjects were retrospectively followed from birth until a mean of 17.2 years of age. The complete medical record of each subject was reviewed. The history and results of each episode of stimulant treatment were compared by gender, DSM-IV subtype of ADHD, and type of stimulant medication. Overall, 77.8% of subjects were treated with stimulants. Boys were 1.8 times more likely than girls to be treated. The median age at initiation (9.8 years), median duration of treatment (33.8 months), and likelihood of developing at least one side effect (22.3%) were not significantly different by gender. Overall, 73.1% of episodes of stimulant treatment were associated with a favorable response. The likelihood of a favorable response was comparable for boys and girls. Treatment was initiated earlier for children with either ADHD combined type or ADHD hyperactive-impulsive type than for children with ADHD predominantly inattentive type and duration of treatment was longer for ADHD combined type. There was no association between DSM-IV subtype and likelihood of a favorable response or of side effects. Dextroamphetamine and methylphenidate were equally likely to be associated with a favorable response, but dextroamphetamine was more likely to be associated with side effects. These results demonstrate that the effectiveness of stimulant medication treatment of ADHD provided throughout childhood is comparable to the efficacy of stimulant treatment demonstrated in clinical trials.
There's something interesting about a medication that's this safe and effective. We don't see that very often in medicine, even physiologic substances like thyroid hormone have more side-effects.

3 comments:

george said...

Ritalin has a variety of effects - just ask the people who did the online searches in the research behind this link!

Ritalin Side Effects said...

My name is Lance Burnet and i would like to show you my personal experience with Ritalin.

I am 56 years old. I have taken Ritalin for 30 years. I have been diagnosed with a mild form of narcolepsy. I use 4 (10 MG ) pills per day. The drug ahs worked wonders and eliminated the drowsiness and sleep attacks. My concern now is the length of time I have been on it. When taking a "drug holiday" it seems like my symptoms are worse.

I have experienced some of these side effects-
rebound effect when dosage wears off.

I hope this information will be useful to others,
Lance Burnet

John Gordon said...

I've had a longstanding pubmed search running on the combination of "ritalin" and "tolerance".

Most psychiatrists and neurologists believe there's no true tolerance, but I personally find that hard to believe. I don't have much science I admit, it's just that most substances that affect neurotransmitters seem to have some associated tolerance effects.

It doesn't seem to be huge I'll admit, it seems less severe than the tolerance associated with caffeine and the withdrawal effect seem smaller than withdrawal from chronic coffee use.

I'm not surprised that Lance would find his symptoms seem worse off Ritalin, though I'd also hope (expect) that if he was off Ritalin for a few months they'd return to baseline. Probably much wiser not to try that experiment though!