Ritalin- The Over-Prescribed Drug

Ritalin and ADHD

Stimulant medications (e.g., methylphenidate and amphetamines) are often prescribed to treat individuals diagnosed with attention-deficit hyperactivity disorder (ADHD). ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development. This pattern of behavior usually becomes evident in the preschool or early elementary years, and the median age of onset of ADHD symptoms is 7 years. For many individuals, ADHD symptoms improve during adolescence or as age increases, but the disorder can persist into adulthood.
Ritalin is a "brand-name" for a medication made from Methylphenidate. Methylphenidate (MPH) is a stimulant used to treat Attention Deficit Hyperactivity Disorder, or ADHD, in both children and adults. Ritalin begins to work in about 15 or 20 minutes. It peaks in effectiveness at 1.5 to 2.5 hours, and lasts for about 3.5 to 4.0 hours. Ritalin will increase the brain's ability to inhibit itself. This allows the brain to focus on the right thing at the right time, and to be less distracted, and less impulsive. Ritalin will increase the "signal to noise ratio" in the brain.

The Problem

The drug does help some people pay attention and function better; some of my own patients have benefited from it. But too many children, and more and more adults, are being given Ritalin inappropriately. Psychiatry has devised careful guidelines for prescribing and monitoring this sometimes-useful drug. But the five-fold jump in Ritalin production in the past five years clearly suggests that these guidelines are being ignored and that Ritalin is being vastly over-prescribed.

Why is Ritalin Over-prescribed

Under the pressure of managed care, physicians are diagnosing ADHD in patients and prescribing them Ritalin after interviews as short as 15 minutes. And given Ritalin's quick action (it can "calm" children within days after treatment starts), some doctors even rely on the drug as a diagnostic tool, interpreting improvements in behavior or attention as proof of an underlying ADHD -- and justification for continued drug use.
Studies show that Ritalin prescribing fluctuates dramatically depending on how parents and teachers perceive "misbehavior" and how tolerant they are of it. When a drug is prescribed because one person is bothering another -- a disruptive child upsetting a teacher, for example -- there is clearly a danger that the drug will be abused. That danger only increases when the problem being treated is so vaguely defined.

Society’s Role

The surge in both ADHD diagnoses and Ritalin prescriptions is yet another sign of a society suffering from a colossal lack of personal responsibility. By telling patients that their failures, misbehavior, and unhappiness are caused by a disorder, we risk colluding with their all-too-human belief that their actions are beyond their control and weaken their motivation to change on their own. And in the many cases where ADHD is misdiagnosed in children, we give parents the illusion that their child's problems have nothing to do with the home environment or with their performance as parents. With the demand for Ritalin growing, we must be increasingly wary about giving out a drug that can be beneficial but is more often useless or even harmful.

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