Methylphenidate (Ritalin) Addiction

Methylphenidate, better known by the brand name Ritalin, has been used to treat Attention Deficit/Hyperactivity Disorder (ADHD) and to a lesser extent, narcolepsy.

When used as prescribed by a physician, Ritalin can improve focus, concentration,  school and work performance in children and adults with ADHD. However, since methylphenidate is a central nervous system stimulant, it can be a drug that is abused.

Short Term Ritalin Effects 

When used as directed, Ritalin is a mild stimulant that can increase alertness, decrease the desire to sleep, and improve concentration.

When tested in children, Ritalin improves ADHD symptoms and classroom behavior. However, when Ritalin is abused, it acts in a manner similar to other stimulants like amphetamines or more specifically, cocaine.

Just like cocaine, Ritalin blocks dopamine from being recaptured by neurons once it is released. This released dopamine is both pleasurable and habit-forming. When Ritalin is crushed and snorted or injected, it can cause intense feelings of euphoria and exhilaration.

Short Term Damage

Even at relatively low doses, Ritalin and other forms of methylphenidate can cause a mild euphoria. The stimulant also causes:

  • Appetite suppression
  • Headache
  • Abnormal heart rhythms
  • Insomnia
  • Increased heart rate and blood pressure

Long Term Damage of Ritalin Addiction

Surprisingly, there is little data that shows the toxic effects of long term Ritalin use in humans.

Drawing on studies of other stimulants, it has been suggested that long term Ritalin use might predispose you to:

  • Paranoia
  • Psychosis
  • Sensitization

Others have cautioned about later cognitive problems associated with long term use. While Ritalin can have several severe short term consequences, the long term effects are poorly studied.

Overdose

Even very large doses of swallowed Ritalin are not likely to be fatal.  However, megadoses may require hospitalization due to the following:

  • Manage blood pressure instability
  • Possible seizures
  • Delirium
  • Extreme agitation
  • Coma

However, injected methylphenidate can be lethal.

Signs of Ritalin Addiction and Abuse

When Ritalin is used without prescription to enhance performance in school or work, it is very difficult to detect its use, short of finding unmarked pills or a prescription in someone else’s name.

Most of the effects of low dose oral methylphenidate, even in the abuser, will appear to observers to be positive (e.g. highly productive, minor weight loss).

When the Ritalin abuser is using the drug for its euphoric effect, others might notice drug-seeking behaviors like increased secrecy, unexplained losses of money, even minor crimes all in an effort to support their habit.

Serious abusers will have increasing problems with sleep—going for periods without sleep and then not being able to sleep when it is sorely needed. Abusers will seem edgy, irritable, and withdrawn.

Adverse Interactions

Ritalin may increase and decrease the effectiveness of other medications. Ritalin may reduce the effectiveness of blood pressure drugs, both by increasing their metabolism (breakdown) but also by increasing blood pressure directly.

On the other hand, blood thinners, seizure medicines, and tricyclic antidepressant drugs may increase in concentration because methylphenidate inhibits their metabolism.

Therefore these drugs may work too well (e.g. over-thinning the blood) or increase the number of severity of side effects of that drug.

Additional Sources

  • Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics. Oct 2001;108(4):1033-1044.
  • Swanson JM, Wigal SB, Wigal T, et al. A comparison of once-daily extended-release methylphenidate formulations in children with attention-deficit/hyperactivity disorder in the laboratory school (the Comacs Study). Pediatrics. Mar 2004;113(3 Pt 1):e206-216.
  • Vastag B. Pay attention: ritalin acts much like cocaine. JAMA. Aug 22-29 2001;286(8):905-906.
  • Dafny N, Yang PB. The role of age, genotype, sex, and route of acute and chronic administration of methylphenidate: a review of its locomotor effects. Brain Res Bull. Feb 15 2006;68(6):393-405.
  • Klampfl K, Quattlander A, Burger R, Pfuhlmann B, Warnke A, Gerlach M. Case report: intoxication with high dose of long-acting methylphenidate (Concerta((R))) in a suicidal 14-year-old girl. Atten Defic Hyperact Disord. Dec 2010;2(4):221-224.
  • Levine B, Caplan YH, Kauffman G. Fatality resulting from methylphenidate overdose. J Anal Toxicol. Sep-Oct 1986;10(5):209-210.