Ritalin

I’ve been reading a lot about methylphenidate lately. Commonly known as Ritalin and Adderal, drugs that are supposed to be prescribed for attention deficit disorders and, less commonly, narcolepsy are apparently all the craze for overachieving high school and college students. The statistics are alarming:

• According to a 1996 Drug Enforcement Agency (DEA) study of three states (Wisconsin, South Carolina, and Indiana), roughly 30-50 percent of adolescents in drug treatment centers reported “non-medical” use of methylphenidate. However, it wasn’t identified as their primary drug of abuse.
• In the last 10 years, the number of preschoolers taking ADD/ADHD drugs has tripled; the number of school-age children has multiplied by 20. More than 2 million American children are prescribed drugs for ADD/ADHD. Adderall represents about a quarter of the market.
• Last year, Nature published a commentary which looked into the ethics of such drugs and sparked off a heated debate in a Nature Network forum and among fellow bloggers. More recently, the magazine released the results of an informal survey of over 1,400 readers, which showed that about 20% admitted to using cognitive enhancers for non-medical reasons and a far higher proportion approved of such use.

Ritalin is, in many ways, a time machine. It offers the means to cram a weeks worth of studying into one infinitely productive night. Kickstart My Heart, a well written article for n+1 magazine, is easily the best Ritalin abuse memoir I’ll ever read. If you have ten minutes and enjoy good prose or valuable insights, read the whole thing:

The feeling begins about twenty minutes after you take the pill: a mental tightening, as though someone had refined your scope of vision into a narrow and penetrating line. All peripheral distractions disappear (you would make a very poor hunter or soccer player). There is a slight fluttering of the heart, and gentle, persistent waves of warmth that are not distracting unless it is hot outside. This is how I experienced Adderall; some people have panic attacks and others feel nothing at all.

Any actual amount of time spent under the influence is hard to describe, because time passes very quickly. It’s a euphoric drug, but also an alienating one. If I took a pill with my morning coffee, it would wear off by early evening. All of my work for the coming week would be finished, and I could take an aspirin, shower, and go to bed. Having missed the transition from day to night as well as all three meals, my dreams would be hysterical, but I always woke the next day feeling chipper and accomplished.

Surprisingly, Ritalin’s mechanism of action is poorly understood. We understand what happens physiologically but we’ve no clue how the physiological processes result in focused attention.

Volcow et al. published a recent paper in PLoS reported on by Ed from Not Exactly Rocket Science. Ed explains:

To test this idea, Volkow used a PET-scanner to measure the amount of glucose (sugar) used by the brains of 23 volunteers as they did some mathematical calculations. The volunteers were injected with either methylphenidate or a placebo and asked to solve simple arithmetical problems, whose difficulty had been tailored to their individual abilities. As a control, they were asked to look at, but not respond to, images of scenery.

When faced with the pretty pictures, the volunteers brains behaved in the same way regardless of what they were injected with. It was only when they had to do the more complex mental task that the effects of methylphenidate were revealed. The brains of both groups burned up more glucose but while those that had been shot up with placebo used up 21% extra sugar, those that were drugged with methylphenidate only needed half as much – an extra 11%.

These figures suggest that the drug is indeed focusing the brain’s activity and dramatically reducing its energy demands.[…]

Volkow’s work could help to explain why cognitive enhancers like methylphenidate can hone brain performance in some people and some contexts, but be equally detrimental in others. Sleep-deprived individuals, or those with ADHD, may benefit from a chemical that deploys their brain’s resources in a more efficient way. People whose brains are already working at their best could suffer from being focused any further.

So there it is, Methylphenidate, the stimulant that makes the brain work less.