Ritalin – The science and the good things

I can write books about my medication. About how these little pills I take every day effect my life, both good and bad. How I can not live without them but hate to live with them, how they help me to win the fight with my ADHD devil, but also make me loose on parts of this fight and parts of myself. How everyday I struggle between seeing the good and the bad, about how I wish to stop taking them but continue to do. It is a weird pill, with some weird effects that seem to differ every day.

The science

According to  Myers RL (August 2007). The 100 most important chemical compounds: a reference guide. p. 178. Ritalin, or Methylphenidate has been in our world since 1944 and was synthesized by chemist Leandro Panizzon as a drug to help his wife, Rita, who suffered from low blood pressure. The drug was used for depression, senile behavior, lethargy and narcolepsy. Since the 1960’s it has been silently used to treat children suffering from ADHD, but when in the 1990’s the ADHD diagnosis came to be better understood and more generally accepted, the production and prescription of methylphenidate grew extremely. Today methylphenidate is the most common medication used in ADHD treatment.

The funny thing is that science, even today, does not completely understand how this medicine invented for low blood pressure works in ADHD brains. The effect of Ritalin is hard to understand, but I think the basics are: ADHD brains have trouble with dopamine control, we spill it too fast and are therefore always in search of more, methylphenidate can connect to our dopamine receptors so we can stop searching, and because we don’t need to search anymore, we can focus on important things. See the text below for the scientific explanation.

While its exact mechanism is unclear, methylphenidate (MPH) has been shown to act as a norepinephrine and dopamine reuptake inhibitor (NDRI), thereby increasing the presence of these neurotransmitters in the extraneuronal space and prolonging their action.There is a dose-related effect of psychostimulants on receptor stimulation, where higher doses are shown to increase norepinephrine (NE) and dopamine (DA) efflux throughout the brain which can result in impaired cognition and locomotor-activating effects. In contrast, low doses are found to selectively activate NE and DE neurotransmission within the prefrontal cortex which is an area of the brain thought to play a prominent role in ADHD pathophysiology, thereby improving clinical efficacy and preventing side effects. The lower doses used to treat ADHD are not associated with the locomotor-activating effects associated with higher doses and instead reduce movement, impulsivity, and increase cognitive function including sustained attention and working memory. Methylphenidate’s beneficial effects in sustaining attention have also been shown to be mediated by alpha-1 adrenergic receptor activity. Clinical findings have shown that children with ADHD have an abnormality in the dopamine transporter gene (DAT1), the D4 receptor gene (DRD-4), and/or the D2 receptor gene that may be at least partly overcome by the dopaminergic effects of methylphenidate, suggesting a possible mode of action.


The good things

Although science is not completely sure what is happening inside me when I take methylphenidate, besides an increase in my blood pressure, the pills work, they make the fight with my ADHD devil much more easy. When I take my medication the speed of my brain seems to be reduced, I become able follow my thoughts, even give them direction sometimes, control them on the very good days. It is like my house, if I don’ take my Ritalin it is a mess, clothes, trash, dishes and things are spread around everywhere, chaos. Once I do take my Ritalin it becomes organized, I’m able to find things and there is space. Besides the organization and the space I gain from my pills, they also create filters, filters that make me able to focus on one thing at a time, filters that prevent me from being distracted by everything, filters that keep out the input I don’t need, and only let the things in that are important for the thing that I’m doing at that moment. To explain this again with my house, if I take my Ritalin and I want to make my vegan cheese rice cracker I will actually do this without watering the plants, cuddling with my rabbit, or playing a game on my phone before succeeding. When I take my pills, I can set a goal and I won’t stop until I complete this goal and can move on to the next. I always say: I work like a robot, give a to-do list and I will make sure it will be finished at the end of the day. But this does kot mean that I don’t have to work to be able to do these things. If I allow myself to be distracted or if there’s just to much going on in my life and I can not set clear goals for myself the pills won’t magically make these things disappear. It is the combination of the Ritalin and my willpower that makes me succeed in doing what I have to do.

Often we hear about this discussion related to ADHD, if it’s real, if it’s not just a way to transform ADHD brains (mostly children) to the way we want them to be, to make us fit in society. All the major medical groups recognize ADHD as condition that should be treated but there are many people, even professionals, that believe ADHD is fake, and that the medication to treat ADHD is just a study-drug, just a tool to unlock our full potential, to claim a spot in this world where you need to be the best to be something. This discussion makes a bit angry. I do suffer from a real disease and my medication does help a lot. Yes, it does help me to focus on my work, and yes it did help me a lot while I was a student, but besides this, the pills even help me to make food, to do my groceries, to shower, to clean, to feed my rabbit, to paint, to listen, to control. If I would not take my medication I would not just become less good, fast or focussed at my job, if I stop taking my pills everything I do in my life becomes harder. Every second, a million of thoughts will flow through my brain and when this happens it becomes impossible to even do the smallest thing. I won’t eat, I won’t shower, I won’t relax. I won’t be able to do what I want, nor what I need to do, because the chaos takes over everything. The first reason I take Ritalin is not to fit in to society or to preform better, it is to be able to live with myself, to not go completely crazy.

Methylphenidate knows a long list of side effects of which a lot I am experiencing, besides, I also encounter a lot of struggles with myself when it comes to taking my medication, but still I decide every day that the benefits of taking Ritalin are greater than the disadvantages, the things I gain from Ritalin are greater than the things I loose. I can promise anyone who reads this, that if the benefits from taking methylphenidate would be limited to just a better work performance, I would stop immediately. Methylphenidate does not make me smarter, it does not give me work related super powers. Whenever I take a pill I still need to work hard to be good at my job, I still need to motivate myself and I still need to fight to keep focussed, like any other person.

Ritalin is not a miracle pill that makes me excel at what I do, all it does is helping me to create a little bit of space and hand me the tools to create some filters. Once I take a pill I can not automatically focus, I still need to work to control what I’m doing, I still need to work to have control over my mind. While writing this blog today, I spend a lot of time on the floor, cuddling with my rabbit, I did research on umbrellas, I ignored my mom and friends that called me, I actually should have been cleaning the house and I should have had some food and water while writing. Ritalin is no magic, because if it was, my day would have been totally different. The reason I take my daily dose of methylphenidate for more than 9 years now, is just because it gives me the opportunity to create some peace within myself, the possibility to have control over my brain, and with this, have control over my life, the space to be me, but not without my own willpower. I take methylphenidate because without it I would go crazy, I would make myself crazy, I would not survive my own thoughts.

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