View Full Version : taking ritalin long term


davida
12-16-14, 10:28 AM
I was diagnosed 6 months ago and have been taking ritalin

I also have 2 kids on ritalin and now 2 more that might need it.

I am trying to find out what affects ritalin can have long term.

Are there any long term affects if I take it for years?

sarahsweets
12-16-14, 03:21 PM
Ritalin has been around 50+ years so its pretty safe.

davida
12-16-14, 03:33 PM
and there is no build up even after a number of years

TXJK14
12-16-14, 03:35 PM
Long term effects could be good grades, good jobs, a pretty balanced life. Of course thats all assuming you don't rely completely on the meds.

Okay, I know what you meant, yes I think they are quite safe to take long term. I have been on Ritalin for at least 18 years and I haven't had any negative effects that I contribute to Ritalin usage.

I have recently (I won't go into detail here because I have another thread about it) started a hormone/testosterone therapy kind of deal because my levels were quite low. I wouldn't say it's directly related to my Ritalin usage because the past 8 years of my life have been very stressful. I think the stress and me trying to carry as much as I did and have had an effect on my health and physical well being more so then anything else.

I would say don't worry so much about long term effects being negative because those are all "what ifs." Instead think about how much better life can/could be because you're getting the help you need.

BellaVita
12-16-14, 05:13 PM
David Archuleta? :eek:

I agree with Sarah, it's a safe drug that's been prescribed forever.

davida
12-17-14, 05:35 AM
how many pills do you take?

davida
12-17-14, 05:41 AM
how many mg do you take a day?

CBDialog
12-31-14, 10:03 PM
I suggest you consider the brain hindering long term effects if you start your child at too young of an age on such a powerful drug.

Brain atrophy is a real possibility.

chelona
01-03-15, 11:46 AM
Any evidence for this theory? I don`t think so...

CBDialog
01-03-15, 08:19 PM
Is there any research regarding Ritalin not causing brain damage?
It seems like there is poor evidence that shows people with ADHD have smaller brains than non-ADHD. However those same studies tend to not take into account the drug or medication use of participants. This makes me think that drugs which are known to change your brain can be bad for it( cause it to atrophy) if stimulants are stopped or they may cause your brain to shrink while you are on them. There are no tests proving this, but I am trying to see a neurophycologist so I can get my brain mass measured then compared to the average person my age to see how much smaller my brain might be comparatively.

From what I can understand stimulants cause all of the problems that they supposedly "treat." Because there is no evidence to suggest that helps long term once the medication is stopped, because it does not help. There is only evidence that suggests it isn't the medications fault for making your "ADHD" worse, it is simply your "ADHD" that is at fault.

Dealing with poor neurofunctioning made me very depressed. Now I am trying to learn what might be wrong with me.

Essentially I hope to gather evidence suggesting use of stimulants may cause the brain to atrophy.

namazu
01-04-15, 02:26 AM
Is there any research regarding Ritalin not causing brain damage?
There's limited long-term research that would provide clear answers one way or another. Stimulants have been used for decades without obvious evidence of long-term harm, but that said, there are all kinds of logistical, ethical, and other issues that make answering this question extremely difficult.

It seems like there is poor evidence that shows people with ADHD have smaller brains than non-ADHD. However those same studies tend to not take into account the drug or medication use of participants.
That may have been true at one point, but there's been an explosion of research in brain imaging in the past couple of decades. Numerous studies have taken into account drug and medication use, and still found differences.

Here are results for a search of PubMed (http://www.ncbi.nlm.nih.gov/pubmed/?term=adhd+AND+%22medication+naive%22+AND+brain+im aging) (a database of papers published in scientific journals) on the search terms ADHD, brain imaging, and "medication-na´ve". (Medication-na´ve means "never tried medication" -- so this search term helps find studies that include people whose brains won't be affected by stimulant use.) There are plenty of studies showing group differences between people diagnosed with ADHD and people without ADHD that cannot be explained by medication use.

There is also evidence, especially from animals, that doses, timing of administration (relative to development), and other factors, influence the effects of medication on the brain.

Overall, there's really a lack of good information about long-term use of stimulants at therapeutic doses in humans. It's definitely an important issue, I agree, and one that deserves further study with more people being treated for ADHD for longer periods of time.

But we already do have ample evidence that untreated and undertreated ADHD lead to all kinds of short-term and long-term consequences (in education, relationships, employment, and also health). We know that ADHD increases the risk of injury due to accidents (a recent study suggested that medication reduces this risk (http://www.reuters.com/article/2014/12/18/us-health-adhd-injury-idUSKBN0JW1XX20141218)), the risk of smoking (which has plenty of harmful effects), the risk of divorce, of school failure, of difficulty keep a job, of developing other psychiatric disorders, and of engaging in self-harm and even committing suicide.

So when considering the long-term effects of stimulants (or the possible long-term effects, in the absence of solid evidence), it's important to keep in mind that untreated ADHD isn't benign, and ADHD itself can cause great harm.

Of course, if you can treat your ADHD without medications, that's wonderful, and then you don't have to worry about whether or not you're risking long-term problems.

But for the many people with ADHD who cannot manage the condition with behavioral and environmental (etc.) strategies alone, the known, serious risks of unmitigated ADHD need to be balanced with concerns about short-term medication side effects and unknown long-term effects.

That balance will be different for each person, and there's no universal answer.

This makes me think that drugs which are known to change your brain can be bad for it( cause it to atrophy) if stimulants are stopped or they may cause your brain to shrink while you are on them. There are no tests proving this, but I am trying to see a neurophycologist so I can get my brain mass measured then compared to the average person my age to see how much smaller my brain might be comparatively.
Neuropsychologists do not generally measure brain mass. They observe and measure specific cognitive functions that can point to how well different aspects of your brain function, and they can help pinpoint weak areas or brain damage. However, they usually use different types of tests (not imaging) to do this -- seeing how well you can listen, look, remember, organize, speak, reason, and physically accomplish tasks.

A neurologist may order brain imaging studies, but generally only if there's a reason to suspect damage to the brain as a result of pre- or perinatal problems, stroke, brain injury, or some other reason to suspect a brain problem that would be apparent and important to localize.

It's not standard procedure for ADHD. This is because there's a lot of inter-individual variation in brain volumes, and also different parts of the brain may be differentially affected. While researchers have found differences in the average volume of specific parts of the brain between people with and without ADHD, there's enough of a range among ADHDers and among normal people that it's not currently possible to look at a single individual's brain compared with others of the same age/sex/etc. and identify whether or not the person has ADHD.

There are some proponents of using brain imaging, such as Daniel Amen, who runs a clinic that does SPECT imaging. But so far there's not good evidence that this type of imaging gives reliable / useful results of the sort Dr. Amen claims.

The imaging is very expensive and not covered by most insurance. Unless you can find a brain imaging study of people with ADHD near you that will give you results for free for your participation, you're looking at $1000-$2000 and up for basic imaging that won't tell you much, unless you have actual brain lesions or extreme damage.

From what I can understand stimulants cause all of the problems that they supposedly "treat." Because there is no evidence to suggest that helps long term once the medication is stopped, because it does not help. There is only evidence that suggests it isn't the medications fault for making your "ADHD" worse, it is simply your "ADHD" that is at fault.
I'm confused by what you're saying here.

No one claims that stimulants "cure" ADHD permanently. Medications treat (reduce symptoms and help prevent problems from) the condition while people are taking them. And yes, when people with ADHD who were taking medications stop taking them, their ADHD symptoms will no longer be treated.

But that's a far cry from saying that medications cause the problems they're supposed to treat. As you said later, it's the ADHD itself that causes the symptoms. (That's not to say that stimulants don't cause side effects or worsen problems in some people, especially people with comorbid disorders. But most people who take stimulants for ADHD already had the ADHD-related problems to begin with, so those problems can't be blamed on the medication.)

There's been at least one study suggesting that some children who took Ritalin (I think) actually experienced some normalization of brain volumes (again, on average) compared with kids who had ADHD and didn't take medication. But I'm not sure this result has been replicated, and there was only speculation as to why this may occur. I haven't looked at that study for a while, so don't quote me on this, but I'll see if I can find it again. [UPDATE: Here's one such study. (http://www.ncbi.nlm.nih.gov/pubmed/20460495) Again, it's been a while since I read it, and there may be other explanations for the findings.]

Dealing with poor neurofunctioning made me very depressed. Now I am trying to learn what might be wrong with me.

Essentially I hope to gather evidence suggesting use of stimulants may cause the brain to atrophy.
You're not alone in feeling that way. Struggling to function is a challenge for many people dealing with ADHD, and it's one of the reasons people with ADHD are at risk for depression and anxiety.

You might find neuropsychological testing (the non-imaging kind) helpful to give you a better sense of your cognitive strengths and weaknesses -- but that's also expensive and rarely covered by insurance unless there's a compelling medical reason for the testing.

We're only beginning to understand the neurologic bases of ADHD, and of the short- and long-term effects of medication. I do believe that imaging studies and new ways of looking at the brain will help us answer some of these unanswered questions in the years to come.

Instead of seeking to have your brain imaged, which is unlikely to provide you with the answers you seek, your money and time might be better spent on assistance managing your ADHD. I understand that you want to stay away from medications, and that may be the right decision for you, but you might benefit from non-medical treatments -- seeing a psychologist to manage your depression, working with a coach or therapist to develop coping strategies, investing in tools that will help you remember things and manage your time and money, and so on.

Best wishes.

CBDialog
01-04-15, 04:09 PM
I would like to see what studies are out there regarding brain comparisons comparisons of drug naive adhd people with other prior medicated or currently medicated adhdpeople. I have found no studies that compare brain masses of people while taking into account drug history. Your study names a specific area of the brain. Why is the the whole brain mass not taken into account and what other studies do you know of that target other brain areas or the whole thing??
I'll reply to rest of your reply later today. Thank you for the thorough response.

CBDialog
01-04-15, 09:55 PM
Here are results for a search of PubMed (a database of papers published in scientific journals) on the search terms ADHD, brain imaging, and "medication-na´ve". (Medication-na´ve means "never tried medication" -- so this search term helps find studies that include people whose brains won't be affected by stimulant use.) There are plenty of studies showing group differences between people diagnosed with ADHD and people without ADHD that cannot be explained by medication use.


http://www.ncbi.nlm.nih.gov/pubmed/23184398

Here is a study that shows stimulants do have a negative effect on brain mass. I found it in the studies that came up from your link.

CBDialog
01-05-15, 01:00 AM
I will say that I think the term "ADHD" is a witch hunt for people that do not have qualities that mold to our style of education and culture. Categorical minimum criteria meeting does not make for a medical condition requiring medication. Unfortunately that is how our society saw it. I think people are taking stimulants that were never tested fully due to the effects they produce being so desirable.

There is also evidence, especially from animals, that doses, timing of administration (relative to development), and other factors, influence the effects of medication on the brain.

[QUOTE]Overall, there's really a lack of good information about long-term use of stimulants at therapeutic doses in humans. It's definitely an important issue, I agree, and one that deserves further study with more people being treated for ADHD for longer periods of time.

I think stimulants are not an option to stop using once started. You will have lesser brain function when you stop doing them.. So why start? Unless you truly cannot function without them then I suggest you never expose your body to them... I am an unlucky individual that did not knowingly choose to take Ritalin, but I did when I was 6 to age 12. I went through DARE. Learned false information. Went through my whole life with depression and struggled through operating my body and thoughts. I only recently after going through major depression and by a stroke of luck started to investigate stimulants and ADHD. Now I am have learned that long term Ritalin damage from exposure as a child is the likely culprit. I have found another medication that I cannot discuss on here but I will say that it has made me curious about things and capable to functioning.

But that's a far cry from saying that medications cause the problems they're supposed to treat. As you said later, it's the ADHD itself that causes the symptoms.

I do suggest that stimulants worsen the symptoms they are meant to "treat." I found a study that showed dopamine transporter increases in Ritalin users.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0063023

Here is the problem: What causes ADHD? No one can say.. I would say dopamine regulation is the cause. If that is true then clearly Ritalin has altered the regulation of it in patients from this study and I would call it a damaging effect. I think when you are not happy your brain will shrink. Dopamine plays a big role in how happy you are. My theory is that you become depressed from Ritalin and it makes your brain atrophy because it makes you sad.

I do think that my brain might be smaller because of Ritalin. My quality of mental health and simple happiness is not good.
I do appreciate that you think I need to learn to manage my ADHD, but you don't know me. I may have ADHD characteristics, but I also have clear inconsistencies that I want to learn more about because I have to. Getting a brain scan performed on me sounds like the best thing I can do for myself and anyone else that may have stimulant caused issues. Seeing professionals only got me suggested that I am depressed and they think I have social anxiety. They didn't think I had ADHD because it wasn't on my medical record that they had access to. I did not know they didn't know my medical history. For 4 months I went to them and finally after I tried to kill myself at one point, but luckily did not do so, I found out they did not know I was on Ritalin as a child and that I was diagnosed ADHD. I retrieved my written records from Kaiser and brought them to the psych office. The psychiatrist instantly changed his opinion about giving me stimulants, they didn't want to do it before.. I didn't want to go back on them because I knew they were a one way track, but I broke down and asked for them because I didn't know what else to do after being totally sober for months from everything else. I had started my other medication before I brought them the records from be being prescribed Ritalin as a child. So now I was very cautious when the psychiatrist suggested that I should probably be on a stimulant again... His opinion instantly changed. They didn't think I was ADHD until I had proof of it... Isn't that silly.

namazu
01-05-15, 01:38 AM
http://www.ncbi.nlm.nih.gov/pubmed/23184398

Here is a study that shows stimulants do have a negative effect on brain mass. I found it in the studies that came up from your link.
Thanks. It's an interesting study. I skimmed it just now, and it turns out the results were more complicated than just "the volume decreased". (They were not only comparing unmedicated ADHDers, medicated ADHDers, and controls, but also following some of them over time, with changes in medication use, and also looking at some kids.)

What the authors of this study actually found (quote from paper below) was that methylphenidate seemed to be associated with short-term decreases in the volume of the ventral striatum, especially among people who hadn't taken stimulants before.

But they also found that the decreases in volume in individual patients seemed to disappear with longer duration of methylphenidate use. They therefore called this observed volume change a "transitory effect" -- one that doesn't seem to be permanent, even when people continue medication use.

It should be noted that, although the VStr volumes of the ADHD group dropped below control volume after treatment, there was no statistically significant deviation from the control group in the main medicated sample, which had a longer mean treatment duration than the group of formerly medication-na´ve ADHD patients. Together with the regression results, these findings suggest that VStr volume will eventually stabilize at the volume of healthy control subjects. In fact, the mean left and right VStr volume of the medication-na´ve adults with ADHD were larger than those measured in the control group, although this difference was not statistically significant. This may point to a compensatory volume increase (reflecting, e.g. an increased number of dendritic spines and branches) built up to cope with a chronic depletion of striatal dopamine in untreated patients, which disintegrates in response to a sudden dopamine overflow.

(The last bit of that is speculation.)

So I'm not really sure what to make of these results overall (if I'm understanding correctly what they found):
- in the original groups, unmedicated adult ADHDers had slightly higher VStr volumes than controls (not statistically significant), previously-medicated adult ADHDers had somewhat lower VStr volumes than controls (also not statistically significant);
- methylphenidate appears to cause decreases in the volume of the ventral striatum in people who are new to the medication (10 men scanned before and after starting methylphenidate);
- these changes in brain volume appear to be temporary, and in individual patients, volume appears to return to normal with continued treatment.

?

Keep in mind that many imaging studies are done with very small samples due to the cost and difficulty of doing the imaging procedures. In this case, all of the adult participants were male, though the kids included boys and girls.

It will be interesting to see how these results fit with other studies.

namazu
01-05-15, 02:28 AM
I think stimulants are not an option to stop using once started. You will have lesser brain function when you stop doing them.. So why start? Unless you truly cannot function without them then I suggest you never expose your body to them... I am an unlucky individual that did not knowingly choose to take Ritalin, but I did when I was 6 to age 12. I went through DARE. Learned false information. Went through my whole life with depression and struggled through operating my body and thoughts. I only recently after going through major depression and by a stroke of luck started to investigate stimulants and ADHD. Now I am have learned that long term Ritalin damage from exposure as a child is the likely culprit. I have found another medication that I cannot discuss on here but I will say that it has made me curious about things and capable to functioning.



[quote=CBDialog]I do suggest that stimulants worsen the symptoms they are meant to "treat." I found a study that showed dopamine transporter increases in Ritalin users.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0063023
Yes, this study does suggest that the brains of ADHDers may compensate for medications over time, which could potentially lead to tolerance of medication and worsening of "baseline" symptoms when discontinuing medication. If you stop taking stimulants, it is likely that over time, your brain will re-adjust to no meds, and you would be back where you started, ADHD symptom-wise.

I think when you are not happy your brain will shrink. Dopamine plays a big role in how happy you are. My theory is that you become depressed from Ritalin and it makes your brain atrophy because it makes you sad.

I do think that my brain might be smaller because of Ritalin. My quality of mental health and simple happiness is not good.
There have been a number of studies that associate depression with long-term changes in the brain, so there may be something to the idea that brain changes associated with depression could be contributing to your ongoing mental health problems and poor quality of life.

I'm not sure the changes can be directly attributed to Ritalin, though. Many people take Ritalin or other stimulants for years without it causing depression or sadness, and find it improves their lives. Obviously what works for one person isn't necessarily good for another person.

If Ritalin did trigger your depression (which it can do in some people), or if you've just been unlucky enough to develop chronic depression, it's possible that you're feeling long-term effects of it. However, from a practical and scientific standpoint, it would be nearly impossible to prove direct involvement of Ritalin one way or another.

I do appreciate that you think I need to learn to manage my ADHD, but you don't know me. I may have ADHD characteristics, but I also have clear inconsistencies that I want to learn more about because I have to. Getting a brain scan performed on me sounds like the best thing I can do for myself and anyone else that may have stimulant caused issues.

My suggestion wasn't meant as an insult, and I'm sorry if it came across that way. You said that you've felt depressed over the fact that you have poor neuropsychological functioning. So my thinking is that you may need additional strategies to manage or work around your difficulties may improve your functioning and mood. It wasn't clear what else you may have tried to improve your functioning besides prescription medications and other substances.

Whether or not you have an ADHD diagnosis, and whether or not it's correct, it's clear from your post that you're struggling and unhappy, and it's probably worth looking into non-drug-based treatments and supports as well. If that involves doing more research into your specific neuropsychological strengths and weaknesses, that's great.

Just keep your expectations for brain imaging modest -- a lot of neurological dysfunction doesn't show up clearly on a scan, and you may be setting yourself up for disappointment if you expect everything to be clear. Maybe you will discover something useful, which would be great. But most likely, you'll still be in a position where you'll need to figure out how to manage or work around whatever neurological "inconsistencies" you're dealing with.

Seeing professionals only got me suggested that I am depressed and they think I have social anxiety. They didn't think I had ADHD because it wasn't on my medical record that they had access to. I did not know they didn't know my medical history. For 4 months I went to them and finally after I tried to kill myself at one point, but luckily did not do so, I found out they did not know I was on Ritalin as a child and that I was diagnosed ADHD. I retrieved my written records from Kaiser and brought them to the psych office. The psychiatrist instantly changed his opinion about giving me stimulants, they didn't want to do it before.. I didn't want to go back on them because I knew they were a one way track, but I broke down and asked for them because I didn't know what else to do after being totally sober for months from everything else. I had started my other medication before I brought them the records from be being prescribed Ritalin as a child. So now I was very cautious when the psychiatrist suggested that I should probably be on a stimulant again... His opinion instantly changed. They didn't think I was ADHD until I had proof of it... Isn't that silly.
ADHD and depression and anxiety aren't mutually exclusive. In fact, they often go together (even in people who have never taken psych meds). Let's face it; it's frustrating and discouraging to struggle every day with things that other people can do much more easily, and to have problems with school and relationships and work and money as a result.

I'm sorry you had such a rotten experience with the professionals you dealt with, and that it had such negative effects on your life.

I also had difficulty getting appropriate treatment at Kaiser, despite having a documented history of treatment dating back to my youth. Doctors usually do look for some evidence of childhood symptoms / diagnosis / treatment in adults who come in with some suspicion of ADHD, but they're not always quick to suggest ADHD in adults with complex mental health issues unless the possibility is explicitly brought up.

(Actually, I think there's been some talk recently of a strike by mental health professionals at Kaiser due to their feeling that mental health concerns are being systematically ignored/minimized. But that gets into politics and other issues. Anyway, you're not alone in feeling like Kaiser mishandled your mental health treatment.)

Anyway, I hope you get things figured out.

CBDialog
01-06-15, 01:12 AM
Yes, this study does suggest that the brains of ADHDers may compensate for medications over time, which could potentially lead to tolerance of medication and worsening of "baseline" symptoms when discontinuing medication. If you stop taking stimulants, it is likely that over time, your brain will re-adjust to no meds, and you would be back where you started, ADHD symptom-wise.

Why is it likely that over time your brain will re-adjust to put you back to where you started with ADHD? I haven't really found studies that show this. There are studies that various parts of the brain change and change again once medication is stopped. But the brain is altered. You can't say the brain goes back to "normal." Also when one says that medication "normalize" the brain. I don't see it being good to have whatever natural way your brain would have developed changed by stimulants. If you "normalize" a part of your brain it is now altered away from what is what your brain was born to have developed. If you are 6 feet tall and your right leg is "normalized" then you have one leg that is shorter than what is right for you because normalizing suggests there is an average size. The average size of a person is shorter than 6 feet tall. Following this logic I think that it is supremely dangerous to assume stimulants do no harm.

I am not going to be holding my breath for much anymore. It would be great to find a correlation between brain part mass, age of use, and quantity of stimulants use because that would explain many of my problems as well as the problems of others that have been on these drugs. A class action lawsuit could be possible if a correlation can be traced to drug causation but I hold no breaths; not anymore, I understand more than I ever wanted to about this subject and I hope I don't die an expert on it. I hope I can leave it all behind and we can all learn something from our American health care experiment.