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Washington Advanced imaging research has answered a 40-year-old question about methylphenidate (Ritalin), which is taken daily by 4 million to 6 million children in the United States: how does it work? The answer may unsettle many parents, because the drug acts much like cocaine, albeit cocaine dripped through molasses (J Neurosci. 2001;21:RC121).
Taken orally in pill form, methylphenidate rarely produces a high and has not been reported to be addictive. However, injected as a liquid it sends a jolt that "addicts like very much," said Nora Volkow, MD, psychiatrist and imaging expert at Brookhaven National Laboratory, Upton, NY. "They say it's like cocaine."
click on the source url to view the images - I spend longer trying to get those right than they are worth to the impact of the story
Representative distribution volume PET images of the radiotracer [11C]raclopride from one of the study participants show that radiotracer binding is reduced at the level of the striatum (bottom left) after oral administration of 60 mg of methylphenidate. Reduced radiotracer binding indicates decreased availability of open dopamine receptors after methylphenidate-induced increases in extracellular dopamine. Cocaine produces a similar effect in those who take it. (Photo credit: Courtesy of Brookhaven National Laboratory)
Acknowledged as leaders in the field of brain imaging of drug effects, Volkow and colleagues have spent several years tracing the effects on the brain of drugs of addiction, using positron emission tomography (PET) and other advanced techniques. Among their long list of findings, they've identified the brain's dopamine system as a major player in compulsive behavior, including drug taking and overeating.
"I've almost been obsessed about trying to understand [methylphenidate] with imaging," said Volkow at a recent media conference. "As a psychiatrist, sometimes I feel embarrassed [about the lack of knowledge] because this is, by far, the drug we prescribe most frequently to children."
So the team went to work with PET scans to examine the dopamine system, which stimulates reward and motivation circuits during pleasurable experienceseating, having sex, learning. To pick one of many pleasures, tasting chocolate ice cream will trigger cells in the basal ganglia to release dopamine molecules. These float across the synapse to neurons in a reward circuit. Receptors on these cells sop up the dopamine, activating signals that translate to "this experience is worth paying attention to." Too much signal and the experience feels unpleasant, overstimulating. Too little, and the experience elicits a yawn; no pleasure, only boredom and distraction.
Volkow wanted to know how methylphenidate affects this signal. But instead of focusing on dopamine receptors, sh
Ritalin is a much to expensive way to go.
We dope kids so teachers can tolerate them.
What we should do is dope the teachers so they can tolerate the kids.
I like it. H*ll, I'd even support some tax dollars for it, in lieu of doping the children...
From the part of the story that you didn't post:
"We were surprised as hell," said Volkow. "We didn't expect this." Instead of being a less potent transport inhibitor than cocaine, methylphenidate was more potent. A typical dose given to children, 0.5 mg/kg, blocked 70% of dopamine transporters. "The data clearly show that the notion that Ritalin is a weak stimulant is completely incorrect," Volkow said.
wonder how I missed it - I selected all the text and copied....
He!!'s Bell's - all of the story showed up on preview. Here's the rest:
Volkow wanted to know how methylphenidate affects this signal. But instead of focusing on dopamine receptors, she tracked another part of the system. After the pleasure signal is sent on its way, dopamine molecules recycle back to the neurons that produced them. There, transportersalso called autoreceptorsact as vacuum cleaners, scouring the synapse for another go-around.
Earlier research had shown that cocaine blocks about 50% of these transporters, leading to a surfeit of dopamine in the synapse and a hit of pleasure. Because of methylphenidate's chemical similarities to cocaine, pharmacologists thought that it might work in the same way, only less potently, blocking fewer transporters. Animal studies with high doses of methylphenidate indicated that this could be the case.
"We were surprised as hell," said Volkow. "We didn't expect this." Instead of being a less potent transport inhibitor than cocaine, methylphenidate was more potent. A typical dose given to children, 0.5 mg/kg, blocked 70% of dopamine transporters. "The data clearly show that the notion that Ritalin is a weak stimulant is completely incorrect," Volkow said.
More pondering led the team to consider two theories. Methylphenidate could be blocking the recycling of dopamine exactly as cocaine does, leading to strong signals that would yield a high and lead to addiction. But this did not jibe with four decades of clinical experience.
So they considered another possibility. Perhaps methylphenidate seeps into the brain slowly, and as one by one the drug molecules block the transporters, dopamine cells shift gears. Like a union foreman yelling to an assembly line to slow down, the cell interprets the transporter congestion as a signal that too much dopamine is being produced. The neuron cranks down production, sending less dopamine into the synapse, suppressing the reward signal.
The two theories opposed each other. But Volkow was unfazed. "We had to let the data speak for itself," she said.
That meant measuring the amount of dopamine floating in the synapses. Fortunately, the investigators had at hand another radioactive label that binds only to open dopamine receptors. A weak PET signal would mean low numbers of open receptors, which in turn would mean that large amounts of dopamine occupied the synapse.
After combining data from the volunteers, the team got its second surprise. Those who took methylphenidate displayed high levels of extracellular dopaminejust like people using cocaine. But if methylphenidate works like cocaine, why aren't millions of US children getting high and becoming addicted?
It finally started to make sense. Children with ADHD produce weak dopamine signals, meaning that usually interesting activities provide fewer rewards. In effect, their attention circuitry is underfed. At the same time, they experience a related effect: random, distracting neuron firing. Or, as Volkow put it, more noise and less signal. This background hum interferes with concentration, making the child more distractible.
Methylphenidate flips the relationship, upping the signal and reducing the noise. After someone swallows methylphenidate, it enters the bloodstream and eventually finds the brain, where it blocks dopamine transporters and increases attention signaling. Again, cocaine acts the same way. But the two drugs differ in a significant way: methylphenidate takes about an hour to raise dopamine levels, whereas inhaled or injected cocaine hits the brain in seconds. "It is the speed at which you increase dopamine that appears to be a key element of the addiction process," said Volkow.
While the team is unclear on why this speed factor is so important, future research will focus on it. They also plan to map dopamine levels in volunteers who have ADHD when they are at rest or while concentrating. Other research will search for molecular tools to screen children for dopamine transporter levels; those with high levels could be identified early and encouraged with behavioral solutions before methylphenidate is prescribed. "We know that social interactions can increase dopamine receptors," said Volkow, but whether better interplay also affects transporter levels is unknown.
The long-term dopamine effects of taking methylphenidate for years, as many do, are another unknown. The only two large epidemiological studies conflict. One reports more drug addiction in children with ADHD who took methylphenidate compared with children with ADHD who took no drug (J Learn Disabil. 1998;31:533-544); the other shows the opposite result (Pediatrics. 1999;104:e20).
Because people with low levels of dopamine receptors are at risk for drug addiction, Volkow said that researchers need to understand if methylphenidate can alter the whole dynamic of the dopamine pathway. "Could chronic use of Ritalin make you more vulnerable to decreased dopamine brain activity as cocaine does? It's a key question nobody has answered."
One good thing about it is Tennessee is backing off on ADD ADHD quite a bit. I wish I could find the article from Knox News on it but I lost it. Ritalin should be a last choice when all else fails. In some kids I can see it's benifits to actually help their condition but to many more it isn't.
I "think" the problem is that only a small group of the medicated are the afflicted. The "all else fails" part to me is almost a diagnostic "rule out" process. I don't think avoiding sugar or going to bed earlier or any of the other stuff will "fix" a problem with dopamine receptors - but they will demonstrate that it wasn't add/ADHD in the first place.
This is an important study. It seems they are on the road to medically diagnose ADD instead of psychiatric observation. This may prevent the misdiagnosis of prescribing Ritalin for bipolar disorder as what happen at Columbine. It would also indicate that for milder cases that other stimulates might do the same a Ritalin. Just ask your average family doctor in 1960 that told parent to have their spastic children drink coffee.
I "think" the problem is that only a small group of the medicated are the afflicted. The "all else fails" part to me is almost a diagnostic "rule out" process. I don't think avoiding sugar or going to bed earlier or any of the other stuff will "fix" a problem with dopamine receptors - but they will demonstrate that it wasn't add/ADHD in the first place.
I agree the numbers are too high but the article I saw put me onto another aspect of it. It's not the transmitters or lack of but rather the transmission and interpitation system itself is damaged. This get's away from a psychiatrist field though and goes more into neurology.
The high number is likely being caused by a mimicing disorder that the psychiatrist think is ADD ADHD. The behaviorial symptoms are very simuliar but thats where it stops. Knox County was using Speech Patholigst and found a very high percentage we in fact not ADD ADHD but had Vestibular System damage. You dom not want to give these kids Ritalin. Their problem is too much stimulation and not being able to interpit audio and visual situations correctly. As well the ability to preform multiple task such as listening and taking written notes is near impossible it's one or the other. When you start throwing things too fast at them their brain goes into conflict which produces the ADD ADHD behavioral patterns.
The parents suspecting the worse rather than a good physical workup including a look into vestibular damage take the kid to a psychiatrist that doen't have a clue. Most of those honestly have not heard of this as it is newer research being done by researchers in the Vestibular field.
We dope kids so teachers can tolerate them.
B I N G O !
Is this what is being mistaken for ADD ADHD and if so wouldn't Ritalin to those with this diagnoses be harmfull? Read the symptoms listed in the links below. It would explain the epidemic as well.
Rx Nation- are our children being
medicated to death?
Came across this article from yesterday, in which the author suggests that the next DSM be based on a more scientific classification of diseases, rather than on the symptoms alone.
So the NEA came up with a phony condition to explain away their ineptitude in handling "difficult" children, the pharmaceutical companies came up with a drug to treat it, the soccer moms (and dads) lapped the whole scam up like milk and honey. You gotta love it when a plan comes together. Only trouble is, we have this whole segment of a generation who have been turned into zomboid psychopaths in waiting. Oh, I know, we'll invent a government program to treat them as they reach adulthood. That way, we can generate a few million more who are utterly dependent on the nanny state for their very survival. Gosh, what a swell idea!
A teacher once told me I needed to have my son evaluated for ADD and possible drug therapy. I got up in her face and told her that if I ever heard those words come out of her mouth again, I would sue her until it permanently ruined her life. She was smart enough to know I meant it. My son will be entering NC State next year to finish a degree in mechanical engineering. He will be transferring from a Community College with a 4.0 average. Oh, and he did it all without the aid of drugs.
This is a plea to all parents of children in the public schools. Take my example. Don't hand your little ones over to the social engineers to experiment with their minds and souls. When they throw this phony ADD/hyperactivity crap at you, blow up, get mad, get up in their faces. They will back down.
Just so you'll know, Mozart and Einstein would both have been classified as ADD. I, for one, am sure glad there was no ritalin around when they were children.
Don't hand your little ones over to the social engineers to experiment with their minds and souls.
Homeschool!
If I knew 13 years ago what I know now, there would have been no other choice. God bless homeschoolers, they are our only hope of preserving our society, culture, and freedom.
20 years ago, when we made the decision with our first child, homeschool wasn't even on our radar screen. Now it is an integral part of how the littlest one is coming along. Even 13 years ago things were very different - plus I think it has to be an individual decision with each child and each school.
Well Mozart and Einstein likely did not have ADD.; They likely had C.A.P.D. instead. The environment they would have worked under would have provided the necessary conditions for their vocations. No ADD is not a NEA magical trick. Ever hear of medical science? To be exact Neurology? It might surprise you to learn it was actually a research Psychiatrist/Neurologist who was successful in starting to sort out the differences between ADD ADHD dyslexia, TMJ, and other related disorders? TMJ the jaw disorder? Yes that's right TMJ. They are all related.
ADD ADHD is not of the same origins as C.A.P.D. and to pop the so called NEA Ritalin drug them balloon it will not work on a C.A.P.D. child. The rise in ADD ADHD is not because teachers have nothing better to do it's because technology in entertainment industry got way ahead of medical research in it's adverse affects it has on a persons body. Thank Nitendo, Atari, Disney and others for the dramatic ADD ADHD increase.
Up till just a very few and I mean in the past 5 years it was not possible to distinguish ADD ADHD from other disorders. That now is possible. It can be done by doctors and specialist who can not as much even prescribe you an Aspirin to be exact.
The way to diagnose ADD ADHD is through eliminating all other causes the most likely is C.A.P.D. which in behavior is like ADD ADHD but has distinct characteristics that a Speech Pathologist or Audiologist can detect. I think we can both agree that they have no pharmaceutical interest nor for that matter ties to the NEA.
Home schooling kids with this works great. These kids are distracted easily just by the class room environment alone. The simple noise of an airconditioner can make learning difficult for them. But environment modifications is the answer including the use of an FM radio tuned off station. Not AM though as it will distract them. The sound properties of FM is unique.
In the 1960's I was the only kid in the school who had taken Ritalin. I was also the only one wearing a patch over their eye. The Ritalin didn't work. It was stopped quickly. With just what I know from my experiences with it I can watch a kid and pick up on the CAPD traits. They are the ones playing baseball who duck down rather than swing. The coach gets mad and says it's not going to hurt you. Wrong! The kid is reacting not to a baseball but a preceived danger by their sensory system coming at him. The brain demands they respond accordingly. He knows it's a baseball. The sensory system however does not and perceives it as a danger and demands his body act accordingly. When he doesn't then you get ADD ADHD behavior from that conflict but not ADD ADHD. That is one example. But it is the same situation that triggers them from certain tv shows and video games as well. These kids will likely have poor eye-muscle coordination as this condition originates in their Inner Ear which is the coordinator of sight sound and balance. The dealing with this problem and trying to function in an ever increasing fast moving world has given us a generation of these kids and adults.
It's not a conspiracy it's the simple fact that we have gotten technology that is too fast paced for a lot of kids as well as adults. The technology boom has created the rise in supposed ADD ADHD and anxiety. Society's moral decline has created an environment for kids without conscience who shoot up schools the two problems are not related except to entertainment being a trigger.
This is quieter thread so I will post a response here. The other thread has become very emotional.
I understand at what you are driving in your comments on technology. However, what you are describing has been known for quite a while (close to 100 years, I believe) as a form of autism. Sadly, most autism is profound and renders its victims unable to function in society. All of us are subject to varying levels of autism. All of us have varying triggers for autistic behaviors. Sadly, in their quest to make everyone the same and to press humanity to the lowest common denominator, the social engineers have found it more convenient to suppress and banish these behaviors with a pill or a needle. Yes, we have come a long way from believing that savants were possessed by demons and we don't rattle beads in their faces or perform exorcisms on them. But have we really improved so much? At the bottom of it, how much different is it to administer chemical cocktails which steal their souls than to dance around in scary masks and scream at spirits? We congratulate ourselves on how advanced we are and how we have made our lives better through chemistry, but has our society advanced and improved over what it was 50 years ago? 100 years ago? I could argue convincingly that it has not. I can also make the case that taking the easy way out of our troubles has led to the kind of society we face today. Kids misbehaving? Well, it must be ADHD, here have some drugs. Give the little rascals a chemical lobotomy, everything will be better. While you're at it, here's some prozac for Mom so she won't drown her kids and some valium for Dad so he won't open up on his co-workers with an automatic weapon. But if they do, we'll put them on lithium and turn them loose again. Everything will be okay. I guess I'm getting old. I can't understand why anyone would want to spend time watching God's creation through a drug-induced stupor.
Well, my rambling quota is used up for now. By the way, I didn't make that part up about Einstein and Mozart. The NEA and the APA have both presented articles on the subject. Sad, but true.
Autism they pretty well have linked to vaccines. CAPD is thought to be linked to ear infections, allergies, ect. They pretty well are getting CAPD pinned down. If I was told my kid was possible ADD ADHD I would take the kid to a speech Pathologist for testing for CAPD. Especially if their medical history hinted Vestibular problems. These conditions if caught early can be treated and dealt with. The longer it goes untreated the worse it gets the more damage is done. I'm talking about simple anti biotics for ear infections and treatment for allergies.
ADD ADHD is likly CAPD I'll explain why later. But untreated CAPD can as well later result in General Anxiety Disorder. Got to go for a while.
The general characteristics of ADD ADHD suggest a chemical problem as Ritalin in true ADD ADHD kids does work. ADD ADHD as well usually leaves at puberty the bodies chemical change seems to the furnish that chemical. Little is known about ADD ADHD. It think it's real but I think it's not that common. The disorders have different origins which says different treatments and causes. The damage in a CAPD kid is started early by the 2 year of life it can be present. You're gone see responses from them that you won't from ADD ADHD. As a kid visual events that scared me caused me to stop up my ears audio events I closed my eyes. One eye was only functional at a time as well. All symptoms then pointed to what is known as Vestibular dysfunction now.
The teachers actually did notice my problems more as they had seen it. Now they weren't your college grads these were seasoned teachers in the 1960's ADD ADHD was not common nor was Ritalin though it was there. Like I said the Ritalin didn't help but some physical therapy did. I had to learn to live with one eye functional and had to work on eye-muscle co-ordination to a certain extent it improved. I got through high school and the service.
All during this time I still thought I had ADHD. I also still had severe sinus allergies at least several times a year. 7 years ago I developed some Neurological dysfunctions that could not be explained by a cat scan, MRI, ekg, eeg, blood work or any other procedure. I developed a intolerance to certain audio and visual stimulation that would result in reactions from my central nervous system. In short it was like getting hit by a cattle prod. No pain but a sudden startle reaction.
The doctor gave up after the usual test and sent me to the shrink saying it was Anxiety Disorder. What does he do? Gives me Anti-depressants which again like Ritalin worsen the condition. I was on Xanax as well. While taking Xanax I showed improvement when the anti-depressants were given it worsened.
One day I found a book in a second hand store written by a research Neurologist/ Shrink. He found a substantial link between what was then being called ADD ADHD, Dyslexia, TMJ, and Anxiety disorders. His adult anxiety patients all had one common denominator a history of Vestibular damage. He was successful in a lot of cases by using motion sickness medication and anti-histamines. Usually an adult who has Panic Disorder has it for about 6 months to a year he states because the infection clears up quickly the person recovers.
In my case the damage up till 7 years ago was 35 years in the making. The shots I took for the allergy as a teen slowed it down somewhat. A person with Vestibular Damage may go through life and never realize it. Or due to stresses of life it can come on in the form of Anxiety Disorder in a matter of minutes. Ok I read his book and then understood the damage and where it was.
A few years ago I found some more information that confirmed the doctors theory and went into it deeper. Kids that they thought were ADD ADHD in our local schools it seems were not ADD ADHD. Audiologist tested them and all but a very small number showed up CAPD. All had Vestibular history. They said Ritalin was not beneficial treatment and in most cases either masked the symptoms or worsened them. Now I understand why Ritalin and anti-depressants would not help this.
Yea me and about 4 shrinks disagreed on my treatment plan none would say that this was my problem but not for the reason you think. Vestibular Dysfunctions are not in their field. I did find one who was an anxiety specialist and understood this was the cause of my problems. The anti-depressants were stopped and a small maintenance dosage of Xanax a cousin to Librium or Valium was given. Xanax is another medication given a bad rap because doctors didn't prescribe it correctly or for it's intended use which is Anxiety Disorder.
I've been on it 7 years no craving for higher dosages or rebound effects. But I will say the patient must understand the risk involved. One is dependency the other is responsible usage which includes very little alcohol if any. At the same time though Agoraphobia is not something I desire to add to this mess so the medication is a must. Without it I would not be able to function as I would be in a constant attack state just from my home enviroment. I learned what triggers it. I avoid what triggers it again that goes against most all shrinks advice but remember they are treating phobia and not neurological dysfunction.
Look it's senseless to wholesale condemn a disorder like ADD ADHD as a farce. It's not a farce but it's a lack of doctors, parents, and teacher, knowing which is which. If a teacher learns what CAPD is as well as the parent the kid is helped. If not you possibly will see an adult down the road with some disabling problems. It does not go away.
I got the Tinnitus, jabbing ear pain, spasms, poor balance, and inability now to concentrate at times on even a simple task. It would be a waste for a kid with CAPD to not get needed help because people misunderstand ADD ADHD.
My sources or not from the National Institute of Mental Health by the way I search the Vestibular Disorder Association and related sites for this info. They are the ones who see and mention cognitive complications. As a matter of fact you look in mental health sites and you will not see Inner Ear dysfunction mentioned. Yet I have talked to and helped quite a few like me to realize whats happened to them. I got a relative who went two years before an older General Practitioner said he had inner ear dysfunction. The old geezer was right too. He asked the right questions and knew what he was looking for. Tell me heard of any friends with an inner ear infection lately? I haven't yet growing up it was a common diagnoses among the old family doctors.
Had the information on CAPD been aviable in the 1960's and it's cause perhaps some of the damage I have could have beeen more limited. Now they know or pretty well see the linkage to it.
FYI
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