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Ritalin Tolerance: Next Steps and How to Lower It Safely

Ritalin is a prescription stimulant medication, with the active ingredient methylphenidate, which is designed to treat attention deficit hyperactivity disorder (ADHD). It may be prescribed off-label for other conditions like narcolepsy or weight loss, but this is rare.

Methylphenidate was first synthesized in 1944, and it was prescribed throughout the late 1950s and early 1960s to treat chronic fatigue, depression, psychosis associated with depression, narcolepsy, and side effects such as sleepiness or drowsiness associated with other medications like Valium. Throughout the 1970s and 1980s, prescription use of Ritalin grew. Between 1991 and 1999, sales of Ritalin spiked 500 percent in the United States, but most of those prescriptions went to individuals, mostly children, who were diagnosed with ADHD.

Methylphenidate works on the brain by increasing the activity of dopamine, a neurotransmitter associated with many important tasks including feeling happy or feeling pleasure, which triggers the reward system to reinforce certain behaviors. For people with ADHD, the brain has less available dopamine, so increasing the brain’s production and neurons’ ability to use this important neurotransmitter improves symptoms of lack of attention and hyperactivity.

In people who do not have ADHD, stimulating the reward center can lead to abuse. Drugs that release these neurotransmitters increase the risk of developing a tolerance for the medication because the brain will produce less dopamine in response to the same dose of the drug over time.

In people who do not have ADHD, stimulating the reward center can lead to abuse. Drugs that release these neurotransmitters increase the risk of developing a tolerance for the medication because the brain will produce less dopamine in response to the same dose of the drug over time.

Signs of Ritalin Abuse and Tolerance

NCBI in which a measured dose of a substance — a 5 mg (milligram) prescription opioid painkiller, a 5-ounce glass of wine, or a line of cocaine, for example – no longer triggers the same physical and mental effects it once did. You may not get as much pain relief, you may not feel as happy, you may feel adverse effects like mood swings, or you may not get as high.

People who misuse or abuse drugs are more likely to become tolerant of them because they do not take medications as prescribed. They may up their dose without speaking to a doctor first, or they may begin to consume more of the drug recreationally to achieve the initial sensations they once did.

People who take prescription medications can also become tolerant of the substance. If you do not receive the same benefits from your prescription drug as you did at first, speak with your doctor. You may need to change doses, take some time off from the medication to adjust, or switch to a new medication. This is an important conversation to have with the doctor who oversees your care. Taking more of your prescription drug without talking about the issue with your doctor is a form of misuse.

Ritalin abuse may lead to side effects, especially at high doses that have not been prescribed. High-dose side effects include the following:

  • Intense excitement
  • Exhilaration
  • Agitation
  • Anxiety or paranoia
  • Uncontrollable physical twitches 
  • Dilation of the pupils
  • Confusion or delirium
  • Repetitive movements or performing meaningless tasks
  • Hallucinations, including the feeling of bugs crawling on or under the skin
  • High blood pressure and rapid pulse
  • Dry mouth
  • Nausea or vomiting
  • Fever or sweating
  • Seizures
Ritalin Abuse

Methylphenidate Abuse Leads to Tolerance Faster Than Taking It As Prescribed

The United States consumed about 69 percent of the global Ritalin supply in 2012. The same year, the Monitoring the Future (MTF) survey found that 0.7 percent of eighth-grade students, 1.9 percent of 10th-grade students, and 2.6 percent of 12th-grade students reported abusing Ritalin for nonmedical reasons, often as study drugs or performance enhancers. 

The National Survey on Drug Use and Health (NSDUH) for 2011 reported that 4.9 percent of people between the ages of 18 and 25 used Ritalin without a prescription or for nonmedical reasons at least once in their lifetimes.

While many stimulants, like cocaine and meth, have both medical uses and clandestine manufacturers, the U.S. Drug Enforcement Administration (DEA) reports that there is no illegal production of methylphenidate, leading to uncontrolled doses on the black market. Essentially, all Ritalin abuse involves diversion of the drug. A person with ADHD gives or sells some pills to a friend, someone steals the medication from a person with a prescription, a doctor writes a fake prescription, or a person reports false symptoms to get a prescription for the drug.

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Ritalin is listed as Schedule II, according to the DEA, so it has important medical uses. People who do not have a condition that benefits from the medication will feel high, or euphoric, and may become addicted to the substance.

Whether you take Ritalin as prescribed, or struggle with Ritalin abuse, you may develop a tolerance for the substance. If you struggle with Ritalin addiction, finding an evidence-based detox program is crucial. If you take this medicine as prescribed, your doctor may have you take less to reduce your tolerance, stop taking it for a short time, or switch to a different medication that will be more effective.

Work With Your Doctor on Taking a Ritalin Break If Necessary

You should report tolerance to your doctor. When you feel like your dose of Ritalin isn’t working well anymore, this may be a sign of tolerance. Your doctor can diagnose whether you have developed a physical tolerance for the medication or not.

Developing tolerance for a medication you take as prescribed is normal if you take the substance for months or years. Ritalin controls ADHD symptoms well for many people, but it may not work forever. Your doctor will know how to proceed in treating this behavioral condition.

In some instances, your doctor may recommend that you take less Ritalin or take a break from the drug altogether for a week to a month. This helps your body adjust to not taking the drug anymore, and your brain can recalibrate its own chemistry. You may experience some negative symptoms, but this does not mean you have become addicted to a drug that you need for routine medical treatment.

The benefits of taking a break from Ritalin include:

  • If you have several side effects, like low appetite; these will ease up
  • You can see if behavioral treatments work alone
  • Your doctor can see if your symptoms are changing and require a different approach

However, there are some downsides like: 

  • Your symptoms may temporarily get worse
  • You need to be extra attentive about symptoms
  • It can take some time for a new prescription to take effect

NIDA notes that tolerance is often part of an addiction, but becoming tolerant of a substance is not the same as being addicted to a drug. If you have not been prescribed Ritalin to treat ADHD or to use off-label for a specific reason, then you are abusing this drug, and your physical and mental health is at risk. Unfortunately, many people in the U.S. abuse this drug after they are initially exposed to it in school.

Ritalin Is Not a Performance Enhancer

The term “study drug” refers to stimulant substances that are abused to increase focus and concentration during cram sessions before exams or to keep one awake all night to study and write papers. High school and college students notoriously abuse these drugs, mistakenly thinking they enhance academic performance.

The first generation of children exposed to Ritalin when their peers with ADHD began to take it assumed that these medications would improve performance for everyone. The compulsive habits formed around taking Ritalin and other ADHD prescription drugs have led to a generation of young adults who still abuse these substances in the workforce.

Evidence-based detox, followed by behavioral treatments in a rehabilitation program, are the core components of ending Ritalin addiction. If you have a tolerance for Ritalin and don’t use it for medical reasons, it’s a sign that you need help.

Sources

(October 29, 2013). Ritalin. Center for Substance Abuse Research (CESAR). Retrieved January 2019 from http://www.cesar.umd.edu/cesar/drugs/ritalin.asp

The National Center for Biotechnology Information. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628209/

(May 2013). Methylphenidate. Drug Enforcement Administration (DEA), Office of Diversion Control, Drug & Chemical Evaluation Section. Retrieved January 2019 from https://www.deadiversion.usdoj.gov/drug_chem_info/methylphenidate.pdf

Ritalin. ADDitude Magazine. Retrieved January 2019 from https://www.additudemag.com/medication/ritalin/

Should Your Child Take an ADHD Medication Break? WebMD. Retrieved January 2019 from https://www.webmd.com/add-adhd/childhood-adhd/adhd-medication-hiatus-benefits#1

(June 2018). What are Prescription Stimulants? National Institute on Drug Abuse (NIDA). Retrieved January 2019 from https://www.drugabuse.gov/publications/drugfacts/prescription-stimulants

Study Drugs. University Health Services, the University of Texas at Austin. Retrieved January 2019 from https://healthyhorns.utexas.edu/studydrugs.html

(October 19, 2016). Millennials Took Adderall to Get Through School. Now They’ve Taken Their Addiction to the Workplace. Quartz (QZ.com). Retrieved January 2019 from https://qz.com/812604/millennials-took-adderall-to-get-through-school-now-theyve-taken-their-addiction-to-the-workplace/

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