
Now we know why Ritalin works - chaostheory
http://www.smartplanet.com/technology/blog/rethinking-healthcare/now-we-know-why-ritalin-works/380/
======
goodside
"Why do stimulants like Ritalin turn ADHD kids normal but turn normal kids
into hopped-up screaming meamies?"

The second half of this, that normal kids on Ritalin and Adderall will be
overstimulated and unable to concentrate, is just plain false. Both have been
shown to improve concentration in healthy controls (with the notable
exceptions of people with anxiety, OCD, or other hyperglutamatergic problems,
and especially not people with schizophrenia). That's why it's prescribed to
pretty much everyone: because it works for pretty much everyone.

Some studies:

[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=R...](http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Retrieve&list_uids=7862911&dopt=abstractplus)

<http://www.ncbi.nlm.nih.gov/pubmed/18522689>

~~~
liminalist
Really? Ritalin makes me calmer and helps me sleep a lot better. Does it do
that for pretty much everyone?

~~~
dbz
I'm an Aderal person. If I want to work at 3 AM. I take some Aderal and I will
have the ability to think and not fall asleep no matter how tired I get. So
it(slightly different it) definitely does not do that to everyone.

On a side note: I have ADHD (and dyslexia but not really important) and Aderal
can sometimes make me more active that before-Yes it depends on how much I
take at one time, but still. I wouldn't say it calms me down. Meh

~~~
ScottWhigham
Same here - almost exact reaction. I remember as a kid that Ritalin used to
calm me down but, as an adult, these are definitely stimulants to me today.

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k0n2ad
No matter how you look at it, Ritalin, Adderall, Concerta and similar drugs
are amphetamines or amphetamine analogues. You can take them (at a threshold
dose that is unique to your body), and you will feel more focused,
concentrated and on top of things. Take too much of it (this includes people
with "ADHD") and you will have manic symptoms.

Do the medications help people with problems concentrating, impulsiveness and
attention (collectively known as ADD)? Yes. Are there healthier ways to change
your brain? Most definitely. I'd like to see a kid who is on ADHD get
prescribed an exercise/meditation/therapy routine and compare the results to
someone treated with medication. I'm sure the results would surprise a lot of
people. Our body is a feedback-oriented system. "Chemical Imbalances" in the
brain are often remedied with lifestyle changes. This includes "diseases" such
as depression, anxiety and adhd. The corporations that research these
conditions are quick to jump to conclusions based on limited scientific
information if it means they have a good chance of success. It's been
scientifically proven that exercise and diet play an enormous role in helping
you concentrate and pay attention. But you know what? Advertising exercise
won't make Shire Pharmaceuticals any richer. It's way easier for parents to
resort to a medication as well. Who has time to monitor their kids anymore?
Advertisements would have you believe that it's your only choice. AND they
make everything sound all scientific, when in reality they are picking and
choosing data. It's really a sad situation, but I hope there are enough people
out there who know about the alternatives. It sucks being so dependent on
these stimulants that you can't focus without them - you are bound to used
them for the rest of your life. And who even knows what the long term effects
are? The results are just starting to come in...

~~~
blueben
Actually, the results won't "surprise" a lot of people. For most ADHD
sufferers: Exercise and therapy are somewhat effective, medication is even
more effective, and combining the two approaches is the most effective. Big
surprise.

The results are not "just starting to come in", though that's a common claim
for folks who aren't actually familiar with the field. Ritalin has been
studied for over 70 years. People have been taking it for decades on end. The
long term results are that people with ADHD lead better lives. How horrible.

~~~
k0n2ad
No doubt, there are plenty of cases when medication is the right option.
However, there are many more cases where it's not.

How we do psychology? We take a bunch of symptoms that seem to coincide with a
group of individuals and we label it as a disorder :
<http://en.wikipedia.org/wiki/Adhd#DSM-IV_criteria>

The fact that these symptoms exist and cause problems for many individuals is
of no question - that's why we have a "disorder" label associated with it.
There is no dispute that medication is effective in treating these symptoms,
either.

However, the claim that medication "even more effective" is flimsy, if not
flat out wrong. The problem is that there are many more studies devoted to the
"effects of ritalin on ADHD" than there are to the "effects of exercise and
ADHD." Or meditation, or biofeedback, or eating 7 lbs of celery a day, or
whatever. To make the claim that "drugs are more effective" is easier because
studies of this nature are more prevalent - but it doesn't make it right. That
would be a total confirmation bias.

A difficulty in comparing medication to other methods is that medication =
instant gratification and instant results. You eat a pill. A half hour later,
you are focused, less scattered and more attentive. In the similar way to how
coffee wakes you up if you are tired. It's easy to make an experiment out of
such results. Exercise, in contrast, isn't instant. Exercise increases levels
of nor-epinephrine and dopamine... but not nearly as rapidly (or with as
little work) as an amphetamine compound. Steady and healthy levels of
serotonin (which is now being studied as another player in the ADHD game)
don't begin to rise until weeks of daily exercising. It may be slower, but our
bodies are capable of changing, and for quantities of any given chemical being
pumped out to increase, you need to keep doing things that keep causing it to
be released. You need to form habits that make your body more effective at
producing it's own chemical cocktails. Take a basic course in human physiology
or neuroscience if you don't believe how amazing and capable our bodies and
brains are at adapting and improving.

Furthermore, a disorder label can easily be misconstrued by a young individual
with ADHD. They might think to themselves, "Wow, finally, a word to describe
all the problems I'm having. It's not my fault after all, I'm sick, and I need
medicine." It sucks because instead of really trying to go beyond the
condition by using their will, they may give up and go the route of altering
their minds externally - just to keep up with their peers. Is that a bad
thing? Well, I'll leave that up to the reader.

It is my personal opinion that that overcoming challenges of ADHD is not only
possible through other, healthier methods (exercise, meditation and
learning/coping strategies), but is more rewarding as well (speaking from
personal experience).

However, no one can do this by themselves - and it sucks that some people do
not have the support, and that schools don't have a 15 minute exercise break
every 3 hours, and that they don't let you eat snacks in class, and that we
are constantly exposed to electronic stimulation from a very young age, that
some of us don't learn how to control our intake of these things. Television,
video games and other forms of electronic stimulation have been proven to
release dopamine (Jeez, what doesn't?). A person with ADHD can easily focus to
a show on TV with quickly changing camera angles, loud sounds, constant
dialogue and continuous novelty. We grew up with this. But, when we are in
class, we fidget, and daydream and blurt things out because this stimulation
is not present, so our bodies are attempting to mitigate the dopamine
withdrawal through the constant production of activity, of both the mind and
the body.

Finally, Ritalin hasn't been studied for 70 years. It's been about 40. It
didn't start being used for ADHD until The late 60s, and wasn't in widespread
use until the 90s - which is when the more serious studies began to come out.

There's much more to say, but I'm getting tired :)

Sources: [http://www.usatoday.com/news/health/2006-03-26-adhd-
treatmen...](http://www.usatoday.com/news/health/2006-03-26-adhd-
treatment_x.htm)
[http://www.sciencedaily.com/releases/2004/12/041220013546.ht...](http://www.sciencedaily.com/releases/2004/12/041220013546.htm)
<http://www.medscape.com/viewarticle/565830>

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carterschonwald
its not really news that Ritalin and other Schedule II stimulants work by
increasing the amount of Dopamine in the brain, though the article's point
about there being structurally fewer dopamine receptors might be.

That being said, for those with moderate - severe adhd, those prescription
stimulants are the difference between a functional happy lifestyle and one
which isn't.

~~~
daniel-cussen
_...Those prescription stimulants are the difference between a functional
happy lifestyle and one which isn't._

As an ADD, I can attest to this. I would even go further: with Strattera, it
feels like I have two minds that work simultaneously.

One is free to ponder on the workings of the universe and all things abstract
therein.

The other that is like a nanny. It takes care of piddling shit like not
getting hit by traffic, remembering why I went into a room, basic politeness,
not pissing people off, the whereabouts of my possessions, and remembering if
I have to be somewhere at a given time.

Sure, I could take no medication and try focussing more on the basic things
I'm supposed to remember instead of being a space cadet, but I could never get
myself to. It's just not sexy enough. I prefer to "have two minds."

~~~
cracell
You actually like Strattera? I went on that stuff for a month and it was the
worst feeling ever. It felt like a gun pressed up against the back of my brain
all the time, I pretty much wanted to die.

Ritalin and traditional stimulates on the other hand are always great but I
build up a tolerance quickly. (Currently I just use various caffeine sources
to concentrate.)

~~~
jamesbritt
This is the interesting thing about ADD: Why do some drugs help some, but not
others, for what appear to be a common set of symptoms?

~~~
blueben
For the same reason there are dozens of NSAIDS and pain killers. Humans are
complex systems, and complex systems exhibit complex behaviors including
differing reactions to similar inputs.

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pkaler
I work out twice a day. It's the best way I've found to keep myself sane and
productive. I've never taken any drugs but I'll sleep 10+ hours a day or get
ridiculously jittery if I don't.

And I've also found that I am most productive if I have a coffee exactly at
6AM and 3PM.

I have spreadsheets to track my sleep and caffeine consumption with respect to
productivity. Classic signs of ADHD.

~~~
garply
Caffeine is a drug.

~~~
pavs
The good type of drug, the type you don't have to steal from your room-mates
secret stash.

------
Semiapies
"What they found was the ADHD people had fewer of these cells, meaning our
brains are less capable of processing dopamine, the chemical 'attaboy,' than
other people. _It’s all gone into the Journal of the American Medical
Association._ "

Those dopamine-thieving bastards.

------
pmiller2
The real news here isn't so much "why Ritalin works," but that we now have a
coherent theory of the pathophysiology of ADHD (fewer dopamine receptors in
the brain). That the theory explains why Ritalin (and other meds) work is just
a very nice consequence of the theory.

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jganetsk
Gotta love any article that tries to take on numerous very complex phenomena
and package them together into a very simple sound bite.

~~~
cracell
I really enjoy how every single mental disorder has to do with not enough or
too much dopamine.

~~~
camccann
To be fair, almost everything that happens in the brain has to do with
dopamine one way or another.

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scott_s
Blankenhorn's comments after his post are just as good as the post itself.

------
yters
I think the real reason we have so much neuroticism in our culture is that we
don't believe there is an accessible realm of objective, real value. We think
that everything we find pleasure and meaning in is merely physical, thus
doomed to elimination. However, we yearn for unchanging meaning, and can never
find satisfaction in these transient distractions.

Seems that instead of focusing on things like therapy and medication, we
should try to find an absolute source of meaning that actually satisfies us.
Something like a more reason based approach to dealing with neuroticism,
identifying the actual root and trying to find its solution, would be much
more effective. But, I've never heard of such a thing. Instead, it's all about
regulating ourselves and trying to become normal, though since no one is
normal there doesn't seem to be such a thing.

~~~
Psyonic
Sounds good, suggestions as to an absolute source of meaning, that doesn't fly
in the face of rationality?

~~~
yters
Yes, free will and purposeful intelligence. Essentially, if all intelligence
boils down to algorithms of one sort or another, then per the no free lunch
theorem, all we can expect is randomness. All appearances of order and meaning
are merely illusory.

However, I think I've empirically established we (or at least I) have free
will and purposeful intelligence. Thus, at least I can access meaning.

<http://www.box.net/shared/u13u3agxqg>

