Can I take Dexedrine and Ritalin together?
Ritalin belongs to the group of Amphetamines and is subject to Narcotics Act, therefore every prescription must be reported. It is energizing and produces pharmacological effects similar to those of cocaine and other amphetamines. Methylphenidate is also used for the treatment of narcolepsy (a sleep-wake disorder with symptoms such as daytime sleepiness, cataplexy, and fractional night sleep, also translated as "unrestful sleep"). However, the increase in the production and use of this drug in recent years can largely be attributed to the treatment of ADD children. An increasing number of Abuses can recently be traced back to adolescents who take methylphenidate for its stimulating effects: to drive away tiredness, to increase attention, to be able to study all night or to experience the euphoric effect. Pharmaceutical tablets are mostly taken orally or pulverized nasally. Some addicts dissolve the tablets in water and inject, the insoluble fillers in the tablet clogging small blood vessels and causing serious problems Damage in the lungs and retina. In the mid-1990s, the drug became a party drug that schoolchildren sniffed in powdered form like cocaine in the United States.
Effects and side effectsAccording to the manufacturer, Ritalin should be prescribed to children with "hyperkinetic behavioral disorders as part of an overall therapy". It is no Remedy, but merely suppresses symptoms and must therefore be taken continuously. Whether Ritalin dependent power is controversial. Effects according to Rätsch (1998):
- mood-lifting and euphoric
- gives a feeling of increased energy
- increases alertness, alertness and performance
- lowers appetite
- drives away tiredness
- Blood pressure and pulse increase
- the pupils dilate
- the muscles are supplied with more blood
- Oxygen and glucose concentrations in the blood increase
- In some cases, empathogenic and hallucinogenic effects can also occur.
Possible Side effects are insomnia, loss of appetite, and stomach upset. Low oral doses (2.5-20 milligrams) lead to reactions that correspond to the biochemical preparations of the body in fright, flight or attack reactions: increased blood pressure, accelerated pulse, relaxation of the bronchial muscles, increased alertness, euphoria, excitement, alertness, a reduced feeling of tiredness , Loss of appetite, lightening of mood, increased motor activity and the urge to talk, performance increases briefly, dexterity and fine motor skills can deteriorate. These undesirable effects often subside as the duration of therapy increases. Other side effects include overexcitability, fatigue, sadness, anxiety, tearfulness, headache, dizziness, weight loss, dry mouth, diarrhea, and constipation. In moderate doses (20-50 milligrams) there is stimulation of breathing, slight tremors, restlessness, further increases in motor activity, sleep disorders and more pronounced states of excitement. Fatigue and appetite are suppressed to a greater extent. Overdose leads, for example, to cramps, fever, tremors up to circulatory collapse and respiratory paralysis. These undesirable effects often subside with continued use. After prolonged use you can when suddenly weaning Pronounced depression and fatigue occur as a withdrawal syndrome. It may take a few weeks for the sleep pattern to fully normalize. Interactions at Mixed consumption with other substances are risky: With alcohol interactions are not calculable, alcohol poisoning is possible. cannabis can increase the effect of Ritalin, hallucinations can occur! With Ecstasy ingested, the circulation is heavily stressed, a greater loss of fluid is possible. Anxious people, people with cardiovascular diseases, high blood pressure, hyperthyroidism and mental illnesses (schizophrenia, Tourette's syndrome, depression, etc.) and pregnant women should not consume Ritalin. A study by the M.D. Anderson Cancer Center (University of Texas) suggests that methylphenidate may be carcinogenic is. In this study, chromosomal abnormalities (such as mutations) were found in 12 children (standard dose administration) after three months. The relationship between chromosomal abnormalities and cancer is well documented.
In a long-term study by Gene-Jack Wang et al. (2013) showed that in adult ADHD patients, long-term use of the stimulant Ritalin in the reward center increased the protein (dopamine transporter) that the drug was supposed to inhibit, suggesting that tolerance to the drug may develop over time, which would make stopping Ritalin worse. After the end of the one-year intake, the DAT availability in some brain areas of the reward center (putamen, caudate, ventral striatum) had increased by up to 24 percent. It is assumed that the increase is a reaction of the cell to the increased concentration of the messenger substance in the synaptic cleft.
Attention disorders became the "Fashion diagnosisExperts therefore warn against using the drug without hesitation, because not every restless, lively child is hyperactive. Pediatricians and psychiatrists are overwhelmed with the exact diagnosis and also resort to the Ritalin prescription prematurely for other types of disorders. Ritalin influences the Metabolism of the brainis the popular theory. The neurotransmitter is missing in the brain regions in which attention and movement are controlled Dopamine. Neurotransmitters are chemical substances that are released at the synapses (endings of nerves) and intervene in the communication between the neurons. So they have the function of one Messenger substance. Dopamine is such a signal transmission substance and influences emotional and mental reactions in the central nervous system and controls movement designs, e.g. facial expressions. Disturbances in the dopamine balance are observed or suspected in various diseases: For example, the Parkinson's disease (Paralysis) attributed to a lack of dopamine in certain areas of the brain. In schizophrenia, too, there is likely to be an imbalance compared to healthy people. In addition to its function as an exciting neurotransmitter, dopamine is important as a precursor to noradrenaline and adrenaline. The lack of dopamine disrupts data processing in the brain. The researchers have not yet deciphered why this is so. Nor do they know what actually happens in the brain when taking Ritalin and why, paradoxically, the mostly hyperactive children can be soothed with a stimulant that they can follow the lesson and function properly for a few hours. Research has shown, for example, that when methylphenidate is administered intravenously, it blocks the DAT transport mechanism of the neurotransmitter dopamine, which can increase the dopamine concentration in the brain. However, it was not known to what extent the therapeutic amounts usually taken orally for ADHD (in the USA often 10-20 mg / 2-4 times daily) also lead to a significant change in the dopamine level. Nora D. Volkov et al. succeeded in measuring the change in dopamine levels after taking methylphenidate tablets. It was found that the active ingredient blocks the transport mechanism even when taken orally (50-75% in the experiment) and thus contributes to the desired increase in dopamine concentration. However, this increase turned out to be quite different among the test subjects. The reason for this should be further investigated, as this could be the answer to why the drug does not work (equally) in all patients. The result of the New York research team fits in with other research results that have found that the DAT transport mechanism in ADHD patients is more active, whereby the neurotransmitter dopamine is removed from the cells too quickly. Eleven men between the ages of 20 and 40 took part in the study. The test subjects did not suffer from ADHD. The scientists believe that there is no reason to doubt that dopamine levels will also increase in ADHD patients after taking methylphenidate. The extent of this increase could, however, be different. Further research must also be carried out to determine whether the effect of the drug on the DAT transport mechanism diminishes with long-term use. The effect of methylphenidate was measured with the aid of the PET (positron emission tomography) imaging method in the striatum, a part of the endbrain. The results of this study have provided additional knowledge about the effect of Ritalin (here the active ingredient is usually injected) when it is misused by drug users. Taking it as a tablet obviously does not have the same effect that drug users want. This observation raises the question of whether the active ingredient methylphenidate may not have any or too little effect when taken orally. In their report in the Journal of Neuroscience, the researchers state that the dopamine concentration increases with oral intake to the same extent as intravenous administration. Nevertheless, the test subjects did not report a "high" feeling, as test subjects in previous studies who were given the active ingredient intravenously. The scientists attribute this to the different time span until the full effect. After intravenous administration, the dopamine concentration increases within a few minutes, with oral intake it takes about 1 hour to achieve the full effect and this longer period gives the body the opportunity to slowly adapt.
How does methylphendidate work?
People with ADHD or other cognitive disorders are often prescribed the active ingredient methylphendidate, which is supposed to help them concentrate better, but even those not affected by this disorder are increasingly using this drug in the course of brain doping to improve their memory or theirs in general to increase mental performance. Methylphendidate and related drugs intervene deeply in the brain metabolism by inhibiting the reception of neurotransmitters such as dopamine, so that the concentration of these messenger substances in the brain increases. However, it is unclear whether the increased dopamine levels then directly increase performance or rather indirect effects are responsible for the observed effect. Dopamine plays a role in learning processes and working memory as well as feelings of reward and motivation, with methylphendidate possibly being responsible for making people more motivated. Westbrook et al. (2020) have developed a model that dopamine could lead the brain to focus more on benefits in cost-benefit calculations. Weighing up the costs and benefits of an activity is a fundamental brain function that is mostly unconscious. Westbrook et al. (2020) tested this assumption in an experiment by first documenting the natural dopamine concentration in the stratium - it controls the interaction of emotion, motivation, cognition and movement - in their test subjects. In a series of cognition tests, they then had the choice between difficult and easy tasks, with higher amounts promised as a reward for a high level of difficulty. It showed that decision-making behavior also depended on dopamine levels, with people who produced less dopamine tending to avoid cognitive challenges and being more receptive to the costs associated with the difficult tasks. Subjects with high dopamine levels therefore concentrated primarily on money, i.e. that is, they were more focused on utility. One could conclude from this that methylphenidate only indirectly increases performance by increasing motivation. Accordingly, dopamine increases the will to achieve a goal cognitively at an early stage in the decision-making process, so that ultimately one can concentrate better and complete a task more successfully.
Methylphenidate as a substitute drug?
So Ritalin works like that cocaine into dopamine metabolism so that it could help cocaine addicts get away from addiction, comparable to methadone in heroin addiction. Cocaine addicts Like people with attention deficit syndrome, they have poor control over their impulses, i.e. they are poor at suppressing spontaneous reactions. In an experiment in the United States, test subjects who had used cocaine regularly for 8 to 18 years were given an injection of methylphenidate. When subjected to reaction tests on the computer, the subjects performed better than the control persons in the experiment, who had only received an injection of saline. In the test subjects' brain, the drug had also changed the activity of the nerve cells in the prefrontal cortex. However, many are looking for the massive kick of cocaine and are therefore less likely to know what to do with the substitute than some heroin addicts with methadone, although methadone fails with a considerable number of heroin users and is therefore given to this heroin in some countries. High doses of Ritalin can cause changes, at least in the reward center of the mouse brain, similar to those found in cocaine addicts. Nora Volkow, the director of the National Institute for Substance Abuse in the United States, warned against treating children and adolescents with ADHD with Ritalin or similar preparations. According to recent studies in animal experiments, methylphenidate changes the synaptic connections in the amygdalaso that there could be an effect beyond the duration of the application. Whether this is positive or rather disadvantageous for the user can hardly be deduced from animal studies. ADD is difficult to diagnose. The elaborate magnetic resonance recordings of the brain metabolism, with which American researchers have proven the lack of dopamine, are not possible in the reality of pediatricians and child psychology. There is therefore a high risk that Ritalin will also be administered to children whose behavioral problems arise for other reasons. Before diagnosing ADD have to other causes of abnormal behavior to be clarified:
- Depressive and Bipolar Disorders
- Anxiety disorders
- Addictions such as alcohol addiction, gambling addiction, eating disorders, etc.
- Disorders with oppositional defiant behavior / behavioral disorders in children
- Learning disabilities, especially weaknesses in writing and reading
- Psychotic illnesses and developmental disorders
- Obsessive-compulsive disorder
- Personality disorders
- Tic disorders
- Hypo- and hyperthyroidism
- Sleep disorders
- Hereditary diseases (chromosomal disorders such as Klinefelter syndrome)
- Brain injuries, trauma
The desired changes in behavior occur in 70 to 80 percent of children after taking Ritalin. However, Ritalin is no cure. The desired behavior must be practiced and consolidated through other forms of therapy. First and foremost, behavior therapy is appropriate, but relaxation methods, occupational therapy, psychomotor exercises can also be helpful, possibly also homeopathic preparations. In a number of cases that should not be underestimated, a change in diet can bring success. Both the general waiver of treatment with methylphenidate and the exclusive treatment with methylphenidate without accompanying psychotherapeutic interventions as well as high-dose treatment with methylphenidate are after the Opinion of the professional associations for child and adolescent psychiatry and psychotherapy to be rejected in Germany as inadequate treatment strategies.
In 2010, 1.3 million tablets containing methylphenidate were administered to children and adolescents in Germany, an increase of 5200 percent within 17 years, so the question arises as to why there are suddenly so many congenital transmitter disorders. A noticeable number of restless children and adolescents between the ages of six and 21 were also observed in the years from 1947 onwards. At that time, a large number of nervous disorders, excessive nervousness, motor restlessness, poor concentration, sleep and speech disorders were diagnosed in children. Presumably it was a variety of traumatizations after the war, such as the break-up of families, experiences of separation and an absent or traumatized father, i. In other words, there was no favorable milieu at the time that could have helped to compensate for the wounds suffered. Even today, in the age of increasing divorce rates in families, there is often a lack of stability and the father figure, which is a problem especially for boys. In addition, some children are left to their own devices too early today, i. In other words, there is a lack of support and limitation, while autonomy is often promoted on one side.
The development pharmacology working group, which has now been established and which arose in connection with the research of the Göttingen neurobiologist Hüther, tries to scientifically investigate this "miracle cure" for stressed parents. Hüther points out that there is still virtually no research on the question of how the administration of Ritalin affects the development of the human brain. Experiments with children cannot be done for ethical reasons, but experiments with rats clearly indicate that methylphenidate (Ritalin) has a negative effect on the maturation of the dopamine system. Long-term research on side effects is also few and far between. In addition, the "metabolic disorder" theory is an assumption - now common, but not yet proven. Above all, cause and effect have by no means been clarified: Psychosocial influences also change the metabolic processes in the brain, so that the one-sided attribution of the cause, "genetic defect of the metabolic system", is very shaky. The majority of the (non-medical) child and adolescent psychotherapists working in Germany are also very critical of the new trend of distributing ADD diagnoses en masse and treating them with Ritalin. A large part of the impairments diagnosed as ADD can be identified as other psychological disorders when diagnosed more precisely, or the ADD diagnosis is at least very questionable as the sole cause of the existing problems of the child. Meanwhile there is a trend to assign "normal", only somewhat lively children with the ADD diagnosis and to prescribe Ritalin, according to the circular diagnosis: if Ritalin works, ADD is present. Even the (medical) child and adolescent psychiatrists recommend careful differential diagnosis and cautious medication in their guidelines. See e.g. the official statement of the German Society for Child and Adolescent Psychiatry http://www.dgkjp.de/stellung.htm.
One can assume that the phenomena that are nowadays summarized under the diagnosis ADD are a multitude of very different phenomena with different causes (partly neurophysiological, partly psychosocial, partly psychodynamic). In this respect, a purely symptomatic ADD diagnosis is not to be thought of as much and the standard prescription of Ritalin, sometimes without an effect check, should be examined more critically. Incidentally, one should ask who might be most interested in the fact that there is such a thing as an organically based "disease" ADD and that it is treated with medication, and that in large numbers ...
ADD stands for the English "Attention-Deficit-Disorder" and describes a diagnosis which is primarily characterized by considerable impairment of concentration and sustained attention, self-regulation functions, planning and action control, impulse control disorders and, optionally, motor hyperactivity (ADHD) . In German-speaking countries, the term ADHD and sometimes also ADS is used for ADD / ADHD. In Switzerland ADD is also known under the term "POS".
Children with hyperactivity and attention deficit disorder (ADD ->) are at risk in their psychological development, school and professional education as well as social integration. Excessive motor restlessness, disturbed attention, impulsiveness and easy excitability make life difficult, so that the suffering is great. According to this, the disorder has disease value, which is why the WHO has included it in the catalog of mental illnesses.
The treatment of children with hyperkinetic disorders should only take place if it is based on diagnostics that refer to examination findings on physical, cognitive and psychological functions as well as social ties that are relevant to the disorder. A somatic neurological examination (body height, body weight, heart rate, blood pressure), laboratory diagnostics (differential blood count, electrolytes, liver status, thyroid and kidney function values), a resting EEG and cognitive performance diagnostics are therefore essential. Orientational family diagnostics and behavioral analysis are necessary.
The drug treatment is part of the psychotherapeutic and specifically educational care of the child in cooperation with the family and, if necessary, with kindergarten, school and other institutions that look after the child. The mere restriction to pharmacotherapy disregards elementary needs and demands of children and contradicts the rules of good clinical practice as well as diagnosing or prescribing without examination.
The medical therapy control has to regularly monitor eating behavior, growth, cardiovascular functions and general behavioral development (occurrence of tics?), The latter if necessary using established scales for behavioral assessment.
Newsgroup: de.sci.psychologie: 37019 Subject: Re: Prosac / Retalin Date: Wed, 4 Jul 2001 00:13:59
Rätsch, Christian (1998). Encyclopedia of Psychoactive Plants. Botany, Ethnopharmacology and Application. Stuttgart: Wiss. Verl.-Ges. Aarau.
Nora D. Volkow. Gene-Jack Wang, Joanna S. Fowler, Jean Logan2, Madina Gerasimov, Laurence Maynard, Yu-Shin Ding, Samuel J. Gatley, Andrew Gifford, and Dinko Franceschi (2001). Therapeutic Doses of Oral Methylphenidate Significantly Increase Extracellular Dopamine in the Human Brain. The Journal of Neuroscience, 21, pp.1-5.
Michael Huss & Ulrike Lehmkuhl (undated). Hyperkinetic today, addicted tomorrow? Risks and opportunities in the development of children with hyperkinetic syndrome (HKS).
WWW: http://www.liga-kind.de/neu/pages/301huss.htm (02-03-07)
Schmidt, Hans-Reinhard (undated). Does my child have ADHD? That's impossible!
Wang G-J, Volkow ND, Wigal T, Kollins SH, Newcorn JH, et al. (2013). Long-Term Stimulant Treatment Affects Brain Dopamine Transporter Level in Patients with Attention Deficit Hyperactive Disorder. PLoS ONE 8 (5): e63023. doi: 10.1371 / journal.pone.0063023.
Westbrook, A., van den Bosch, R., Määttä, J. I., Hofmans, L., Papadopetraki, D., Cools, R. & Frank, M. J. (2020). Dopamine promotes cognitive effort by biasing the benefits versus costs of cognitive work. Science, 367, 1362-1366.
The pharmacologist Arvid Carlsson discovered this around 60 years ago Dopamine and received the Nobel Prize in Physiology or Medicine in 2000 for his research into signal transmission in the nervous system. His research enabled a targeted treatment of Parkinson's disease, clarified connections between neurotransmitters in the brain and emotional states and led to the development of modern antidepressants.
According to the current state of research, the picture continues to be controversial. On the one hand, theoretical-pharmacological considerations as well as a number of animal experiments and clinical results speak in favor of the addiction-promoting effect of methylphenidate, on the other hand, some clinical studies point in the opposite direction. According to the latter studies, children with HKS who were treated with methylphenidate appear to be less susceptible to addiction disorders than children with HKS who have not been treated with drugs. In the drug-treated group, however, the risk of addiction does not fall below that of the normal population, so that all considerations of trying to solve the drug problem with methylphenidate must be rejected. In the studies mentioned, the increased risk of addiction in children with HKS could only be reduced to the normal level.
As part of the required close-knit medical care, the children's lack of compliance should be counteracted with targeted escape attempts - ideally during the long holidays. If the omission attempts are planned and with the direct involvement of all those involved, including the teaching staff, a comprehensive picture of the previous medication effects and the possibility of assessing the further necessity of pharmacological treatment for the benefit of the child emerges. Addiction as a long-term consequence does not seem - if at all - to be due to methylphenidate, but to the already increased risk of addiction in children with HKS, especially in combination with a disorder of social behavior. The described favorable long-term effects on the development of addiction are possibly due to a stabilization of the school and family situation of the child as well as to the reduction of his frustration in almost all areas of life.
Michael Huss & Ulrike Lehmkuhl (undated). Hyperkinetic today, addicted tomorrow? Risks and opportunities in the development of children with hyperkinetic syndrome (HKS).
WWW: http://www.liga-kind.de/neu/pages/301huss.htm (02-03-07)
In Curative Education Research (2001, Issue 3), Jürgen Walter provides a literature review based on American research under the title "Can Ritalin (methylphenidate) improve school performance for students with attention and hyperactivity issues?He is primarily concerned with the effect of Ritalin specifically on learning and school performance. The main effect of drug treatment is the short-term behavioral "manageability" of hyperkinetic children. Improvements in behavior are highly likely to be very little improvements in school performance accompanied. Since relatively positive teacher judgments about improvements in school performance on the one hand could hardly be confirmed by special tests on the other hand, independent measurements should be made when evaluating the impact on school performance. As an explanation for the supposed paradox that psychostimulants improve the core symptoms relatively reliably, but hardly school performance in the medium and long term, it can plausibly be assumed that Ritalin per se (a) can hardly compensate for knowledge and competence deficits and (b) high ones Attention, low impulsivity, and low hyperactivity are necessary, but by no means sufficient, determinants of school performance.
Reward instead of Ritalin
At the University of Nottingham, the project is researching "Motivation, Inhibition and Development in ADHD Study”(MIDAS), what goes on in the brain of children with AHDS. The children had to cope with different tasks and it was found that almost the same effect as with the administration of Ritalin was achieved when the children received rewards such as praise for correct solutions. The effects of medication and rewards were also visible in the EEG, because once the correct solution has been reported, event-related potentials arise. Although the rewards in children with AHDS had a somewhat weaker effect than drug therapy, especially in the case of mild illnesses, an effect can obviously also be achieved with educational measures, while Ritalin or comparable drugs should be limited to severe illnesses.
Groom, Madeleine J., Scerif, Gaia, Liddle, Peter F., Batty, Martin J. Liddle, Elizabeth B., Roberts, Katherine L., Cahill, John D., Liotti, Mario & Hollis, Chris (2010). Effects of Motivation and Medication on Electrophysiological Markers of Response Inhibition in Children with Attention-Deficit / Hyperactivity Disorder. Biological Psychiatry, 67, 624-631.
Arguments of the Ritalin opponents
In 1986 the International Journal of the Addictions published a comparative study of more than a hundred scientific publications dealing with the Side effects from Ritalin grapple. These include, among others: paranoid psychoses and delusions, hypomanic and manic symptoms, hallucinations, extreme isolation, anxiety, insomnia, risk of addiction, psychological dependence, nerve twitching and cramps, aggressiveness. The U.S. Forces are refusing to accept recruits who are taking Ritalin or similar psychoactive drugs. Anyone who was put on Ritalin as a child and no longer uses the pharmaceutical drug is declared unfit for work. In addition, children in particular often receive not only Ritalin, but also antidepressants (Prozac, etc.). This combination significantly increases the health risk and can lead to strong emotional fluctuations.
In November 1998 the American National Institute of Mental Health held a meeting that aimed to clarify the cause of ADD once and for all. It was concluded that ADD was not a definite diagnosis and that there were no scientific results to show that ADD was due to a malfunction of the brain. In addition, there were no positive long-term effects when using Ritalin.
In 1996 a television sport revealed that the largest American non-profit organization dealing with ADS and running information campaigns in schools, public events and in the media is sponsored by the Ritalin manufacturer Ciba-Geigy (now Novartis) in the millions. 90 percent of all Ritalin production is sold in the USA. In 1988 two tons of tablets were prescribed, in 1997 it was 14 tons! Over six million US school children are already under the influence of Ritalin.
Why psychoactive drugs are experiencing such a boom in the USA has to do with the American health system: Over 90 percent of people are insured in so-called "Managed Care" systems, which pay close attention to costs. In other words: The personal care by therapists is replaced by the use of psychotropic drugs.Psychotherapeutic treatment is not paid for by the health insurers, but Ritalin is. Because of this, spending on psychiatric treatment in the United States has decreased by 80 percent. The American pediatrician, family therapist and Ritalin critic Lawrence Diller: "It is so much easier for us to diagnose a child's disorder and give him pills than to respond to his needs."
By the way: The Association of American Pediatricians has expanded the guidelines for the dispensing of methylphenidate to children: In future, children from the age of four may be treated with the active ingredient, which has moved the limit down by two years. However, the guideline recommends that children between the ages of four and five should first be treated with behavioral therapy. If there are no significant improvements, treatment can be carried out with methylphenidate. However, where there is no behavioral therapy available, methylphenidate medication can be started immediately. Primary school children aged 6 to 11 can be treated with Ritalin and / or behavioral therapy, for 12 to 18 year olds the administration of methylphenidate is recommended, possibly supplemented by therapeutic measures.
Declining trend in the prescription of Ritalin in Germany
A downward trend was observed for the first time from 2012 to 2013: The consumption of methylphenidate fell by 2 percent compared to the previous year, but too much optimism is not appropriate, because after the rapid increase of the last few decades, it has stabilized at a high level, and this has to be added that there are now various other preparations that have about the same effect. The slowdown in development has two main causes: On the one hand, those affected and doctors have become aware that, under the influence of the pharmaceutical industry, it has been quite exaggerated so far, i. This means that the prescribing practice of the early years has subsided, as has the willingness of those affected or their parents to simply take methylphenidate because the doctor recommends it. On the other hand, there have been various regulations by politicians and authorities in recent years to curb the prescription madness to protect children. With an average daily dose of 30mg, around 60 million daily doses were still consumed in Germany in 2013, and in 2010 56 million daily doses of methylphenidate were prescribed by statutory health insurance physicians.
In a statement by the Swiss National Ethics Commission (2011), serious concerns were raised about the increasing use of psychotropic drugs in enhancement, the pharmacologically produced increase in the performance of the brain. Accordingly, the enhancement in children deserves special attention: "There is an increasing tendency to pharmacological interventions that do not yet affect (fully) judgmental people, about which adults, as a rule the parents, are also allowed to make decisions on health issues. This tendency gets an additional boost from the parents' motivation to want and ensure only "the best" for their child. Often, "the best" is defined with a view to future life in society: the parents usually want that Child survives well in the competition for education and a job, especially by improving their cognitive, but also emotional and social skills and increasing their “stress resistance.” This competition begins very early, increasingly when they start school. It is well known that psychotropic drugs also have an effect on healthy children The incentive for parents to use such funds is correspondingly high to encourage the child's attention and concentration, making them more competitive. Such an “optimization” of the child's abilities takes place without expenditure of time and also goes unnoticed, so that the parents do not have to make critical comments. From an ethical perspective, the fact that the diagnosis of, for example, attention deficit disorder, oppositional defiant behavior or an anxiety disorder is a technical challenge because the distinction between normal and abnormal child behavior is difficult to draw. It can also be assumed that the increase in the consumption of psychotropic drugs has also shifted or shifted the standards as to which behaviors of a child or adolescent are socially acceptable and "normal" - or are classified as pathological. Since the diagnosis is also influenced by such social assessments and an interest in children in kindergarten and school behaving appropriately, a further increase in prescriptions is to be expected. This example shows that the demarcation between enhancement and the need for therapy is culturally and historically variable - and therefore also requires ethical reflection. The consumption of pharmacological agents can have further effects on the character because the child is taught that only with the help of such agents can they "function" in a socially recognized manner. Insofar as his character traits are adjusted with drugs and made dependent on psychotropic drugs, it has consequences for his personality development and his self-esteem and could promote the development of patterns for addictive behavior. The pressure to conform that children are under from their parents and educational institutions enforces a standard of normality that reduces tolerance towards childliness. The variety of temperaments and ways of life could also be reduced and ultimately the child's right to an open life path could be endangered. The NEK-CNE advocates adapting living conditions to the interests and needs of children. Because the qualities of childhood, which do not concern aspects of social competition and performance, but rather play, friendship and leisure relieved of success, could otherwise lose their appreciation - and with it the childhood itself.
National ethics committee in the field of human medicine (2011). Human Enhancement: About the "improvement" of humans with pharmacological means. Opinion No. 18/2011.
WWW: http://www.bag.admin.ch/ (11-11-21)
A new model based on developmental biology and developmental physiology
All disease models are always Simplification of mostly very complex and individually very different processes. They are thus characterized by inadmissible generalizations, by overemphasis on individual aspects and editorialistic neglect of other aspects of the process that leads to the condition that we define as a specific disease. Nevertheless, we need such models in order to understand the pathogenic process, recognize it in good time and, if necessary, correct it. Since the earlier it takes place, the easier it is to correct such a process, disease models from which preventive, diagnostic and therapeutic action strategies can be derived are of particular value.
On the basis of the newer findings that have now been added and the re-evaluation of existing results that has now become possible, an attempt can now be made to design a model of the process that leads to the development of symptoms that are currently understood as a disease entity and referred to as ADHD. In contrast to the previously used chain of arguments, which has now become quite questionable, this new thought model is characterized by the fact that it corresponds to and can be derived from the current state of knowledge not only in the field of neurobiological ADHD research, but also in developmental biology and developmental psychology .
This model assumes that there are children who are newborns and during their time Toddler phase are considerably more alert, alert, curious and easier to stimulate than others. Why this is so, whether these children already have a more highly developed dopaminergic system that reinforces their drive at the time of their birth, whether this characteristic is genetically determined or only arose during intrauterine or early postnatal development, can initially remain open. More important than this particular "talent" that the child has brought with them is what the child makes or must do with it in the further course of its development during the first years of life. Since the further maturation of the dopaminergic projection tree obviously depends on how often the dopaminergic system is activated by the perception of new stimuli and stimuli, children who grow into our world with this special alertness and stimulability all too easily run the risk of falling into one Vicious circle to guess:
Since they are already particularly alert and all too easily stimulated by new stimuli, their dopaminergic system is activated much more frequently than that of other, "normal" children and stimulated to increased growth of its axonal processes. Because their dopaminergic, drive-controlling system is developing better and better and thus also working more effectively, these children are more and more easily stimulated and stimulated by all kinds of new stimuli. If it is not possible to break this vicious circle now, it is only a matter of time before such a child becomes conspicuous due to its excessive drive, its enormous inner restlessness, its constant search for new stimuli, i.e. due to its distractibility and lack of concentration . By themselves, such a child is unable to control his or her excessive drive, in a sense it has to fidget all the time and constantly discover new things and get excited about them instead of concentrating on one thing. And it is now increasingly becoming a burden for playmates who refuse it, for parents and educators who cannot handle it and see its further development (at the latest when starting school) endangered.
So the child inevitably gets into one second vicious circle: Through the particularly frequent and intensive use of the nerve cell interconnections created in his brain and responsible for the control of his undirected motor skills, his unselective perception and his untargeted attention, these complex interconnection patterns become better and more effective over time - and others are used less intensively neural interconnections correspondingly less strong - have been developed and expanded. If the child's behavior increasingly gets into psychosocial conflicts and becomes emotionally insecure, the resulting stress reaction leads to an increased release of certain transmitters and hormones, which in turn also contribute to the neuronal interconnections and synaptic connections stabilize and pave the way, which activates the child to restore his emotional balance (Hüther 1998). If it tries to do this by fidgeting, it will become an increasingly "better" fidget and possibly even develop a motor tic. If it tries to do this by disturbing it, it becomes an increasingly "better" troublemaker and develops into an unloved outsider. If it tries by listening away, it will initially become "deaf" in one, possibly even in both ears. If at some point no one knows what else to do, Ritalin is prescribed. And how it then continues has already been described above.
Whether the model concept developed here will prove to be viable in the future and at least broadly applicable does not depend on the type of changes that take place in the brain of an ADHD child, but on the heuristic value that this concept has and which can and must be checked through targeted examination and therapeutic interventions as early as possible. The decisive factor is whether it is possible to get those children who are very early on by their extraordinary alertness and stimulability out of the vicious circle of self-stimulation and that caused by it through forward-looking educational measures (secure bonds, structuring the daily routine, creating a calm and stable development environment) to lead out of emotional insecurity. How your dopaminergic system and all other "abnormalities" in your brain will develop remains to be seen until empirical confirmation of what this new model predicts.
source: http://www.ads-kritik.de/HuetherStudie.htm (02-03-13)
Hüther, G .: Stress and the adaptive self-organization of neuronal connectivity during early childhood. Int. J. Devl. Neuroscience 16 (1998) 297-306.
Hüther, G .: Operating instructions for a human brain. Vandenhoeck & Ruprecht, 2001.
Hüther, G., Adler, L., Rüther, E .: The neurobiological anchoring of psychosocial experiences. Zsch. Psychosom. Med. 45 (1999) 2-17.
Here you have new nerves
The Swiss journalist Brigit Schmid reports on a self-experiment with the title "10 milligrams of work rage - Ritalin is the fashion pill of the performance society. A self-experiment". She writes: "The state in which Ritalin puts me for seven days could do what the neuropsychologist Hennric Jokeit"Abstraction of the self from itself" is called. In the essay “Neurocapitalism” he and the journalist Ewa Hess describe a merging of capitalism, neuroscience and the pharmaceutical industry. Prosperity capitalism has led us to ceaselessly want to realize ourselves. Neuropsychopharmaceuticals that modulate emotional experience and improve attention-economy "fitness" make this easier for us today. "Supply and subjective need create a market that turns over billions and will expand where the post-postmodern self experiences deficits in the performance society, i.e. in school, training, work, partnership and in old age." Globalization acceleration technologies such as cell phones, airplanes and the Internet force us to chemically influence our attention. After the rationalization of space and time, the attack on the self follows: Ritalin enables you to overcome personal limits in order to keep pace. At the same time, capitalist productivity is increased. Every boss would be happy to see my work. Other needs become negligible. In Jokeit's words: “With pharmacology for cognitive performance enhancement, human resources are tapped on the neural level of the self. What follows is the I's abstraction from itself. »"
source: http://dasmagazin.ch/index.php/10-milligramm-arbeitswut/ (09-08-29)
From a newsgroup
Subject: Ritalin = educational chemical
Date: Sun, Oct 14, 2001 23:42:00
Excerpts from the discussion in the newsgroup
Subject: Re: ADD, ADHD, HKS, ...
Date: Tue, Nov 20, 2001
From the FRG: Ritalin in road traffic
The amendment to the Road Traffic Act of April 28, 1998 has been in force since July 1, 1998, according to which anyone who drives a motor vehicle under the effect of a (specified) intoxicant is acting improperly (i.e. subject to a fine).
The simple detection of this agent in the blood is sufficient, whereby the concentration is not important, as is the case with alcohol.
Since bicycles are not motor vehicles, they are not covered by this regulation.
However, the law then provides for the decisive exception: if this intoxicating substance results from the intended use of a drug prescribed for a specific case of illness, there is no administrative offense.
Ritalin as well as the alternative amphetamine juice basically belong to these forbidden intoxicating substances, since the law does not provide for a detailed breakdown, but only designates basic substances in an attached list, which may not be found in the blood of a driver.
However, if the driver can prove that he has taken this substance as intended on a medical prescription for the treatment of ADD / HKS, the offense of an administrative offense does not apply.
However, since it is repeatedly heard that parents of affected children sometimes use the preparations prescribed for their children in the form of self-medication, I would like to expressly warn against driving a motor vehicle afterwards as long as traces of the agent are still found in the blood . The regulatory offense can be punished with a fine of up to DM 3,000.00.
source: Federal Association of Parents' Initiatives for the Promotion of Hyperactive Children
WWW: http://www.osn.de/user/hunter/ritalin.htm (01-10-26)
The neurologist and sleep researcher Ronald Chervin (University of Michigan) analyzed statements made by the parents of 866 children between the ages of two and thirteen about sleep behavior and their impulsiveness and ability to concentrate.16 percent of all children were described by their parents as snorers. Of the children who snore heavily in their sleep, 22 percent suffered from behavioral disorders such as inattentiveness according to their parents - compared to 12 percent with occasional snores. He explains the connection with the fact that children, exhausted from poor sleep, try to compensate for their tiredness with hyperactivity. This could also explain why, paradoxically, stimulant drugs like Ritalin are effective agents for children with hyperactivity and attention deficit.
source: "Pediatrics" of the American Medical Association (AMA)
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