If you are being treated or are going to be treated for ADHD, it is important to look at a study released last week by the journal PLOS One. For many patients, the popular ADHD medication methylphenidate (Ritalin) has been shown to have both positive and negative effects. This study shows that treatment with methylphenidate increased the amount of dopamine transporters in the brain by 24% over the course of just one year of use. Likely, this is not a good thing.

Dopamine is the brain chemical largely thought to be responsible for reward-motivated behavior, and ADHD is often associated with low dopamine activity. In your brain, synapses are the places where neurotransmitters like dopamine stimulate action. Dopamine transporters are responsible for clearing dopamine from the synapse into surrounding cells once the dopamine has “fired” its signal. The more quickly dopamine gets cleared from the synapse, the less dopamine is available to do its work. Methylphenidate gets results by blocking dopamine transporters, giving your brain more opportunity to get the benefit of the dopamine.

You don’t want excessive amounts of dopamine transporters hanging out in your brain, or whatever dopamine you do have gets cleared quickly.

This study, done by noted neuroscientists Gene-Jack Wang and the National Institutes of Drug Abuse Director Nora Volkow and others, dealt with adult sufferers of ADHD who had never before been treated with medication.

They took 18 never medicated ADHD adults and did PET scans on them before and one year later. They compared the ADHD adults to 12 normal control subjects, also scanned at baseline and then a year later. The ADHD subjects treated with the drug showed a 24% average increase in dopamine transporters, while the control subjects showed no increase in transporters.

It appears that while methylphenidate is blocking the transporters, it’s also somehow inspiring the multiplication of them. Imagine, then, what happens to the person with ADHD who wants to stop taking medication. He or she may be even more vulnerable than before taking medication.

There is a lot to learn, and clearly ADHD medications have long term benefit for many. However, it brings into sharp relief the reality that we ought to be cautious in the prescription and use of pharmaceuticals in the treatment of any condition of the brain, including ADHD.

The reality is that ADHD is for the most part being treated with too much medication and not enough case-by-case understanding.

Shortly after I began brain SPECT imaging work over thirty years ago, I realized that ADHD is not a single or simple disorder. There isn’t just one brain SPECT pattern for sufferers of ADHD. It took me several years and thousands of scans to identify at least six unique SPECT patterns in ADHD patients, each of which ought to be treated differently.

If you had chest pain, your doctor would go through a series of diagnostics to discover the exact nature of it before prescribing you any medication or suggesting any procedure. In my experience, ADHD should be approached with the same attitude of caution, discovery, thoroughness and sensitivity. One treatment does not fit every ADHD patient!

Have you ever discontinued use of Ritalin or other stimulants for the treatment of ADHD, only to find symptoms return? Tell me about it in the comments.

  • Norine Hodges

    My son used Ritalin for most of middle school. I also helped him create other strategies. I advised him to stop taking Ritalin in high school because I was afraid he would become dependent on the drug and not have sufficient coping skills without the drug on board. However, he developed a strong desire for coke cola. He still suffers form the inability to stay focused, to follow a complicated set of directions and has used marijuana.

    • Chris

      Norine, your comment sounds like a tragic misunderstanding of what ADD is. Would you “advise” someone who needed glasses to read to develop “alternate coping strategies” so they wouldn’t “become dependent” on the glasses? Non-medication coping strategies are fine and very much integral parts of an overall strategy to find ways around this often disabling condition to unlock a person’s ‘real self’ without the disabling effects of ADD holding them back. By You may well be setting up your son for academic and social failure and further blows to his self-esteem. Caffeinated, sugary or aspartame-laden “coke cola” is NOT an effective, targeted med for ADD. Your son is likely self-medicating to alleviate symptoms of his ADD, in leiu of his meds. Please, if your doctor is not well-informed on ADD (many still aren’t!) and/or does not take the time to explain things with you and your son, get and read either (or both!) of “Driven to Distraction” by Dr. Ned Hallowell or “Healing ADD: The Breakthrough Program That Allows You to See and Heal the 6 Different Types of ADD” by Dr. Daniel Amen. Perhaps methylphenidate is not the best fit for your son. There are other medication options which may work better and you may be more comfortable with. In any event, what is most important is getting the right set of coping strategies in place, including medication if needed, and having the profoundly healing benefit of informed professional opinion, not fear, guiding your choices to set your son up for success. Peace, good health and good luck to you and your son in your challenge. (Full disclosure: I have no business or personal relationships with Drs. Amen or Hallowell. I’m just someone who has seen the damage done from people acting out of fear fueled by well-intentioned but misleading or incomplete information, and as this blog is seen by many, I felt compelled to respond)

      • Chris

        Oops- in the above comment, I meant to include the complete version of this sentence: ‘By “advising” away your son’s methyphenidate out of a fear of dependence on it, you may well be setting him up for academic and social failures and missed opportunities which result in blows, perhaps devastating over time, to his self-esteem; it could even become the kind of desperation that in turn may make your son look to street drugs such as marijuana (which allows him to ‘tune out’ of the unalleviated pain of being constantly misunderstood, missing the mark, etc. which untreated or undertreated ADD entails). Sorry – peace, Chris

  • Bill Lipe

    I started by trying several ADD meds until we found that Adderall or Straterra worked.
    After a few months both of them stopped having any appreciative effect. We combined the two for a while longer. Until they didn’t work. My daughter said I was grouchier on the meds…
    I didn’t see the change. I felt like I was responding quicker, which from her point of view may have seemed grouchy.
    In any case I am now un-medicated and back to enduring the throes of inattentive ADD.

    • Julianne

      I have taken Adderall and Strattera. I don’t know if they do any good at all. I think they do.

  • Karina

    My son has been diagnosed and before we put him on any drugs, I will scrimp and pinch so that I can take him to one of the Amen clinics. He is 4 years old. There’s not a lot of child psychiatrists that will work with a child that young.