Dear Dr. Jeff: "I am a student at Bowdoin who is almost at my wits' end about my studies. I am not doing as well as I would like to, and only wish that I knew someone with Ritalin or Adderall. A solitary pill when I need to study is hardly likely to be an overdose.
If a regular dose won't harm a child with ADD/ADHD, then it'll hardly affect an adult like me in any significantly negative way. So, putting away any horror over "self-prescription" that they may have taught you in med school, why should I not take Ritalin?" J.S.
Dear J.S.: Good question! And a question many students might like to see addressed. Let's first get right to the bottom line. Ritalin is a Schedule II Controlled Substance, and by federal and state law, it is only available by special, restricted prescription, for specific medical conditions that do not include fatigue or difficulty concentrating. Taking someone else's Ritalin is illegal, and prescribing Ritalin for all-nighters would result in the loss of one's medical license.
That being said, stimulants like Ritalin are used routinely by the military, for instance, on prolonged missions. Mind you, that might not be the drug's best selling point. Remember the four Canadian soldiers who were mistaken for Iraqi insurgents and killed by a U.S. pilot? The pilot was taking Ritalin to stay alert on his nighttime mission.
On college campuses, meanwhile, stimulants are frequently traded among friends as "study aids." In fact, at Bowdoin, nearly one in five students surveyed has reported doing so during the previous year. Is this as safe as you suggest, J.S.?
I'm not sure that regular doses of Ritalin are particularly benign. Common side effects include loss of appetite and weight loss, inability to fall or stay asleep, abnormal heartbeats, abdominal pain, and abnormal muscle movements and twitching. Possible side effects include elevated blood pressure, chest pain, shortness of breath, dizziness, skin rashes, anxiety, psychosis, and periods of mania and schizophrenia.
While all of these side effects are likely dose-related and reversible after stopping the medication, they are not always or universally so. And these possible side effects are not uncommon. A recent study found that nearly one in 10 children placed on stimulant drugs for ADHD develop psychotic symptoms, which are fortunately reversible as soon as the medications are withdrawn.
Ritalin must not be taken if you have an underlying seizure disorder, cardiac condition, glaucoma, narrowing of your esophagus, stomach or intestines, or are pregnant. It can have very dangerous interactions with other drugs. You can, of course, be allergic to it as well.
I am not trying to "scare" you away from Ritalin. And I'm not horrified by the prospect of self-prescription. I'm just trying to point out that there are very real risks to taking Ritalin, like any prescription medication. These risks need to be thoughtfully considered in the context of your medical history and with an understanding of your physical and mental status and needs.
Treatment with Ritalin, like treatment with any prescription medication, involves more than just prescribing. It also includes monitoring for side effects and continually evaluating the risk-benefit ratio of treatment.
One final point, J.S. If you are struggling with your academic work load and not doing as well as you'd like, you'd be well advised to talk it over with your advisor and/or dean. Staying up later on Ritalin to study is not the answer.
And if you are having trouble concentrating, remember that the likely causes are inadequate sleep, diet or exercise, or recreational drug or alcohol use, or stress, depression, or anxiety. Less commonly, medical conditions like hyperthyroidism can also cause similar problems. You may want to come into the Health Center to look into those possibilities.
Be well!
Jeff Benson, MD
Dudley Coe Health Center