Comparing the abuse potential of methylphenidate versus other stimulants: A review of available evidence and relevance to the ADHD patient

Duke Child and Family Study Center, Duke University Medical Center, Durham, NC 27705, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 02/2003; 64 Suppl 11(Suppl 11):14-8.
Source: PubMed


The use of psychostimulants to treat attention-deficit/hyperactivity disorder (ADHD) has been controversial for a number of reasons. In an effort to clarify the extent to which the psychostimulant methylphenidate has abuse potential, the existing published evidence has been reviewed and is summarized here, with an emphasis on delineating a number of related but independent issues that are often confused. Methylphenidate produces behavioral effects associated with abuse potential as assessed by traditional assays, but the relevance of this literature to the clinical use of the drug in the treatment of ADHD is ambiguous at best. Existing neuropharmacologic data suggest that methylphenidate has pharmacokinetic properties that reduce its abuse potential as compared with other stimulant drugs of abuse, such as cocaine.

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    • "Eur J Pharmacol (2015), administered intravenously by monkeys (Bergman et al., 1989) and rats (Nicholson et al., 2009) and in humans, bupropion increases arousal, mood and euphoria (Cousins et al., 2001). Methylphenidate is also known for its abuse potential (Kollins, 2003). Nevertheless, this has never been a reason to retract it from the market. "
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    ABSTRACT: First line antidepressants are the so-called SSRI's (selective serotonin reuptake inhibitors), e.g. fluvoxamine, fluoxetine, sertraline, paroxetine and escitalopram. Unfortunately, these drugs mostly do not provide full symptom relief and have a slow onset of action. Therefore also other antidepressants are being prescribed that inhibit the reuptake of norepinephrine (e.g. reboxetine, desipramine) or the reuptake of both serotonin (5-HT) and norepinephrine (e.g. venlafaxine, duloxetine, milnacipran). Nevertheless, many patients encounter residual symptoms such as impaired pleasure, impaired motivation, and lack of energy. It is hypothesized that an impaired brain reward system may underlie these residual symptoms. In agreement, there is some evidence that reuptake inhibitors of both norepinephrine and dopamine (e.g. methylphenidate, bupropion, nomifensine) affect these residual symptoms. In the pipeline are new drugs that block all three monoamine transporters for the reuptake of 5-HT, norepinephrine and dopamine, the so-called triple reuptake inhibitors (TRI). The working mechanisms of the above-mentioned antidepressants are discussed, and it is speculated whether depressed patients with different symptoms, sometimes even opposite ones due to atypical or melancholic features, can be matched with the different drug treatments available. In other words, is personalized medicine for major depression an option in the near future? Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Jan 2015 · European Journal of Pharmacology
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    • "Methylphenidate (MPD) enhances cognitive and behavioral function by acting, at least in part, on the prefrontal cortex (PFC). Recent reports state that the use of MPD as a cognitive enhancer has become widely abused among college students and adults.1–3 Due to the PFC’s critical role in higher cognitive functions, it is considered one of the main brain regions to respond to acute and chronic MPD administration.4,5 "
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    ABSTRACT: The prefrontal cortex (PFC) is part of the collective structures known as the motive circuit. The PFC acts to enhance higher cognitive functions as well as mediate the effects of psychostimulants. Previous literature shows the importance of PFC neuronal adaptation in response to acute and chronic psychostimulant exposure. The PFC receives input from other motive circuit structures, including the ventral tegmental area, which mediates and facilitates the rewarding effects of psychostimulant exposure. PFC neuronal and locomotor activity from freely behaving rats previously implanted with permanent semimicroelectrodes were recorded concomitantly using a telemetric (wireless) recording system. Methylphenidate (MPD) is used as a leading treatment for behavioral disorders and more recently as a cognitive enhancer. Therefore, the property of MPD dose response on PFC neuronal activity was investigated. The results indicate that MPD modulates PFC neuronal activity and behavioral activity in a dose-dependent manner. PFC neuronal responses to 0.6 mg/kg elicited mainly a decrease in PFC neuronal activity, while higher MPD doses (2.5 and 10.0 mg/kg) elicited mainly increased neuronal activity in response to MPD. The correlation between MPD effects on PFC neuronal activity and animal behavior is discussed.
    Full-text · Article · Feb 2014 · Journal of Experimental Pharmacology
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    • "Like cocaine, MPH inhibits the DAT, which increases synaptic levels of DA, and this is presumed to mediate MPH's reinforcing effects and abuse potential. In laboratory studies, it has been shown that animals will repeatedly administer MPH as they do cocaine (Kollins 2003), and humans receiving both drugs indicate a similar " high " (Volkow et al. 1995). A frequent concern regarding the use of stimulants for ADHD is their mechanism of action, which increases DA and thus may increase the risk for overt, illicit drug use. "
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    ABSTRACT: Prescription stimulants are often used to treat attention deficit hyperactivity disorder (ADHD). Drugs like methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine), and dextroamphetamine-amphetamine (Adderall) help people with ADHD feel more focused. However, misuse of stimulants by ADHD and nonaffected individuals has dramatically increased over recent years based on students' misconceptions or simple lack of knowledge of associated risks. In this review, we discuss recent advances in the use and increasing misuse of prescription stimulants among high school and college students and athletes. Given the widespread belief that stimulants enhance performance, there are in fact only a few studies reporting the cognitive enhancing effects of stimulants in ADHD and nonaffected individuals. Student athletes should be apprised of the very serious consequences that can emerge when stimulants are used to improve sports performance. Moreover, misuse of stimulants is associated with dangers including psychosis, myocardial infarction, cardiomyopathy, and even sudden death. As ADHD medications are prescribed for long-term treatment, there is a need for long-term safety studies and education on the health risks associated with misuse is imperative.
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