ADHD Medication: Ritalin Found to be Safe for Long-Term Use According to Study

ADHD is one of the most common developmental disorders worldwide. Ritalin is often prescribed. But what happens with long-term use? A conversation with child psychiatrist Professor Tobias Banaschewski.

Around seven percent of children and two percent of adults have Attention Deficit Hyperactivity Disorder (ADHD). Left untreated, ADHD is associated with an increased risk of emotional problems, poor academic performance, school exclusions, difficulties at work and in relationships, as well as crime and drug abuse.

The most commonly used medication for ADHD is Ritalin. The short-term efficacy and tolerability of Ritalin have been demonstrated by many studies. However, there have been few data on the safety and tolerability of long-term treatment. A new study, just published, aims to address this gap.

Ritalin is also said to be tolerable in the long term.

Ralf Caspary, SWR2: What does your study show?

Professor Tobias Banaschewski, Central Institute of Mental Health Mannheim: The study was conducted at the request of the European Medicines Agency (EMA) because there were hardly any long-term data available. By long-term data, we mean a truly controlled study over two years.

We then examined a total of 1400 children and adolescents in the study to see if long-term treatment of up to two years is tolerable. We found that methylphenidate medication - which is the active ingredient of the drug Ritalin - is very well tolerated, so no unknown side effects occur after longer treatment periods.

Effects on pulse, blood pressure, and appetite

Tobias Banaschewski: It is observed that the pulse and blood pressure slightly increase when taking the medication. However, this increase is generally very small. However, this cannot be inferred to be the case for every individual patient taking the medication. Therefore, pulse and blood pressure should also be regularly monitored.

In addition, there are known side effects, such as decreased appetite in up to ten percent of children and adolescents. This may not always be a big problem, but it can also be a problem.

Children could be treated with Ritalin long term in the future

Ralf Caspary: So if my child had ADHD, could I give him Ritalin for two or three years without any concerns, but it should always be medically monitored?

Tobias Banaschewski: That is the correct summary, which we also reflect in the German guidelines that we are currently revising. There was much concern in the public about whether there might also be psychiatric side effects, changes in body growth, or puberty development to be feared. There was no evidence for this so far. But if it has not been investigated exactly, one cannot say that for sure, of course.

Use of Ritalin polarizes

Ralf Caspary: Has the reputation of Ritalin improved?

Tobias Banaschewski: Overall, yes. But Ritalin is one of the most controversially discussed medications in public. There is the assumption that these behavioral problems are due to the range of normal and would be treated away with medication. And if the children, for example, just got enough exercise, they would have no problems, and this treatment would not be necessary. There were many ideological debates.

ADHD can become a mental burden

Tobias Banaschewski: However, ADHD can occur in very different severity levels. And it can really lead to significant impairments in quality of life. But also in psychosocial functioning at school, at work, and also in dealing with peers. Emotional dysregulation often plays a role in those affected.

This is partly because concentration can be significantly impaired, but also impulse control or emotional impulse control can be poor. The ability to sustain motivation can also be restricted - and all this despite good intelligence. In some cases, it can be quite understandable that for some of those affected with severe ADHD symptoms, this leads to impaired self-esteem, even despite good intelligence, and so on.

First detailed long-term study

Ralf Caspary: If the medication is now also safe in the long term, what was it like before when we didn't know that?

Tobias Banaschewski: The medication Ritalin has been used worldwide since the 1960s and is one of the most well-researched medications. There have been over 180 randomized studies and over 20 meta-analyses that have demonstrated its efficacy and good tolerability, but not over the long term and not as systematically as we have done now.

Groups of untreated children and adolescents were not really included consistently because most people, of course, eventually take medication. But we included countries where the supply is poorer.

Researchers hope for better availability of Ritalin

Ralf Caspary: The WHO has so far rejected including Ritalin in the list of essential medicines. Will that change now?

Tobias Banaschewski: Yes, we hope very much that our results will help to dispel the existing uncertainties that have led the WHO not to include Ritalin in the list of essential medicines.

Affected individuals from low- or middle-income countries, in particular, have significantly fewer opportunities to receive treatment for ADHD. This is often reserved for those who can afford it privately. And considering the risks associated with severe ADHD, it should be possible for people from other countries to have reasonable access to treatment as well.