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Ritalin vs Concerta
Comparing Concerta and Ritalin – which is better?
Methylphenidate belongs to a class of medications, known as the central nervous system (CNS) stimulants. It works by altering the amounts of certain natural substances in the brain.
Determining which is better between the two is a difficult task. The results may vary from individual to individual.
Some ADHD patients respond better to Concerta, while some respond better to Ritalin. In some cases, patients respond in the same manner to both these ADHD medications.
Methylphenidate is a psychostimulant and it is the most popular drug molecule used in the treatment of ADHD.
Conventional wisdom should dictate that the use of stimulants should worsen the symptoms of ADHD especially hyperactivity. However, at low doses and with mild stimulants such as methyphenidate, the opposite effect is usually achieved.
Although methylphenidate is mostly associated with ADHD, it is also used to treat narcolepsy and postural orthostatic tachycardia. Other uses (although off-label) include the treatment of obesity, lethargy and depression especially in cases where other drug treatments no longer work.
Even though there were concerns that methylphenidate drugs such as Ritalin and Concerta which are essentially stimulants would produce unwanted side effects, new research findings are putting such concerns to rest.
Scientists have now discovered that methylphenidate works mostly in the prefrontal cortex and has very few effects outside this area of the brain. The prefrontal cortex is the part of the brain responsible for attention, impulse and decision-making.
This discovery proves that methylphenidate drugs are safer than earlier thought and that the potential for addiction and abuse, at least in children, is very low.
Because clinical doses of methylphenidate targets the prefrontal cortex, drugs like Ritalin and Concerta do no act like stimulants at therapeutic doses. They do not affect the arousal center but rather fine-tune the neurons of the prefrontal cortex.
Methylphenidate tweaks the brain chemistry in two important ways. First, it blocks the reuptake of two neurotransmitters at the synapses or junctions of neurons. These neurotransmitters are dopamine and norepinephrine.
In this way, methylphenidate behaves like other stimulants such as amphetamine but to a lesser extent. It binds to and blocks both dopamine transporter and norepinephrine transporter at the synapses. This is unlike amphetamine which does not bind to the transporters but instead substitutes itself for dopamine and norepinephrine at the transporters.
The second mechanism of action of methylphenidate is by promoting the release of more dopamine and norepinephrine in the brain.
The combined effect of these two pathways is to increase the levels of dopamine and norepinephrine in the brain. These neurotransmitters are present at levels not so high as to induce the euphoria associated with amphetamines and opiates. Rather, they are available in amounts that improve the symptoms of ADHD.
Dopamine, for example, fine-tunes the firing of the neurons allowing actual neuronal signals to be transmitted over background signals or “noise”. In this way, it improves attention and mental focus as well as decrease the frequency of distraction in people diagnosed with ADHD.
Recent neuroimaging studies of the action of methylphenidate on the brain have shown that these increased levels of dopamine and norepinephrine are mostly found in the prefrontal cortex.
This selective targeting of the prefrontal cortex is chiefly responsible for the clinical efficacy of Ritalin and Concerta. This is because if the levels of dopamine and norepinephrine were increased all over the brain, hyperactivity and euphoria, instead of calm and mental focus, would result.
Psychology researchers David Devilbiss and Craig Berridge from University of Wisconsin-Madison published their research on the effect of Ritalin on the prefrontal cortex of rats in the journal, Biological Psychiatry in 2008. By monitoring the activity of neurons in the prefrontal cortex, they were able to determine the effect of methylphenidate on this part of the brain.
Their results showed that the drug, at therapeutic doses, improved the ability of the neurons of the prefrontal cortex to respond to signals from the hippocampus.
This means that the drug enhanced the prefrontal cortex to accept behavior-related signals and then use them for better cognition as well as longer lasting attention and memory.
At higher doses (like the ones achieved during drug abuse), the prefrontal cortex was far less efficient and even showed signs of cognitive impairment.
The summary of the research paper showed that methylphenidate drugs are able to produce their positive effects by amplifying stronger signals and weakening the lesser signals that form the basis of distraction.
The only difference is that Ritalin is just a standard tablet, while Concerta is a specially formulated capsule which slowly releases methylphenidate, over an extended period of time so the individual does not have to keep taking Ritalin frequently.
Concerta is the newer and long-acting preparation of methylphenidate. Its effect can last for up to 12 hours. It was developed using an amazing technology called OROS (osmotic-controlled release oral delivery system).
OROS utilizes the water in the gut to allow the medicine to be absorbed gradually, through the process of osmosis.
ADHD patients, who had to take Ritalin tablets 3 times daily, can now get the same dose of medication with just one capsule daily.
It is easy to switch from regular Ritalin to Concerta. You just need to take the total of your daily Ritalin dose and change it to the Concerta capsule that is closest to that dose.
For example, if you or your child is taking 5mg of Ritalin three times daily, the total dose is 15mg of Ritalin. You can change this to 18mg Concerta capsule.
Concerta is available in 27mg, 36mg, and 54mg pills to provide flexible dosing options. If you are unsure of the correct dosage, consult with your health care practitioner.
Both Concerta and Ritalin have certain common side effects, which are usually mild and limited to the first days or weeks of therapy.
Some of the common side effects are upper respiratory tract infection, abdominal pain, vomiting, headache, insomnia, increased cough, pharyngitis, dizziness, and sinusitis.
Adverse side effects can be explained by the stimulation of the autonomic nervous system. The activation of the sympathetic nervous system might cause a mild increase of the pulse.
Concerta must be swallowed whole. It can't be chewed or crushed. Ritalin can be opened and sprinkled on food, if your child can't swallow pills.
Concerta is not suitable for everyone, especially for children with anxiety, tics, or Tourette's syndrome. However, it might be a good option for other children with ADHD.
If you are pregnant, planning to become pregnant or are breast feeding, consult your health care practitioner before switching your medications.