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4 Ritalin Alternatives

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4 most commonly used Ritalin alternatives (drugs), and natural alternatives as well.

Ritalin is a prescription medication used for the treatment of ADHD (attention deficit hyperactivity disorder). 

As per the Nemours Foundation, Ritalin works by maintaining normal levels of dopamine and norepinephrine within the brain. 

Children and adults suffering from ADHD have deficiencies in producing these neurotransmitters. 

Ritalin is part of a group of ADHD medications called stimulants. For most children, this medicine is effective in alleviating ADHD symptoms, and they tolerate it well.  

How Does Ritalin Work?

Ritalin is a psychostimulant drug that acts on the brain but, more specifically, in the prefrontal cortex of the brain.

It contains methylphenidate, which is similar in structure to amphetamines. Therefore, methylphenidate produces therapeutic effects similar to those of the amphetamines.

This effect blocks the reuptake of the neurotransmitters, dopamine, and norepinephrine from the synapses of neurons. It does this by binding to the transporters responsible for removing these neurotransmitters from the synapses.

Methylphenidate's second mechanism of action is the release of dopamine and norepinephrine from brain cells into the synapses. Lastly, methylphenidate increases the amount of dopamine released (and, therefore, the magnitude of the response) after each stimulus.

Although Ritalin is a stimulant, it does not act like one at the doses in which its recommended because the drug targets the prefrontal cortex and produces few effects outside that part of the brain.

Another explanation for Ritalin's paradoxical action was put forward after examining MRI (Magnetic Resonance Imaging) scans of the brain regions controlling impulse and mental focus. People diagnosed with ADHD show a markedly different response to clinical doses of Ritalin because their brain activities differ from people without ADHD.

After administering Ritalin to ADHD patients, these regions of the brain, especially the prefrontal cortex and the parietal cortex, behave similarly in both ADHD and non-ADHD subjects.

Even though Ritalin is effective for treating ADHD in a lot of patients, there are reasons why a prescriber might seek an alternative. When Ritalin does not adequately address the symptoms of a patient's ADHD, an alternative like Adderall is provided.

Like the amphetamines, Ritalin has a high potential for abuse. While Ritalin does not produce euphoria at clinical doses, it does when crushed and snorted or injected or when it is taken orally in large doses.

Therefore, doctors don't prescribe Ritalin and other stimulant ADHD medications to anyone who has a history of drug abuse.

However, as with any medication, side effects might occur, or the medication might not effectively control symptoms. 

These side-effects are why many individuals seek alternatives to Ritalin. Fortunately, there are several alternatives available to treat ADHD. Here are the four most commonly used and effective Ritalin alternatives: 

Four Alternatives

4 Ritalin Alternatives

Changes in Diet 

There have been several studies that show that a change in diet can help control ADD and ADHD symptoms. 

Experts recommend that individuals inflicted with ADD and ADHD must take a diet high in protein and Omega-3 fatty acids

Foods that are high in Omega-3 fatty acids and protein include lean meat, beans, eggs, and cheese. Fish, such as salmon and tuna, and nuts are excellent sources of Omega-3 fatty acids. 

Both Omega-3 fatty acids and protein encourage the production of norepinephrine and dopamine. 

Diet Exclusion: 

As reported by the Mayo Clinic, a study done by the Food Standards Industry in the United Kingdom has shown a connection between food additives and hyperactive behavior. 

The medical community believes that certain elements, such as dyes, sugar, caffeine, should be completely excluded from the diet to decrease the intensity of ADHD symptoms associated with the disorder. 

Some experts also believe that individuals suffering from ADD or ADHD are more responsive to food additives, such as caffeine, sugar, and dyes, and hence they should be excluded from the diet. 

Changes in Lifestyle: 

Changes in environment and lifestyle can prove to help control ADD and ADHD symptoms. 

Any type of behavioral change requires a well-balanced ADHD treatment plan, including educational, social, and mental therapy. 

Some of the different types of therapies that b used for ADHD are behavioral therapies, psychotherapy, parenting skill training, social skills training, behavioral interventions, and support groups. 

Providing a more stable and predictable environment may also help in decreasing the stimuli experienced by an ADHD sufferer. 

In some cases, children with an attention disorder just require some counseling support. At times, the entire family may need assistance because the condition affects the family as a whole. 

Alternative Medications for ADHD: 

Ritalin is perhaps the most popular medication for ADHD; however, you may consider other stimulants as alternatives to Ritalin. 

Other stimulant medications for ADHD include similar ingredients, but they vary in how long the medicine lasts or how the medicine is released (instant release versus extended-release). 

Some of the alternative medications for ADHD are Daytrana, a methylphenidate patch; Methylin, available in chewable tablets, and liquid form; Adderall XR; Desoxyn; Vyvanse; and Focalin. 

There are two non-stimulant medicines approved for the treatment of ADHD. They are Strattera (Atomoxetine) and Intuniv (guanfacine ER).

The Other Drug Alternatives

Concerta

Concerta (methylphenidate extended-release tablets) is a central nervous system (CNS) stimulant. It is available in four tablet strengths: 18mg yellow tablets, 27mg gray tablets, 36mg white tablets, and 54mg brownish-red tablets. 

Concerta uses osmotic pressure to deliver methylphenidate HCl at a controlled rate. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control. 

The stimulant is used in children six years of age and older, adolescents, and adults up to the age of 65. 

It is a long-acting extended-release tablet of methylphenidate. Methylphenidate is the same active agent in Ritalin, Methylin, and Metadate.

Methylphenidate is formulated in Concerta as a kind of drug reservoir. Small amounts of this ingredient are released in a timely fashion at different times of the day.

The advantage of formulating Concerta in this way is that people diagnosed with ADHD can take their medication once daily. This promotes compliance and reduces the number of times doses are forgotten. 

Concerta should be used as a vital part of an ADHD treatment program, which includes educational, psychological, and social measures. 

Methylphenidate

Methylphenidate is a psychostimulant that is similar to but weaker than cocaine. It also lasts longer in the body.

This drug molecule is approved for the treatment of 3 medical conditions: ADHD, narcolepsy, and orthostatic tachycardia. However, it is also commonly used for treating obesity, depression, and lethargy, especially when other medications fail.

Methylphenidate works by blocking the monoamine transporters, which reuptakes neurochemicals such as dopamine and norepinephrine.

In this way, it increases the levels of these two neurotransmitters in the brain, leading to improvements in ADHD symptoms. Therefore, it increases alertness, attention, and mental focus and reduces fatigue.

Dopamine and norepinephrine are normally taken up and removed at the nerve terminals. The drug molecule not only blocks this reuptake at those sites but also stimulates the release of dopamine and norepinephrine to nerve terminals.

These actions cause a quick rise in dopamine and norepinephrine levels at the synapse of the neurons in the brain. The combined effect is responsible for the quick onset and the long duration of action (4 hours) of the drug.

To further extend the duration, methylphenidate is formulated as an extended-release tablet, which is known as Concerta.

The use of methylphenidate, a stimulant, in the treatment of hyperactivity is paradoxical. However, much like in homeopathy, where small doses of poisons are used to treat the symptoms produced by large doses, methylphenidate produces opposite effects on the brain when compared to stronger stimulants.

Furthermore, different studies have shown that MRI (Magnetic Resonance Imaging) scans of ADHD and non-ADHD individuals point to differences in the brain regions responsible for mental focus, attention, and impulse.

Also, apart from increasing the levels of dopamine and norepinephrine in the neurons, methylphenidate also reduces the rate of glucose metabolism in the brain by as much as half.

Adderall

Adderall contains four related amphetamine salts. These are amphetamine aspartate monohydrate, amphetamine sulfate, dextroamphetamine sulfate, and dextroamphetamine saccharate.

Adderall is available for treating ADHD both as an instant release formulation and an extended-release formulation. However, only the instant release form is used in the treatment of narcolepsy.

The amphetamines are also psychostimulants which act on the central nervous system. However, dextroamphetamine is a lot more potent than levoamphetamine on the central nervous system (except in some ADHD children where the levo form was discovered to provide more benefits).

Levoamphetamine is, however, included in Adderall because it has a faster onset of action and produces more enduring therapeutic effects than the dextro form.

Furthermore, some researchers believe that the levo form is responsible for increasing the levels and activities of norepinephrine, while dextroamphetamine is responsible for doing the same for dopamine.

Amphetamines act as substrates for dopamine and norepinephrine transporters at neuronal synapses. Unlike, methylphenidate in Ritalin, they do not deactivate the transporters but instead, compete with dopamine and norepinephrine as candidates for removal from the synapses.

Adderall and ADHD

Adderall includes a mix of amphetamine salts, and it is known to work as well as Ritalin. It is available in IR and XR form. 

Since its introduction in the 90s, Adderall has become increasingly popular; and it is just a little stronger than Ritalin. 

Some studies have shown that while kids need to take two instant-release Ritalin tablets to cover a day at school, just one instant-release tablet of Adderall works equally well. 

Some other studies have shown that Adderall has a slight advantage over Ritalin in alleviating certain ADHD symptoms. 

One study showed that Adderall was highly effective in keeping people focused on a task and improving their concentration.  However, this wasn't a precise clinical trial and only examined with 37 patients. 

Dr. Tuckman, a renowned clinician who has treated hundreds of adults with ADHD, has this to say: 

Nearly one-third of people with ADHD react best to Ritalin, one-third to an amphetamine-type medication such as Adderall, and one-third react well to both. 

So, it can be concluded that though Adderall is slightly more powerful than Ritalin, both are equally helpful for treating ADHD, and some people react better to one or the other. 

Vyvanse

Vyvanse is a prodrug that must be metabolized by the body and converted into an amphetamine, which is an active drug. 

Vyvanse is also a psychostimulant used in the treatment of ADHD. It contains L-lysine-D-amphetamine or Lisdexamphetamine dimesylate. This active ingredient is composed of dextroamphetamine and lysine.

Dextroamphetamine was coupled with lysine in Vyvanse for two reasons: to increase its duration of action and to make it difficult to abuse. The active part of this prodrug is the dextroamphetamine, and it is released from the drug molecule by enzymes in the red blood cell.

Dextroamphetamine is only one form of amphetamine. The other form is levoamphetamine, which is combined with the dextro form in Adderall. However, it is the dextro form included in Vyvanse, which has greater bioavailability and produces superior stimulation of the central nervous system.

Upon release, dextroamphetamine blocks the uptake of norepinephrine and dopamine at the synapses of neurons. It does this by substituting itself since it has a similar chemical structure.

At high doses, dextroamphetamine can even trigger the release of dopamine and norepinephrine in the brain leading to a high concentration of both neurotransmitters.

These two mechanisms are responsible for the ability of Vyvanse to improve attention span and mental focus.

The two main reasons why the dextroamphetamine in Vyvanse is attached to the essential amino acid, L-lysine is:

  • To formulate a dextroamphetamine-based drug that acts for longer than most of the dextroamphetamine medications used for ADHD.
  • To reduce the abuse potential of the drug by making it more difficult for drug abuse to get dextroamphetamine from Vyvanse.

Vyvanse is available in 30mg white and orange capsules, 50mg white and blue capsules, and 70mg blue and orange capsules. 

The medications must be used in children six years of age and older, adolescents, and adults up to the age of 65. 

Another widely reported benefit of Vyvanse is that it is not usually affected by the food you consume.

Additionally, because Vyvanse is newer to the market, it is often more expensive than other ADHD medications. Furthermore, it is not yet available in standard form.

In short, Vyvanse is an enhanced, extended-release version of the Dexedrine, which is available in generic form.

Strattera

Unlike Adderall, Strattera is a non-stimulant ADHD medication. It contains Atomoxetine HCl.

Atomoxetine was initially investigated for use in the treatment of depression. It is a selective, norepinephrine reuptake inhibitor. Drugs belonging to the classes, selective serotonin reuptake inhibitors and selective serotonin and norepinephrine reuptake inhibitors are known antidepressants.

However, Atomoxetine failed as an antidepressant in clinical trials. Instead, it was found effective for treating ADHD.

Atomoxetine is available in the US as capsules of the following strengths: 10 mg, 18 mg, 25 mg, 40 mg, and 60 mg.

Atomoxetine inhibits the transporters of serotonin, dopamine, and norepinephrine in the synapses. It does not act at their receptors.

Atomoxetine targets the prefrontal cortex for a more specific action. At this site, it causes the levels of dopamine and norepinephrine to rise as much as three-folds. The prefrontal cortex is regarded as the seat of decision-making, impulse control, and mental focus.

Atomoxetine is usually recommended to be taken once or twice daily.

It can take as long as a week before the effects of Atomoxetine are felt, and prescribers often encourage ADHD patients to stay on the drug for as long as two months before reaching a conclusion about its effectiveness.

Atomoxetine therapy is usually started with a low dose, which is gradually increased as the patient develops a tolerance to the side effects.

Strattera is, therefore, a ready Ritalin alternative for ADHD patients who are likely to abuse their medications. Furthermore, since the long-term effects of stimulants in ADHD therapy are still uncertain, some patients prefer not to use psychostimulant ADHD medications such as Ritalin. For such patients, Strattera is an effective alternative.

You may also consider using ADHD supplements such as Listol, ADD-care, Learning Factors, and Focus Formula, to alleviate attention deficit hyperactivity disorder (ADHD) in adults and children.

Strattera Side Effects

Clinical trials have shown that Strattera caused a slower growth rate in kids taking the medication. Some of the side effects include mood swings, fatigue, drowsiness, ear infection, vomiting, appetite loss, depression, runny nose, and headache. 

Side effects in adults include chills, lower sex drive, abnormal dreams, hot flashes, impotence, headache, insomnia, skin inflammations, palpitations, menstrual problems, prostate problems, tingling, sweating, and weight loss. 

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