There are two research articles from the prestigious St. Louis Medical School in St. Louis, Missouri. (The two articles are linked below)

These two article provide disturbing evidence that Ritalin may cause permanent damage to the myocardial (heart) ultrastructure of humans.

Over a million young ADD/ADHD people are now taking Ritalin. How many of these young people and their parents have been informed by their physicians that Ritalin may cause permanent heart damage? Have the manufacturers of methylphenidate carefully investigated the matter of possible heart damage from Ritalin? How harmful is such damage? What current medical research is on-going concerning this matter? Should physicians and the lay public know more about this issue?

Are you aware that the pediatric literature, including textbooks, often recommends that Ritalin be the first medication prescribed to young people with ADD/ADHD? Equally as disturbing to me, because of the Board's power to regulate physician behavior, the Medical Board of California (most of the members of which are not medical doctors) recently stated, "Tricyclic antidepressants are recommended only when the patient's symptoms are resistant to stimulant (Ritalin) therapy, or stimulant therapy is otherwise specifically contraindicated." Adding coal to the fire, the New York Times newspaper recently published an article about adults with ADD/ADHD which stressed the important role of Ritalin in treatment while never mentioning that Ritalin may cause permanent heart damage.

Why is Ritalin commonly recommended as the initial treatment medication over the amphetamines, especially dextroamphetamine? One important reason is based on pure emotions. The amphetamines have a bad reputation because methamphetamine is a common street-drug. People have gone to prison on amphetamine-related charges.

The experience of some physicians, however, is that the amphetamines are in general clinically more effective than Ritalin for the treatment of ADD/ADHD. Moreover, the argument that Ritalin should be preferred to amphetmines is not supported by medical science. Methylphenidate is structurally related to amphetamine, shares the abuse potential of the amphetamines, and its pharmacological properties are essentially the same as those of the amphetamines. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 9th Ed.

The next important question is, should the initial medication treatment of ADD/ADHD be a stimulant or an antidepressant drug? Of course, it should be the "proper drug" for the given individual. The "proper drug" is the one that corrects the specific ADD/ADHD complaints of the individual. In my opinion, that drug is more often an antidepressant than a stimulant. Let's look at the facts.

POSITIVE STATEMENTS ABOUT RITALIN:

• In a few instances, Ritalin (methylphenidate) is the only medication that is effective in an ADD/ADHD individual.
• Ritalin follow-up care by physicians rarely requires electrocardiograms (ECG's) or blood Ritalin level evaluations, both of which are expensive tests.

NEGATIVE STATEMENTS ABOUT RITALIN:

• Ritalin is clearly NOT effective treatment in about 30% of children.
• Ritalin lowers the epileptic seizure threshold.
• Ritalin rarely, if ever, stops bedwetting associated with ADD/ADHD.
• Ritalin reduces appetite dramatically in many children and can stunt growth.
• Ritalin may cause tics which were not present before treatment.
• Ritalin rarely helps ADD/ADHD people wake easily or feel less grumpy in the morning.
• Ritalin rarely helps ADD/ADHD individuals fall asleep more easily at night.
• Ritalin may cause insomnia.
• Ritalin even in a sustained-release form does not have a 24-hour action.
• Ritalin doses commonly must be taken multiple times each day.
• When Ritalin effect wears away, there very often is a severe "let-down" or "emotional crash" and sometimes with return of violent behavior.
• Ritalin can be abused by children and adults.
• Ritalin can cause dependence. Ritalin in high doses can cause cardiac (heart) death.

REASONS WHY ANTIDEPRESSANTS, ESPECIALLY TRICYCLIC ANTIDEPRESSANTS, MIGHT BE BETTER FIRST-CHOICE MEDICINES:

• Tricyclic antidepressants are effective in 80% of young ADD/ADHD people so treated.
• Tricyclic antidepressants are almost always effective for 24 hours, that is, all day and night, even when taken only once a day.
• Tricyclic antidepressants are not followed by a "crash" or "let-down" on days they are taken.
• Tricyclic antidepressants are not addicting.
• Tricyclic antidepressants stop bedwetting associated with ADD/ADHD in about 90% of cases.
• Tricyclic antidepressants do not cause tics.
• Tricyclic antidepressants help ADD/ADHD people fall asleep more easily.
• Tricyclic antidepressants help ADD/ADHD individuals wakes easily in the morning.
• Tricyclic antidepressants do not stunt growth in children.
• Tricyclic antidepressants in overdose may cause cardiac (heart) death, but tricyclic antidepressants in therapeutic doses have never been shown to cause "sudden death" in children.

These are two research articles from the prestigious St. Louis Medical School in St. Louis, Missouri.

1. Fischer, VW et al.Journal of the American Medical Association (JAMA) 1977
   
2. Henderson, TA et al. The American Journal of Cardiovascular Pathology 1994

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