Psychoanalysis as a Replacement of Ritalin

Psychoanalysis as a Replacement of Stimulants that are used as Treatment for ADHD

The purpose of this essay is to explore the efficacy of stimulants as a form of treatment for attention deficit disorder (ADD) in children. In addiction, methylphenidate, which is the most common pharmacological drug prescribed to treat ADD, will be compared to therapy, specifically psychoanalysis, to investigate whether alternative forms of treatment should be given any new consideration.
Before exploring the research regarding the use of stimulants, it is important to describe what ADD is and the medication used to treat it. The DSM-V defines the disorder as “a repetitive pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (DSM-5, 2013). Unlike other disorders that tend to have an onset in early adulthood, such as schizophrenia (schizophrenia, n. d.), ADD or ADHD is usually diagnosed in childhood. Moreover, research suggests that drugs can affect children differently compared to adults. For example, a study found that antidepressants double the risk of suicide ideation for children compared to placebos (antidepressant medications for children and adolescents, n. d.). Other papers have found that the use of antidepressants in adolescents change normal dopaminergic signaling. This highlights the importance in exploring the use of stimulants as a form of treatment for ADD in children.  

As stated before, methylphenidate, also known as Ritalin, is the most common medication used to treat attention deficit with hyperactivity disorder (ADHD Treatment, n. d.). Since it is the most used stimulant, this will be the medication that is compared to therapy, specifically psychoanalysis. Moreover, its main mechanism of action is to increase dopamine in the central nervous system by binding to the reuptake protein. The increased presence of dopamine will adumbrate the abuse potential of the drug, which will be discussed later.

It is important to note that there are certain similarities and differences between abused stimulants such as cocaine and amphetamines and methylphenidate. One of those similarities is in terms of the mechanisms of action. Specifically, cocaine and Ritalin work by binding to dopamine transporters, which blocks the reuptake process (How does cocaine produce its effects, n. d.). This ends up increasing the levels of dopamine in the synaptic cleft, which occurs independently of an action potential (Calipari, E. S., & Ferris, M. J., 2013). Another similitude is that cocaine and methylphenidate compete for the same type of receptors, bind in the striatum, and have on average the same affinity to said receptors (Volkow, et al., 1995). In addition, there is an agreement among researchers that amphetamines have the same pharmacological effects as methylphenidate (Hoffman B. B., & Lefkowitz R. J., 1996; McEvoy G. K. 1999).  Moreover, Ritalin has some of the same effects as the two drugs of abuse mentioned before when the administration is intranasal. It's important to mention that abnormal post-synaptic receptor activation by dopamine in the nucleus accumbens, which is commonly associated with feelings of pleasure, is present in drug addiction. However, this is also seen in non-addicts who consume an addictive substance, which suggests that feelings of pleasure caused by the abnormal levels of dopamine activation is not enough to consider it as addiction. Instead, feelings of craving and compulsive intake have to be present. Moreover, some areas of the brain thought to be involved in these two components of addiction are the Orbital and the Medial Prefrontal Cortex. These two areas of the brain are active in individuals who are addicted to cocaine after using it, but not in non-addicted individuals who consume it. In addition, when methylphenidate is given to cocaine addicts, those two areas of the brain are active, but not in controls. In fact, when cocaine addicts received methylphenidate, it induced cravings for, both, methylphenidate and cocaine (Volkow, et al., 2005).

Even though it has the same mechanism of action as cocaine, it has less of an abuse potential because of its half-life, which is the measurement in which drugs are broken down. In fact, it has been proposed as a form of treatment for cocaine addiction, in the form of replacement therapy. Moreover, the importance of exploring methylphenidate becomes clear when we look at the amount of prescriptions given to children. In the United States, there are at least six million people who are prescribed Ritalin for their ADHD and the rate is increasing. This becomes alarming when we see that a drug that has a potential for abuse is being prescribed to a large population, especially of children. In fact, reports have surfaced of people who abuse this drug (Jaffe S. L., 1991).

As stated before, the efficacy of psychoanalysis will be evaluated for the treatment of attention deficit disorder. A common misconception involving Freud and his ideas is that they cannot be studied empirically or they have, but they have been disproved. Nevertheless, the opposite of said statement is correct as it will become evident by the empirical evidence supporting psychoanalysis. The first study to be used, compared psychoanalysis, as well as cognitive behavioral therapy with and without methylphenidate in regards to the treatment of ADHD and oppositional defiant disorder (Laezer, 2015).

Follow-up was 37.6 months in the psychoanalysis group and 38.6 months for the behavioral therapy with methylphenidate group. In addition, it is important to mention that the psychoanalytic sessions ended, on average, a year before follow-up while children undergoing behavioral therapy were still in therapy and the majority of the group undergoing behavioral therapy and methylphenidate were still taking the drug. This suggests that psychoanalysis has an advantage over the other forms of treatment in terms of either acting faster or making individuals non-dependent on treatment, but more evidence is needed before making this assertion. This is an important fact since patients taking medication usually develop either tolerance or sensitivity to it, which increases the possibility of experiencing side effects or long-term effects of their drugs. In addition, in all groups during follow-up symptoms of ODD, hyperactivity, impulsivity, and inattention were highly reduced. In other words, patients that had finished their psychoanalytic therapy had the symptoms reduced as those that were still taking methylphenidate, which suggests that patients who were using Ritalin had to continue its use, but psychoanalytic therapy was a one-time deal. Moreover, there were also secondary outcome measures taken from the parent's perspective in which all groups' outcomes were equal besides one criteria where patients undertaking psychoanalysis improved significantly in term of internalizing problems. To summarize so far, this study lends support to the notion that psychoanalysis can reduce the symptoms of hyperactivity, attention deficit, and oppositional disorder symptoms as behavioral therapy with medication. Additionally, a common notion about psychoanalysis is that it takes longer when compared to other forms of treatments, but the study found that the medication treatment took on average 29.6 months and psychoanalysis took 25.9 months instead.

In conclusion, methylphenidate is a drug that has the potential to be abused since it acts similarly to cocaine. Taking this into account plus other characteristics such as side effects, long-term effects, etc., it is  important to evaluate other treatments, especially since its prescription rates have grown exponentially and it is being prescribed to children and adolescents, which are going through an important neurodevelopmental stage at that age. Moreover, psychoanalysis is another tool that can be used in the treatment of ADHD and should replace methylphenidate for several reasons. The first one is that it does not have side effects and it does not have abuse potential like methylphenidate does. Additionally, it works faster than the most prescribed stimulant. Moreover, on one hand, once individuals have finished psychoanalytic therapy, the effects of this form of treatment will remain present. On the other hand, most patients have to keep taking medication to be able to manage or reduced the symptoms. 

References

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