Monday, August 1, 2016

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 whether stimulant drugs should still be used to treat attention deficit disorder (ADD) in children. In addition, if the answer to the question made before is no, then what would be the best alternative method of treatment for children with ADD?
Before exploring the research regarding the use of stimulants, it is important to describe what ADD is and the drugs 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, like schizophrenia, which usually starts at early adulthood (schizophrenia, n. d.), ADD or ADHD begins in childhood. Research suggests that some drugs affect children differently compared to adults. For example, a study found that antidepressants double the risk of attempted suicide for children compared to placebos (antidepressant medications for children and adolescents, n. d.). This means that it is important to explore whether stimulants should still be used to treat ADD in children.  

Methylphenidate is the most common medication used to treat attention deficit with hyperactivity disorder (ADHD Treatment, n. d.). Since it is the most used stimulant, methylphenidate, also known as Ritalin, will be the drug that is going to be compared to therapy, specifically psychoanalysis. Its main mechanism of action is to increase dopamine in the central nervous system. The increased presence of dopamine will adumbrate the abuse potential of the drug, however, this will be discussed later.
Cocaine and amphetamines have certain similarities and differences when compared to the main treatment for ADHD. A difference is that they have different mechanisms of action. For example, cocaine works by blocking dopamine transporters, therefore, blocking the reuptake process (How does cocaine produce its effects, n. d.). Amphetamines block the vesicle transporters. And because dopamine is unable to enter the vesicle, it ends up floating inside the terminal transporter. This leads to a reverse mechanism taking place in the reuptake process. Instead of returning dopamine to the terminal button, it ends up on the synaptic cleft, with a greater chance of binding. This occurs independently of an action potential (Calipari, E. S., & Ferris, M. J., 2013).
A similitude is that cocaine and methylphenidate bind to the striatum, compete for the same receptors, and have on average the same affinity to said receptors (Volkow, et al., 1995). In terms of amphetamines, there is an agreement among researchers that they 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.
This drug, which has some of the same pharmacological effects of drugs of abuse, starts to look more dangerous when we see 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. Moreover, the prescription of drugs to treat this disorder is increasing.  This becomes alarming when we see that a drug that has a high 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).
To summarize, what it has been written in this research paper so far is that methylphenidate is a drug similar to cocaine and amphetamines because they increase dopamine in the nucleus accumbens. They have been prescribed to six million people in the U. S. and the majority of diagnosis start at childhood. There is also an increase in the prescription of this drug, independent of the diagnosis and reports of people who abuse this drug can already be seen, especially when mixed with other drugs of abuse such as alcohol or cocaine.
The therapy that will be put forward as a replacement for the treatment of attention deficit with hyperactivity disorder is psychoanalysis. It is commonly thought that Freud or his ideas either cannot be studied empirically or they have, but they have been disproven. Nevertheless, the opposite of said statement is correct. A study compared psychoanalysis, as well as cognitive behavioral therapy, with methylphenidate in regards to the treatment of ADHD and oppositional defiant disorder (Laezer, 2015).
A common misconception is that psychoanalysis is a longer term treatment when compared to other options in the treatment of any disorder, however, the study found that the symptoms of ADHD were controlled first by psychoanalytic therapy, before the treatment with Ritalin or Methylphenidate ended. For the former, it was an average of 25.9 months in therapy. For the latter, it was 29.6 months in treatment. This an important fact since patients or users of the drug would usually develop either tolerance or sensitivity. In other words, psychoanalysis treats the symptoms of ADHD faster and patients don't run the risks of needing more drugs and thus experiencing more side effects or having long-term effects of their drugs. In addition, the study found that once psychoanalytic treatment was finished, patients reported the same level of impact in the symptoms when compared to the ones that were under the influence of the drug. This means that patients that had finished their psychoanalytic therapy had the same effects as those that still were in drug therapy. In fact, patients who were using Ritalin had to continue its use, but psychoanalytic therapy was a one-time deal.
In conclusion, methylphenidate is a drug that has the potential to be abused and has already been abused by those who have a history of drug usage. It is prescribed exponentially and has an impact in the late stages of childhood and adolescence, which are delicate stages in which our brain has greater plasticity. Moreover, psychoanalytic therapy is another tool that can be used in the treatment of ADHD for several reasons. The first one is that it does not have side effects and it cannot be abused like methylphenidate. Additionally, it works faster than the most prescribed stimulant. Moreover, once finished it still has the effects as those that were still using Ritalin. Finally, psychoanalysis also had positive medium and large effects with ADHD and oppositional defiant disorder without depending on treatment, because once the therapy ended the effects remained constant.
Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers. (n.d.). Retrieved from
Attention deficit hyperactivity disorder (ADHD) - Treatment. (n.d.). Retrieved from
Calipari, E. S., & Ferris, M. J. (2013). Amphetamine Mechanisms and Actions at the Dopamine Terminal Revisited. The Journal of Neuroscience : The Official Journal of the Society for Neuroscience33(21), 8923–8925.  
Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.
Hoffman BB, & Lefkowitz RJ (1996). Catecholamines, sympathomimetic drugs, and adrenergic receptor antagonists. In: Hardman JG, Limbird LE, Molinoff PB, et al, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill. 221–224.
How does cocaine produce its effects? (n.d.). Retrieved August 01, 2016, from
Jaffe SL. (1991) Intranasal abuse of prescribed methylphenidate by an alcohol and drug abusing adolescent with ADHD. J Am Acad Child Adolesc Psychiatry. 30:773–775.
Katrin Luise Laezer (2015) Effectiveness of Psychoanalytic Psychotherapy and Behavioral Therapy Treatment in Children with Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder, Journal of Infant, Child, and Adolescent Psychotherapy, 14:2, 111-128, DOI: 10.1080/15289168.2015.1014991.
McEvoy G. K. (1999). American Hospital Formulary Service Drug Information. Bethesda, Md: American Society of Health-Systems Pharmacists. 2038–2040.
Ritalin and Cocaine: The Connection and the Controversy. (n.d.). Retrieved from
Schizophrenia. (n.d.). Retrieved from
Volkow ND, Ding YS, Fowler JS, et al. (1995) Is methylphenidate like cocaine? studies on their pharmacokinetics and distribution in the human brain. Arch Gen Psychiatry. 52:456–463.