The Long-term Effects of Ritalin: An Insight

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Long-Term Effects of Ritalin on Growth

Ritalin is known to exhibit mild inhibitory effects on growth, with the result that children taking the medication are on average slightly smaller than their non-medicated counterparts.[1] It was initially suggested that this decrease in growth rate would be counteracted in the long-term by growth rebound: a period of faster growth later in adolescence, but a study by Swanson et al published in the “Journal of the American Academy of Child and Adolescent Psychology” in 2007 presented evidence suggesting this was not the case, and any effects of Ritalin on growth are likely to be permanent.[2]

The effects of Ritalin on growth appear to be dose-dependent, with doses less than 20mg per day having no growth-suppressing effect. However, growth suppression does represent a common long-term side effect of Ritalin use, and should therefore be considered when making a decision regarding management of ADHD.

Long-Term Effects of Ritalin on Cardiovascular Health

Ritalin is a stimulant medication, and is known to exert mild effects on the heart in some patients. Examples of symptoms experienced by children with ADHD taking Ritalin include increases in blood pressure and mild tachycardia.[3] In children experiencing these effects, there is a chance of increased risk of developing cardiovascular disease later in life, but the effects are both minimal and rare. Currently, medical experts do not advocate routine cardiovascular monitoring of patients taking Ritalin as the risks are considered to be so small.

Risk of Substance Abuse

Individuals suffering from ADHD are known to be at a greater risk of substance abuse later in life.[4] Concerns have been raised regarding Ritalin and other psychostimulants since it was suggested that use of these prescribed substances may exacerbate the risk of later substance abuse.

However, a meta-analysis of the available studies by Wilens et al, published in the journal “Pediatrics” in 2003, found the reverse to be true, with use of stimulants appearing to have a protective effect against substance abuse. Subjects taking Ritalin or other stimulants exhibited a significantly lower risk of developing substance abuse disorders.[5]

Long-Term Effects of Ritalin and Addiction

Methylphenidate is the active ingredient in Ritalin and this substance has the potential to be abused, exhibiting effects similar to cocaine if taken intra-nasally.[6] Methylphenidate is likely to be addictive if abused, but there is no evidence to suggest addiction occurs at therapeutic doses.[7] However, children using Ritalin may suffer from “hyper” rebound and worsening of symptoms on withdrawal.[8]


[1] D Safrer, R Allen, E Barr “Depression of Growth in Hyperactive Children on Stimulant DrugsNew England Journal of Medicine 287:217-220 (1972)

[2] JM Swanson, GR Elliott, LL Greenhill “Effects of Stimulant Medication on Growth rates Across 3 Years in the MTA Follow-UpJournal of the American Academy of Child and Adolescent Psychiatry 46:1015-1027 (2007)

[3] H Gutgesell, D Atkins, R Barst “Cardiovascular Monitoring of Children and Adolescents Receiving Psychotropic DrugsCirculation 99:979-982 (1999)

[4] MH Boyle, DR Offord, YA Racine “Predicting Substance Use in Late Adolescence: Results From the Ontario Child Health Safety Follow UpAmerican Journal of Psychiatry 149:761-767 (1992)

[5] TE Wilens, SV Faraone, J Biederman “Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-Analytic Review of the LiteraturePediatrics 111:179-185 (2003)

[6] W Klein-Schwartz “Abuse and Toxicity of MethylphenidateCurrent Opinion in Pediatrics 14:219-223 (2002)

[7] WA Morton, GG Stockton “Methylphenidate Abuse and Psychiatric Side EffectsJournal of Clinical Psychiatry 2:159-164 (2000)

[8] PR Breggin “Talking Back to Ritalin” Common Courage Press (1998)