Ritalin is a drug that is prescribed to treat attention-deficit/hyperactivity disorder (ADHD). Ritalin, also known as methylphenidate, is a central nervous system (CNS) stimulant. The drug is frequently misused and abused as a “study drug” among high school and college students. In the US, nearly 16 million prescriptions were written for methylphenidate (including Ritalin) in 2016. Ritalin is a schedule II drug, meaning that it has a valid medical use but is also associated with a high risk for abuse and addiction.
Although evidence suggests that tolerance and dependence do not occur in all people, Ritalin tolerance is common among people who use it regularly, especially at higher doses. Misuse and abuse are associated with tolerance, dependence and even addiction.
Ritalin Tolerance Symptoms
According to the National Institute on Drug Abuse, drug tolerance is a state in which someone “no longer responds to the drug in the way that person initially responded.” In other words, if someone has developed a tolerance to a drug, they will need a higher dose of the drug in order to achieve its effect.
Tolerance and dependence are related. When someone is dependent on a drug, they will experience physical and/or psychological symptoms if they reduce or completely stop using a drug. Ritalin withdrawal symptoms include:
- Weight loss
- Dulled senses
- Sleep problems
- Poor memory
How Fast Does Ritalin Tolerance Develop?
There is no simple answer to the question of how fast tolerance to Ritalin will develop. According to one report, tolerance symptoms may appear within days of starting Ritalin or may take more than a year to develop — if they develop at all. Many people who take Ritalin as prescribed may not ever develop a tolerance.
Causes Of Ritalin Tolerance
Not all medical professionals and researchers agree that CNS stimulants like Ritalin cause tolerance, and there is no single theory underlying why Ritalin tolerance develops. Currently, however, there are four main proposed mechanisms for how tolerance to stimulants develops:
- Changes in pharmacokinetics: Pharmacokinetics is the study of how drugs move throughout the body. This theory suggests that the amount of exposure a body has to Ritalin may impact tolerance development. For example, if someone gains weight while taking the same dose of Ritalin, the dose will become less effective because they have more body mass and less overall exposure to the drug.
- Progression of disorder: If ADHD worsens while someone is taking Ritalin, they will require higher doses to manage the symptoms.
- Environmental changes: Changes in the environment may require new or different demands on attention that are not manageable with the current Ritalin dosage.
- Paradoxical decompensation: This is the most complex of the proposed mechanisms. Paradoxical decompensation (PD) is the concept that a drug will temporarily improve a disorder, but the body will want to maintain its previous state (the “normal” state for that person) so will actively work against the drug. Ritalin is thought to work, in part, by increasing levels of the neurotransmitter dopamine. PD is the body’s attempt to counteract the increase in dopamine, so it will find ways to reduce dopamine to the normal level. This can actually worsen ADHD and require higher Ritalin doses.
Potentiation occurs when drugs are combined with other chemicals in an effort to increase or potentiate the effects of the drug. Although there may be cases in which doctors work with their patients to potentiate low doses of Ritalin, potentiation without medical oversight is not recommended.
Ritalin potentiators include:
- Alkalinizing agents: Increasing the pH of your gastrointestinal tract can increase the effects of Ritalin. Antacids allow for more rapid absorption of Ritalin, making it available more quickly.
- Caffeine: Like Ritalin, caffeine is a CNS stimulant that increases levels of dopamine in the brain. Combining caffeine and Ritalin may increase the effect of Ritalin, but it can also cause anxiety, trembling and other adverse effects.
- Nicotine: Nicotine is also a CNS stimulant, but it works by increasing the response of brain cells to dopamine, rather than increasing dopamine itself.
- L-Tyrosine: Dopamine synthesis relies on the presence of tyrosine. Supplementing the body with dopamine precursors (L-tyrosine, for example) may increase dopamine synthesis, making more dopamine available for use. L-dopa is another dopamine precursor.
- Selective serotonin reuptake inhibitors (SSRIs): SSRIs (including antidepressants like fluoxetine) have been shown to potentiate Ritalin effects in the brain by increasing gene expression in specific parts of the brain.
How To Prevent Ritalin Tolerance
The best way to prevent Ritalin tolerance is to take it at the lowest effective dose and as infrequently as possible.
For many people, taking a break from Ritalin can reduce or eliminate tolerance within a matter of weeks. These are often referred to as “drug holidays,” and can help reverse physiological adaptations that have developed over time. For some people, even a weekend without Ritalin can reverse some of the tolerance they have built up, but for others, drug holidays may not be effective. Why people have different success levels with drug holidays is unclear. Regardless, it’s important to always discuss your dosage with your doctor before making any changes.
Getting Help With Ritalin Addiction
Recovering from a Ritalin use disorder can be challenging. By entrusting your care to rehab professionals, you can focus on your own recovery while receiving essential medical and psychological support.
People who attempt to quit Ritalin “cold turkey” often experience very uncomfortable withdrawal symptoms that often cause people to relapse. Tapering the Ritalin dosage over time is the most effective quitting strategy and, by working with medical professionals, you can develop a tapering schedule that is suited to your particular circumstances and minimizes withdrawal symptoms safely.
The Recovery Village Ridgefield offers comprehensive rehab programs for people who are facing prescription stimulant use disorders. Call us today to learn how professional rehab can get you on the road to recovery.
ClinCalc.com. “Methylphenidate.” Updated July 2018. Accessed September 28, 2019.
Center for Substance Abuse Research. “Ritalin.” The University of Maryland. Updated October 2013. Accessed September 28, 2019.
National Institute on Drug Abuse. “The Neurobiology of Drug Addiction.” Updated January 2007. Accessed September 28, 2019.
Ross, Donald C; Fischhoff, Joseph; Davenport, Barbara. “Treatment of ADHD When Tolerance to Methylphenidate Develops.” Psychiatric Services, January 2002. Accessed September 28, 2019.
Yanofski, Jason. “The Dopamine Dilemma-Part II: Could Stimulants Cause Tolerance, Dependence, and Paradoxical Decompensation?” Innovations in Clinical Neuroscience, January 2011. Accessed September 29, 2019.
Van Waes, Vincent et al. “Fluoxetine potentiation of methylphenidate-induced neuropeptide expression in the striatum occurs selectively in direct pathway (striatonigral) neurons.” Journal of Neurochemistry, September 2012. Accessed September 29, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.