Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/S2237-60892012000200010
Trends in Psychiatry and Psychotherapy
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Non-medical use of methylphenidate: a review

Uso não terapêutico do metilfenidato: uma revisão

Luana Freese; Luciana Signor; Cassio Machado; Maristela Ferigolo; Helena Maria Tannhauser Barros

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Abstract

INTRODUCTION: Methylphenidate is a psychostimulant medication used for the treatment of attention deficit hyperactivity disorder and narcolepsy. However, it has also been used for non-medical purposes, e.g. to produce euphoria, to increase self-esteem, and to achieve the so-called neurocognitive enhancement, decreasing the feeling of tiredness and increasing focus and attention. OBJECTIVE: To describe, from theoretical and contextual points of view, the potential for abuse and non-medical use of methylphenidate. METHOD: The PubMed, SciELO and Cochrane databases were searched using the following keywords in Portuguese: metilfenidato, transtorno do déficit de atenção com hiperatividade, facilitadores dos processos cognitivos or agentes nootrópicos, and abuso de substâncias; and in English: methylphenidate, attention deficit disorder with hyperactivity, cognitive enhancement or nootropic agents, and substance abuse. Studies published between 1990 and 2010 were selected for review. RESULTS: Non-medical use of methylphenidate is a relevant topic that raises important ethical and scientific questions in several areas, e.g. pharmacological and neurobiological characteristics, evidence of methylphenidate use, forms of non-medical use of methylphenidate, mechanisms of action, and therapeutic application of methylphenidate. According to the review, methylphenidate can generally influence performance as a result of its stimulatory effect. Notwithstanding, evidence does not support the conclusion that it can enhance cognitive performance. CONCLUSION: Health professionals need to acquire expert knowledge and inform patients and their families on the methylphenidate potential for abuse when used with non-medical purposes.

Keywords

Methylphenidate, attention deficit disorder with hyperactivity, nootropic agents, substance-related disorders

Resumo

INTRODUÇÃO: O metilfenidato é um medicamento psicoestimulante usado no tratamento do transtorno de déficit de atenção e hiperatividade e da narcolepsia. No entanto, a droga também vem sendo utilizada com fins não terapêuticos, por exemplo para produzir euforia, aumentar a autoestima e obter o chamado aprimoramento neurocognitivo, diminuindo a sensação de cansaço e aumentando o foco e a atenção. OBJETIVO: Descrever, sob o ponto de vista teórico e contextual, o potencial de abuso do metilfenidato quando usado com fins não terapêuticos. MÉTODO: Foi realizada uma pesquisa nos bancos de dados PubMed, SciELO e Cochrane, utilizando os seguintes termos em português: metilfenidato, transtorno do déficit de atenção com hiperatividade, facilitadores dos processos cognitivos or agentes nootrópicos e abuso de substâncias; e, em inglês: methylphenidate, attention deficit disorder with hyperactivity, cognitive enhancement or nootropic agents e substance abuse. Foram selecionados estudos publicados entre 1990 e 2010. RESULTADOS: O uso não terapêutico do metilfenidato é um tema relevante e que suscita questões científicas e éticas importantes sob diversos aspectos, por exemplo características farmacológicas e neurobiológicas, evidência de uso da droga, formas não terapêuticas de uso, mecanismos de ação e aplicação terapêutica do metilfenidato. De acordo com a revisão o metilfenidato pode, em geral, influenciar o desempenho como resultado de seu efeito estimulatório. No entanto, independentemente disso, as evidências não apoiam a conclusão de que ele possa promover um melhor desempenho cognitivo. CONCLUSÃO: É importante que profissionais da saúde tenham conhecimento e informem os pacientes e suas famílias sobre o potencial de abuso do metilfenidato quando usado com fins não terapêuticos.

Palavras-chave

Metilfenidato, transtornos de déficit da atenção e do comportamento disruptivo, agentes nootrópicos, transtornos relacionados ao uso de substâncias

References

Gumy C, Huissoud T, Dubois-Arber F. Prevalence of methylphenidate prescription among school-aged children in a Swiss population: increase in the number of prescriptions in the Swiss Canton of Vaud, from 2002 to 2005, and changes in patient demographics. J Atten Disord. 2010;14:267-72.

Pliszka SR. The neuropsychopharmacology of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005;57:1385-90.

The British Pharmacopeia,. 2009.

Moraska AR, Sood A, Dakhil SR, Sloan JA, Barton D, Atherton PJ. Phase III, randomized, double-blind, placebo-controlled study of long-acting methylphenidate for cancer-related fatigue: North Central Cancer Treatment. J Clin Oncol. 2010;28:3673-9.

Challan TD, Lipsky JJ. Methylphenidate: its pharmacology and uses. Mayo Clin Proc. 2000;75:711-21.

Castells X, Casas M, Pérez-Mañá C, Roncero C, Vidal X, Capellà D. Efficacy of psychostimulant drugs for cocaine dependence. Cochrane Database Syst Rev. 2010;17:CD007380.

Volkow ND, Wang GJ, Tomasi D, Telang F, Fowler JS, Pradhan K. Methylphenidate attenuates limbic brain inhibition after cocaine-cues exposure in cocaine abusers. PLoS One. 2010;5:e11509.

Farquhar S, Fawcett P, Fountain F. Illicit intravenous use of methylphenidate (ritalin) tablets: a review of four cases. Aust Emerg Nurs J. 2002;5:25-9.

Volkow ND, Swanson JM. Variables that affect the clinical use and abuse of methylphenidate in the treatment of ADHD. Am J Psychiatry. 2003;160:1909-18.

Convention on psychotropic substances, 1971. 1971.

Carlini EA, Nappo SA, Nogueira V, Naylor FGM. Metilfenidato: influência da notificação de receita A (cor amarela) sobre a prática de prescrição por médicos brasileiros. Rev Psiquiatr Clin. 2003;30:11-20.

Victor M. Expansores cognitivos e psiquiatria cosmética: estamos preparados? Relato de caso. Rev Bras Psiquiatr. 2009;31:387-95.

Barros DB. Aprimoramento cognitivo farmacológico - grupos focais com universitários. .

Musser CJ, Ahmman PA, Theye FW. Stimulant use and the potential for abuse in Wisconsin as reported by school administration an longitudinally followed children. J Dev Behav Pediatr. 1998;19:187-9.

Wilens TE, Adler LA, Adams J, Sgambati S, Rotrosen J, Sawtelle R. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47:21-31.

Methylphenidate - Substance Summary. .

Volkow ND, Wang GJ, Fowler JS, Ding YS. Imaging the effects of methylphenidate on brain dopamine: new model on its therapeutic actions for attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005;57:1410-5.

Louzã MR, Mattos P. Questões atuais no tratamento farmacológico do TDAH em adultos com metilfenidato. J Bras Psiquiatr. 2007;56:53-6.

Swanson JM, Volkow ND. Serum and brain concentrations of methylphenidate: implications for use and abuse. Neurosci Biobehav Rev. 2003;27:615-21.

Biederman J, Mick E, Surman C, Doyle R, Hammerness P, Harpold T. A randomized, placebo-controlled trial of OROS methylphenidate in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2006;59:829-35.

Volkow ND, Wang GJ, Fowler JS, Gatley SJ, Logan J, Ding YS. Dopamine transporter occupancies in the human brain induced by therapeutic doses of oral methylphenidate. Am J Psychiatry. 1998;155:1325-31.

Gatley SJ, Volkow ND, Gifford AN, Fowler JS, Dewey SL, Ding YS. Dopamine-transporter occupancy after intravenous doses of cocaine and methylphenidate in mice and humans. Psychopharmacology (Berl). 1999;146:93-100.

Levy F. Pharmacological and therapeutic directions in ADHD: specificity in the PFC. Behav Brain Funct. 2008;4:12.

Volkow ND, Wang G, Fowler JS, Logan J, Gerasimov M, Maynard L. Therapeutic doses of oral methylphenidate significantly increase extracellular dopamine in the human brain. J Neurosci. 2001;21:RC121.

Mehta MA, Owen AM, Sahakian BJ, Mavaddat N, Pickard JD, Robbins TW. Methylphenidate enhances working memory by modulating discrete frontal and parietal lobe regions in the human brain. J Neurosci. 2000;20:RC65.

Pattij T, Vanderschuren LJ. The neuropharmacology of impulsive behavior. Trends Pharmacol Sci. 2008;29:192-9.

Koehm M, Kauert GF, Toennes SW. Influence of ethanol on the pharmacokinetics of methylphenidate's metabolites ritalinic acid and ethylphenidate. Arzneimittelforschung. 2010;60:238-44.

Parran TV, Jasinski DR. Intravenous methylphenidate abuse: prototype for prescription drug abuse. Arch Intern Med. 1991;151:781-3.

Biederman J, Monuteaux MC, Spencer T, Wilens TE, MacPherson HA, Faraone SV. Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: a naturalistic controlled 10-year follow-up study. Am J Psychiatry. 2008;165:597-603.

Brown RT, Amler RW, Freeman WS, Perrin JM, Stein MT, Feldman HM. Treatment of attention-deficit/hyperactivity disorder: overview of the evidence. Pediatrics. 2005;115:749-57.

DeVito EE, Blackwell AD, Kent L, Ersche KD, Clark L, Salmond CH. The effects of methylphenidate on decision making in attention-deficit/hyperactivity disorder. Biol Psychiatry. 2008;64:636-9.

Agay N, Yechiam E, Carmel Z, Levkovitz Y. Non-specific effects of methylphenidate (Ritalin) on cognitive ability and decision-making of ADHD and healthy adults. Psychopharmacology (Berl). 2010;210:511-9.

Turner DC, Blackwell AD, Dowson JH, McLean A, Sahakian BJ. Neurocognitive effects of methylphenidate in adult attention-deficit/hyperactivity disorder. Psychopharmacology (Berl). 2005;178:286-95.

Faraone SV, Spencer T, Aleardi M, Pagano C, Biederman J. Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. 2004;24:24-9.

Koesters M, Becker T, Kilian R, Fegert JM, Weinmann S. Limits of meta-analysis: methylphenidate in the treatment of adult attention-deficit hyperactivity disorder. J Psychopharmacol. 2009;23:733.

Mitler MM, Aldrich MS, Koob GF, Zarcone VP. Narcolepsy and its treatment with stimulants: ASDA standards of practice. Sleep. 1994;17:352-71.

Repantis D, Schlattmann P, Laisney O, Heuser I. Modafinil and methylphenidate for neuroenhancement in healthy individuals: a systematic review. Pharmacol Res. 2010;62:187-206.

Advokat C. What are the cognitive effects of stimulant medications: Emphasis on adults with attention-deficit/hyperactivity disorder (ADHD). Neurosci Biobehav Rev. 2010;34:1256-66.

Kandel ER. Cellular mechanisms of learning and the biological basis of individuality. Principles of neural science. 1991:1009-31.

Cools R, Robbins TW. Chemistry of the adaptive mind: Philosophical transactions. Philos Transact A Math Phys Eng Sci. 2004;362:2871-88.

Klein-Schwartz W, McGrath J. Poison centers' experience with methylphenidate abuse in pre-teens and adolescents. J Am Acad Child Adolesc Psychiatry. 2003;42:288-94.

Scharman EJ, Erdman AR, Cobaugh DJ, Olson KR, Woolf AD, Caravati EM. Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45:737-52.

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