Affiliation: Department of Neurology, Mayanei Hayeshua Hospital, 17 Povarsky St, Bnei Barak 51544, Israel.
Since 1972, I have been treating children with amphetamines and somewhat later with methylphenidate (Ritalin) for Minimal Brain Damage, a diagnostic term used in those early years for children with Attention Deficit Hyperactivity Disorder (ADHD). Similar to other colleagues, I have also noted a continuous rise in the interest, understanding, and rate of diagnosis and drug treatment given to children, adolescents and adults of all ages with ADHD. In the "Time magazine", health & family section of September 22, 2010 the title, "ADHD: A Global Epidemic or Just a Bunch of Fidgety Kids?" is not just a reminder by the journalist John Cloud of the new worldwide epidemic of ADHD. He as many professionals in the field of ADHD, "raises a brow" considering the accuracy of the diagnosis when faced with the fact that an increase of 53% in treated boys and 69% in treated girls for ADHD with psycho-stimulants of which Methylphenidate (Ritalin) was the most widely used was observed in Germany during the period of 2000-2007. Moreover, the number of treated youngsters 15-18 years of age has doubled. Most recently it was reported that an increase of about 24% in the rate of diagnosis of ADHD from 2001-2010 was observed in the USA. Unfortunately, there is also a continuous increase in the number of individuals without ADHD who are given (or are taking) Ritalin for cognitive enhancement. Most recently some authorities recommend starting treatment even in children as young as 3.5 years. Ritalin, a psychotrophic stimulant may be used by children for many years following sometimes a short diagnostic clinic visit, and rarely without such a procedure. Considering the above, the present paper will review past and recent knowledge on methylphenidate, its chemistry, pharmacology, mechanism and site of action, efficacy, side effects and use for conditions other than ADHD. Several dilemmas related to possible causes of the "Ritalin epidemic" will be critically discussed.