Astral Codex Ten

Ritalin

9 min read

Ritalin

Article

Ritalin is a recurring brand in the Astral Codex Ten archive, appearing 8 times across 8 issues between January 25, 2021 and May 31, 2023. The archive places it in contexts such as “I give up on amphetamines and start looking at Ritalin”; “Adderall and Ritalin are illegal drugs here”; “was prescribed Ritalin”. It most often appears alongside Adderall, ADHD, DEA.

Metadata

  • Category: Brands
  • Mention count: 8
  • Issue count: 8
  • First seen: January 25, 2021
  • Last seen: May 31, 2023

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Know Your Amphetamines
January 25, 2021 · Original source
US Ritalin consumption in millions of doses/year, probably a good proxy for number of ADHD diagnoses, approximately septupled during the 1990s (source)
Inline links: source
When I treat ADHD with amphetamines, I usually start with Adderall/extended release Adderall, even though realistically Dexedrine would probably be an equally good or better choice. If it's not working very well or there are too many side effects, I switch to Dexedrine/extended release Dexedrine. If Dexedrine doesn't work because it seems too strong or the patient "crashes" too hard afterwards, or if I'm worried the patient is at risk of addiction, I will try Vyvanse (or some other solution to stimulant “crashes”); if Dexedrine works less well than Adderall and I am very confused and the patient is in an experimenting kind of mood, I might try Evekeo. If none of these work, a braver person than I am might try Desoxyn. As for me, I give up on amphetamines and start looking at Ritalin, modafinil, or other options.
Inline links: some other solution to stimulant “crashes”
Highlights From The Comments On "Crazy Like Us"
July 21, 2021 · Original source
Living in Russia, I can say that ADHD (translated as СДВГ) is less recognized by the psychiatry community here because of its unclear aetiology. Doctors usually refuse to treat the patients in the absence of dangerous symptoms, and state the diagnosis as "organic nervous system disorder", "psychoorganic syndrome" or indeed "neurasthenia". Adderall and Ritalin are illegal drugs here. Patients usually get prescribed nootropics (glycine, racetams) and adrenaline reuptake inhibitors (atomoxetine).
Highlights From The Comments On Missing School
August 26, 2021 · Original source
I think there's a few places where missing school would have outsize effects. One is if the kid had some kind of treatable problem (say ADHD) that the parents are not equipped to identify but that possibly somebody at school might recommend taking the kid in for testing. Granted this could still be identified once the kid goes back to school, but if you assume the parent will fail to notice it forever but some teacher/counselor/whoever *might* notice it, then less exposure to the people who might notice will reduce the chance it ever gets noticed. For people who don't find this plausible, do not underestimate the inability of many low income or rural parents to think in these terms. My sister was not diagnosed with ADHD until she was in late high school and was prescribed Ritalin. It was literally life changing for her. It never occurred to my parents to think of her various behavioral problems in terms of anything except childish defiance they could fix with rules.
Study: Ritalin Works, But School Isn't Worth Paying Attention To
July 06, 2022 · Original source
173 kids, mostly Hispanic boys age 7-12, were in a “therapeutic ADHD summer camp” intended to help them learn focusing and attention-directing techniques (style tip: do not call this a “concentration camp”). The kids had two short classes each day, one on vocabulary and one on a grab bag of different subject matters. For the first three weeks, half the kids got Concerta (ie long-acting Ritalin) and the other half didn’t, then they switched for the next three weeks. As an additional test, there was a ten minute period each day when the kids were asked to do math problems as fast as possible. Here are the results:
Skills Plateau Because Of Decay And Interference
August 18, 2022 · Original source
Followup to: Why Do Test Scores Plateau; Ritalin Works But School Isn’t Worth Paying Attention To
Inline links: Why Do Test Scores Plateau, Ritalin Works But School Isn’t Worth Paying Attention To
We find the same phenomenon in formal education; on a standardized test of book learning for student doctors, there’s a big increase the first year of training, a smaller increase the second year, and by year 4-5 the increase is basically indistinguishable from zero (even though some doctors remain better than others). And here I talk about a slightly different phenomenon: ADHD children given Ritalin study harder and better, but haven’t learned any more vocabulary words at the end of a course (even though they haven’t learned all the vocabulary).
Inline links: a standardized test of book learning for student doctors, here I talk about
Finally, I conflated two things in the previous section: a limit on how much you can learn total (eg the doctor who practices for many years) and a limit on how much you can learn per day (eg twenty words of Spanish vocabulary a day). I have no evidence for the latter except the testimony of one acquaintance, and maybe the corroborating evidence from the Ritalin study. Still, if there’s a maximum amount you can learn per day (or, more likely, a diminishing returns curve) that sounds useful to know, doesn’t it? Psych undergrads asking me for study ideas, here’s your chance!
The Government Is Making Telemedicine Hard And Inconvenient Again
March 29, 2023 · Original source
The first fruit of their labor is DEA-407, which makes it hard for telemedicine doctors to prescribe controlled substances. Controlled substances are drugs like Adderall, Ritalin, Xanax, or Ambien that the government has declared to be potentially addictive. The new rules say that telemedicine doctors can no longer prescribe these (or, in some cases, can prescribe them one time in an emergency).
Inline links: DEA-407
Some like convenience and dislike inconvenience As a psychiatrist, a big part of my job is prescribing controlled substances. For example, most guidelines agrees that the first-line treatment for severe ADHD is stimulant medications (eg Adderall or Ritalin). And although psychiatrists hate to admit it, the first-line treatment for temporary crisis anxiety, especially when it’s so bad that the patient isn’t able to listen to your clever plans to solve it with therapy, is benzodiazepines (eg Valium or Klonopin). You can’t be a good well-rounded psychiatrist without the option to sometimes prescribe these drugs. "Well, your patients will have to find a different psychiatrist, or transition off of them”. Nobody ever finds different psychiatrists. Some of my patients are a bad match for my style or areas of expertise, and I’ve tried very hard to find them different psychiatrists, and it never works. Maybe there are no other psychiatrists in their area. Maybe the psychiatrists in their area don’t take the right insurance, or are too far away from mass transit. Maybe the psychiatrists have six month long wait lists. Sometimes it’s just that my ADHD patients get distracted and forget they were supposed to find new psychiatrists, and I can’t hold their hand literally all the time. As for transitioning off the medications, some patients absolutely cannot function at all without them. Did I mention that if you come off of some of them too quickly, you can literally die? The medical regulators grudgingly acknowledge these issues and have placed two loopholes in the law: If you ever see a doctor in person, even once, they can prescribe you controlled substances from then on, even if they only see you by telemedicine afterwards.
Highlights From The Comments On Telemedicine Regulations
April 03, 2023 · Original source
I'm one of those "bad" people who thinks potentially addictive meds should require in-person evaluation. I worked for a psychiatric and social work agency for 15 years. Saw a lot of speed addicts on Ritalin, saw a lot of kids who were place on Ritalin because Mom or the teacher couldn't abide normal play behavior. Many of those kids are addicts cooking meth today.
There were some very dubious telemedicine psychiatry startups that would prescribe Adderall or Ritalin, seemed to have very low prescribing standards, and advertised very aggressively on social media. They were previously only doing SSRIs and the like, but moved to ADHD drugs when this became temporarily possible after COVID.
All Medications Are Insignificant In The Eyes Of God And Traditional Effect Size Criteria
May 31, 2023 · Original source
Some of our favorite medications, including statins, anticholinergics, and bisphosphonates, don’t reach the 0.50 level. And many more, including triptans, benzodiazepines (!), and Ritalin (!!) don’t reach 0.875.