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Dr Matthew Smith on ADHD and Ritalin

Below is a picture of a Ritalin bottle from 1954 (Credit: Wellcome Library, London L0058213)

Today, we associate Ritalin (methlyphenidate) with children and adults diagnosed with Attention Hyperactive Deficit Disorder (ADHD), but this bottle contains tablets that would have been prescribed to a very different type of patient.  That is because Ritalin was first used to treat depressed and geriatric patients, patients whose behaviour was very different from that of hyperactive children.  First synthesised in 1944, Ritalin is a stimulant drug and was first approved for use in adults during the mid-1950s.  Its creator, the pharmaceutical company Ciba (now Novartis) marketed it as a ‘pep pill’, stronger than caffeine, but not quite as powerful as other stimulants, such as benzedrine. 

 The first advertisements for Ritalin did not feature children, but, instead, adults.  Some of these adverts showed severely depressed people, who would have been living in psychiatric institutions.  Others featured ‘before and after’ images of elderly patients or housewives.  One advert showed a ‘before’ picture of a a grey-haired lady facing a mountain of potatoes to peel.  In the ‘after’ picture (after a Ritalin prescription), the potatoes are peeled and she is looking a little cheerier. 

 Despite Ciba’s efforts to market Ritalin as a ‘pep pill’, the stimulant failed to become a best-seller.  But that was not the end of Ritalin’s story.  As early as the 1930s, psychiatrists working at a children’s psychiatric institution in Rhode Island, USA had noticed that stimulant drugs could have a positive effect on the academic performance and behaviour of troubled children.  Although few psychiatrists took notice of these observations at the time, by the late 1950s, escalating concern about the educational abilities of American children during the height of the Cold War encouraged Ciba to consider a new application for their drug: underachieving schoolchildren.  They received approval from the American Food and Drug Administration (FDA) to market Ritalin to children in 1962 and, almost immediately, it became a best-selling drug.

There are many reasons for Ritalin’s success as a drug for children.  Some critics argue that Ciba marketed the notion of ADHD as much as Ritalin.  Others contended that Ritalin was used as a tool to control children, moulding them to meet the expectations of adults.  Ritalin also emerged as a drug for children at the same time as other psychiatric drugs, which helps to explain why it was seen as an acceptable treatment.  But Ritalin also did what it was supposed to: although it did not work for every child and many children suffered side effects, it was an effective way of calming children down and helping them focus.  Ritalin, originally a drug in search of a disorder, became the right drug for the times.  Only time will tell if it continues to be so in future.

Read more about the history of ADHD and Ritalin in Hyperactive: The Controversial History of ADHD (Reaktion, 2012).

 

Discussion questions:

What factors contribute to the success of a psychiatric drug?

Should children be treated with psychiatric drugs?

Why do you think it took so long for Ritalin to become a best-selling drug?

Why do think a stimulant helped to calm down children and help them focus?

Dr Matthew Smith on ADHD and Ritalin