Ritalin, Medikinet, Concerta, Quasym: all these brands refer to a single molecule, methylphenidate (MPH). From the family of stimulants, it is neither an amphetamine nor an amphetamine derivative and can be prescribed in the medicinal treatment of attention deficit disorder with or without hyperactivity (ADHD), both in children and adults. In 2023, children aged 6 to 17 accounted for 65% of treated people who had at least one birth during the year (around 111,000 young patients, or just over 1% of the population in this age group), according to the National Office for Medicines and Security Agency (ANSM). The annual increase has been around 15% since 2021. “We still hear that ‘too many children are taking methylphenidate’, when in fact we are catching up on the issue”“stresses Nathalie Franc, a child psychiatrist at the University Hospital of Montpellier.
To understand how the molecule works, we need to review advances in pathophysiology. Two brain regions are particularly involved in ADHD: the executive function network and the default mode network. The first is activated when you want to perform a task, the second focuses on subjective experience (emotions, introspection or memory, for example). In theory, when one is activated, the other is put on hold. “But with ADHD, when the person must perform an action, the default mode remains active, thus altering executive functions.explains Professor of Child Psychiatry Samuele Cortese, from the University of Southampton in the United Kingdom. It is believed that there is a lack of communication between these networks.. »
“Transient adverse effects”
Functional brain imaging shows that taking MPH rebalances the brain: the brain functions similarly to that of a person without ADHD. At the molecular level, the drug increases the level of dopamine (a neurotransmitter that influences arousal and the motivational system) in the synaptic window. “This allows us to improve concentration, and therefore the quality of learning, and to be more present”specifies Dr. Franc.
In terms of effectiveness, meta-analyses of randomized studies with control groups (the highest level of scientific evidence) show an effect size of around 0.8, a statistically significant figure with a considerable impact on the clinical plan. “We are trying another measure with the MPH, the number needed for tret (NNT), that is, how many patients should we treat to have improvements compared to placebo?explains Professor Cortese. For MPH, it’s about 1.5. In comparison, in depression, you need to treat six people with antidepressants for one to get better. »
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