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Ritalin Withdrawal & Detox

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/25/2020

Number of References: 23 Sources

Ritalin is a very common stimulant medication that is commonly used to treat ADHD and, more infrequently, narcolepsy. While it can be safe and effective for treating these disorders when used as prescribed, it can still be abused. The symptoms of Ritalin withdrawal, while rarely dangerous, can be quite uncomfortable. Even though they may be strictly psychological in nature, these symptoms can still present some indirect risks and make it very difficult for someone to quit using Ritalin. In this article, we will examine how, exactly, this drug works, the specific symptoms of Ritalin withdrawal, the timeline involved, and some effective treatment options.

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Ritalin Pharmacology & Addiction

The medication Ritalin is a medication that contains the psychoactive ingredient methylphenidate. This is a stimulant drug and while producing very similar effects as amphetamines, is distinct from this class of drug although they are very closely related. The mechanism of action that Ritalin utilizes to produce its effects, while not exactly clear, seems to be similar to those used by the amphetamines. By interacting with neurotransmitter transporter proteins, Ritalin can cause levels of certain excitatory neurotransmitters to build up in between neurons, leading to higher levels of excitatory signaling by prolonging the time that these neurotransmitters are able to signal before being removed by the reuptake process.

Known as reuptake inhibition, this process can produce dose-dependent effects, with low doses leading to enhanced concentration and high doses exhibiting the classic stimulant properties such as hyperactivity, euphoria, and impaired cognition. The two major neurotransmitters that Ritalin effects are dopamine and norepinephrine, although the strongest euphoric effects are due to dopamine. Dopamine is a major excitatory neurotransmitter in the brain that can influence cognition, motor control, feeling of reward, and motivation. Norepinephrine is both a neurotransmitter and a hormone and, in the brain, is responsible for attention, focus, and motivation among other things. In the blood acting as a hormone, norepinephrine can increase heart rate, elevate blood pressure, and cause blood sugar levels to spike.

Through chronic use of Ritalin, the brain will respond to the increased levels of these neurotransmitters in an attempt to maintain balance. This process, known as downregulation, is the act of the brain reducing its sensitivity to these neurotransmitters. This can first lead to tolerance to Ritalin, and with continued use will result in physical dependence. A further process known as neurological remodeling will begin after downregulation, and this is the brain making structural changes in an attempt to operate more effectively in a dopamine and norepinephrine downregulated environment. Once downregulation and remodeling have occurred due to chronic Ritalin use, someone will benign to feel mentally unwell when they go too long without using the drug. 1, 2, 3, 4

Symptoms of Ritalin Withdrawal

Within hours of the last drug use, the symptoms of Ritalin withdrawal will begin to appear. These may be mild initially, but within the first few days of Ritalin cessation, they will have reached their peak intensity. Because Ritalin is a stimulant, the symptoms of Ritalin withdrawal are generally depressive in nature. Even though these symptoms may pose no direct, physical risk, they can still be extremely disruptive to someone’s life. Also, they may lead to secondary risks such as suicidal thoughts or suicide attempts, and this risk should be treated very seriously.

Some of the symptoms of Ritalin withdrawal include:

Deep Depression (with or without suicidal ideation)
Anxiety
Fatigue and Lethargy
Headaches
Increased Appetite
Diaphoresis (excessive sweating)
Cognitive Difficulties
Cravings for Ritalin
Anhedonia (reduced ability to experience pleasure)
Cardiovascular Fluctuations (hyper- or hypotension)
Sleep Disturbances (usually hypersomnia followed by insomnia)
Shaking or Tremors
Priapism (prolonged, sometimes painful erections; uncommon) 5, 6
Dystonia (movement disorders, usually involving the mouth; uncommon) 7, 8, 9

These symptoms can be very unpleasant and sometimes quite long-lasting. Depression and the risk of suicide are of particular note, as this can lead to fatal outcomes. Obtaining appropriate care is critical in reducing both the risks and the discomfort of Ritalin withdrawal symptoms. Entering a Ritalin detox center can provide the resources and trained medical professionals to help someone through this difficult period in the safest way possible. This may also provide the tools to give someone the best possible chances of achieving long-term recovery. 10

Ritalin Withdrawal Timeline

The timeline for Ritalin withdrawal symptoms can vary somewhat between people, although for the worst of the symptoms, it is usually no more than a week or two. That being said, less intense but more prolonged symptoms may persist for quite some time in the form of post-acute withdrawal symptoms. These are often mild but can last for months or even years after Ritalin use has ceased. Here we will look at a general timeline that may apply to most people over the first month of Ritalin withdrawal.

Depending on the exact formulation of Ritalin, it can have a different half-life and pharmacokinetic profile. The bounds of Ritalin’s half-life, among all formulations, is between 2.1 to 3.5 hours. That being said, extended-release formulations will introduce the drug into the body more slowly, so this could extend the half-life by ~12 hours. This is fairly short for a stimulant, and this means that usually within around 6 hours of the last use, someone will begin experiencing symptoms of Ritalin withdrawal. 12

First Week

Within hours of the last use, symptoms will begin to appear. The initial phase, known as the “crash” phase will usually resolve within the first three days. This is a rapid appearance and escalation of withdrawal symptoms that will lessen and stabilize fairly soon. The most common symptoms to arrive first are sadness which usually deepens into depression, and a profound and rapidly escalating fatigue and lethargy. Someone may also begin sweating profusely within the first day, and the first night is usually characterized by excessive sleep. Anxiety, anhedonia, headaches, increased appetite, and cognitive difficulties may also be expected the next day. Tremors and cardiovascular fluctuations, such as intermittently rising and falling blood pressure, may be common during the first few days as well. These symptoms often stabilize around the middle of the first week and may begin resolving towards the seventh day.

Second Week

The beginning of the second week often shows some improvement in symptom intensity. While the worst of the symptoms such as tremors, cardiovascular fluctuations, and headaches may be well on their way to resolution, the rest of the symptoms are often still present. Hypersomnia may resolve as the physical symptoms fade, and insomnia normally follows although its origins are psychological rather than physical. Anxiety, depression, and low energy levels often persist mostly unchanged throughout the week although cognitive issues may begin to improve as the week goes on.

Third Week

By week three, the majority of symptoms have usually resolved. That being said, the frequently more severe symptoms of depression, anxiety, and fatigue may have shown some improvement, but are often still quite disruptive. Cravings may also become more noticeable now as the memory of the intense crash and discomfort of early withdrawal fades. If this has not been done so already, it is highly recommended for someone to enter treatment, as relapse is a very real risk with serious repercussions.

Fourth Week and Onwards

The fourth week often shows some lifting of anxiety and fatigue, although depression may still be present. Cravings, too, are frequently still common, and these may persist for some time to come. There are many variables that can affect the longer-lasting post-acute symptoms and their duration and there is often substantial variability in the duration of these symptoms between people. Getting through the most intense phase of withdrawal is the first step, and there is still work to be done.

The Importance of Ritalin Detox

The symptoms of Ritalin withdrawal can be an extremely difficult challenge to overcome alone. It often requires help, not only to make it through withdrawal but to avoid relapse and continue building a new life after Ritalin addiction. Entering a Ritalin detox center can provide medical supervision, medications, and clinical therapy to help reduce the physical and psychological discomfort, and help someone develop skills and tools to deal with life in a healthier way. After detox is completed, these centers can provide referrals or connections to further treatment programs or make introductions to members of the local recovery community. In the end, there is a much greater chance of someone achieving long-term recovery and building a better life if they have the resources of a Ritalin detox center to draw upon.

Physical Effects of Detoxing from Ritalin

While it is true that Ritalin detox does not usually produce direct physical effects, there are some physical effects that can arise as a result of chronic Ritalin use. These effects may not manifest until Ritalin use has ceased, so they can sometimes be mistaken for the effects of Ritalin detox. In the absence of many common physical effects of Ritalin detox, we will include them here. In addition, some of the physical symptoms that are experienced during Ritalin detox actually have deeper neurological or psychological causes. Here, we will take a look at some of the common physical effects of Ritalin use and detox.

Priapism

While this is not necessarily common, Ritalin is increasingly being implicated in the manifestation of priapism. Priapism only occurs in males and is a prolonged, sometimes painful erection that occurs in the absence of sexual stimulus. This is most often an effect of Ritalin use itself, and not Ritalin detox, although in some people it occurs during withdrawal and detox exclusively. The exact causes are currently unclear, although it is thought to be related to the dysregulation of dopamine neurotransmitter systems due to chronic Ritalin use. 5, 6, 11, 13, 14

Dystonia

Another physical effect that may be observed during and after Ritalin detox is dystonia. Dystonia is a movement disorder that can take many forms and, in the case of Ritalin detox, includes ataxic gait, trismus, tardive dyskinesia, and oromandibular dystonias. While not exactly common, some of the most frequently reported Ritalin detox-associated dystonias occur in the face or mouth, although ataxic gait has also occurred after Ritalin detox. The exact causes for this are unknown, but along with priapism, it seems to be related to dopamine system dysregulation and structural remodeling that occurred due to chronic Ritalin use.

Psychological Effects of Detoxing from Ritalin

The psychological effects of Ritalin detox are by far the most severe, and even if they do not cause direct physical effects, they can result in increased risks to physical health. These effects are also the longest-lasting out of all Ritalin detox effects, commonly lasting for weeks, months, or even years in some cases. While they may resolve with time, they can produce great discomfort due to their persistence and long duration. 7, 8, 9, 15, 16

Depression

Possibly one of the most common effects of Ritalin detox, depression is extremely common. It has both neurological and psychological causes, and can also be one of the more persistent effects. Depression can sometimes be so severe as to lead to suicidal ideation or suicide attempts. While the cause is psychological, this can have serious and irreversible physical consequences if treatment is not received, and the risks should not be taken lightly.

As far as neurological causes are concerned, the remodeling that occurs to dopamine neurotransmitter systems and particularly in the limbic system almost certainly plays a role. Dopamine is an excitatory neurotransmitter that plays a large role in positive emotional states and the limbic system is also referred to colloquially as the “reward center” of the brain. This is because it is a major center for feelings of pleasure and reward as well as behavioral reinforcement. Through chronic use of Ritalin, the brain adapts to the consistently high levels of dopamine by reducing sensitivity to this neurotransmitter and then making structural changes to operate more effectively with reduced sensitivity. Once Ritalin use is suddenly ceased, the sharp drop in available dopamine levels results in depressive and negative emotional states. Furthermore, the dopamine receptors require stronger stimulation to become activated, so what little dopamine is present has a reduced ability to trigger these receptors. This can produce a sometimes profoundly hopeless state of mind that seems like it will never lift.

From a psychological standpoint, the loss of a coping mechanism seems to be a contributor. Even though it can be extremely unhealthy, Ritalin use can quickly become a powerful coping mechanism for someone who uses the drug in large doses. Through chronic use, this may eventually become someone’s main way to deal with the stresses of life, even though Ritalin use usually causes many of the problems someone seeks relief from. When this is suddenly removed, it is common for someone to feel helpless and hopeless and unable to use their preferred method of stress relief. When these psychological and neurological causes are combined, the depression experienced can sometimes be debilitating. 10, 17, 18, 19

Cravings for Ritalin

Cravings are another very common effect of Ritalin detox, along with many other drugs. The causes of these cravings can be somewhat similar to those of depression. Again, there are both behavioral and neurological causes, and these can synergize to produce very strong cravings to use Ritalin. Behaviorally, this is very similar to the cause of depression. Someone wants relief, and their main coping mechanism has been Ritalin. When someone is in psychological pain during Ritalin withdrawal they will naturally desire relief, and their first instinct is to think of further Ritalin use.

The neurological causes are directly related to the limbic system, as it is a center for pleasure and reward in the brain. The intense discomfort that often manifests during Ritalin withdrawal will cause someone to want relief, and their main method of getting stress relief recently has been Ritalin use. Additionally, due to dopamine downregulation, the activities or things someone used to do will have a reduced ability to produce feelings of pleasure. The lowered amounts of available dopamine are simply insufficient to stimulate the limbic system as strongly as Ritalin did, so it may be common to feel dysphoria during Ritalin detox. The strong memories of the pleasure produced through Ritalin use can cause someone to reminisce about Ritalin and crave using it again. 11

When Is A Ritalin Detox Center Recommended?

While it may not always be necessary to enter a Ritalin detox center, there are certain or situation cases when this may be highly recommended. Depending on someone’s unique circumstances they may stand a much better chance at recovery if they have professional care, support, and guidance throughout the Ritalin detox and withdrawal process. Some of these scenarios include:

History of Relapse

If someone has tried to get sober from Ritalin or other drugs before, and later relapsed, then their chances of achieving long-term sobriety on their own are quite low. Having medications, therapy, and further treatment can increase their chances of recovery, sometimes substantially.

Co-Occurring Mental Health Issues

There is a high correlation of mental health issues and addiction issues, and while these may be distinct, they may contribute to each other and negative overall outcomes. The depression and anxiety that commonly occur during Ritalin withdrawal may worsen any pre-existing mental health issues of a similar nature, and professional help may be required to allow someone to make it through detox safely and successfully.

IV Ritalin Users

While not exactly common, people do shoot up Ritalin. This method of using the drug can result in much more severe withdrawal symptoms, as well as increase the risk of psychosis during use. If someone has been injecting, they may also have other health issues related to IV drug use, and blood work is highly recommended. Entering treatment would not only increase their chances of recovery but also help to identify and treat any health issues associated with their preferred route of Ritalin use.

Getting Help

There can be many benefits to entering a detox center, these listed are just a few. If someone has been struggling with Ritalin addiction and wants to stop, there are professionals ready to provide help. It may be scary and it may seem impossible at times, but people have and do recover every day. If someone can have the courage to reach out for help and the willingness to receive help, recovery is possible and it can start today.

References For This Article

  1. 1 FDA AccessData: Ritalin (methylphenidate hydrochloride) Tablets Label
  2. 2 StatPearls: Methylphenidate
  3. 3 Molecular Psychiatry: Anti-Hyperactivity Medication - Methylphenidate and Amphetamine
  4. 4 Neuroscience & Biobehavioral Reviews: The Pharmacology of Amphetamine and Methylphenidate - Relevance to the Neurobiology of Attention-Deficit/Hyperactivity Disorder and Other Psychiatric Comorbidities
  5. 5 FDA Drug Safety Communication: Priapism and Methylphenidate
  6. 6 Journal of Pediatrics: Stuttering Priapism Associated with Withdrawal from Sustained-release Methylphenidate
  7. 7 International Archives of Health Sciences: Oromandibular Dystonia Secondary to Methylphenidate - A Case Report and Literature Review
  8. 8 Netherlands Pharmacovigilance Centre: Methylphenidate, Dexamphetamine, and Trismus
  9. 9 USC Herman Ostrow School of Dentistry: Drug-Induced Dystonic-type Extrapyramidal Reactions
  10. 10 Primary Care Companion to the Journal of Clinical Psychiatry: Methylphenidate Abuse and Psychiatric Side Effects
  11. 11 PLOS One: Long Withdrawal of Methylphenidate Induces a Differential Response of the Dopaminergic System and Increases Sensitivity to Cocaine in the Prefrontal Cortex of Spontaneously Hypertensive Rats
  12. 12 FDA AccessData: Novartis - Ritalin hydrochloride (methylphenidate hydrochloride USP) Tablets Label - December 2013
  13. 13 The Turkish Journal of Pediatrics: Priapism Associated with Methylphenidate - A Case Report
  14. 14 Mayo Clinic: Priapism
  15. 15 Journal of Addiction Medicine: Dystonia in Methylphenidate Withdrawal - A Case Report
  16. 16 BMJ Case Reports: Neurological Adverse Effects of Methylphenidate May Be Misdiagnosed as Meningoencephalitis
  17. 17 Journal of Addiction Medicine: Prevalent Intravenous Abuse of Methylphenidate Among Treatment-Seeking Patients With Substance Abuse Disorders - A Descriptive Population-Based Study
  18. 18 Bulletin of Clinical Psychopharmacology: Long-Acting Methylphenidate Toxicity - A Case Report
  19. 19 The Journal of Neuropsychiatry and Clinical Neurosciences: Symptoms of Major Depression After Pseudoephedrine Withdrawal - A Case Report
  20. 20 Addiction & Health: Reporting a Case of Injecting Methylphenidate (Ritalin) Tablets, Intensified Symptoms of Schizophrenia, or Induce Separate Mental Disorder?
  21. 21 Swiss Medical Weekly: Severe Toxicity Due to Injected but Not Oral or Nasal Abuse of Methylphenidate Tablets
  22. 22 United Nations Office on Drugs and Crime: Treatment of Stimulant Use Disorders - Current Practices and Promising Perspectives
  23. 23 Mayo Clinic Proceedings: Methylphenidate - Its Pharmacology and Uses

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