BackgroundThe university stage represents a critical period for the development of individual mental health. Mobile phone addiction is closely linked to depression and anxiety among college students, and both friendship quality and preference for solitude are tightly associated with college students’ mobile phone addiction and emotional health. Therefore, this study aimed to investigate the relationships and internal mechanisms among mobile phone addiction, friendship quality, preference for solitude, depression and anxiety in college students.MethodsA total of 1083 Chinese college students (58.2% female; mean age = 19.87 ± 1.692 years) were included as participants. Data were collected using the Mobile Phone Addiction Index, Friendship Quality Questionnaire, Preference for Solitude Questionnaire, and Depression Anxiety Stress Scale. Data processing and analyses were conducted using SPSS 26.0 and the PROCESS macro.Results(1) Mobile phone addiction was significantly negatively correlated with friendship quality, and significantly positively correlated with both depression and anxiety; friendship quality was significantly negatively correlated with depression and anxiety; preference for solitude was significantly positively correlated with depression and anxiety. (2) Mobile phone addiction not only directly and positively predicted depression and anxiety among college students, but also predicted depression and anxiety through the mediating role of friendship quality. (3) The direct effect of mobile phone addiction on depression and the mediating effect of friendship quality in the relationships between mobile phone addiction and depression/anxiety were both moderated by preference for solitude, whereas the moderating effect of preference for solitude on the association between mobile phone addiction and anxiety was not significant.ConclusionFriendship quality serves as an important mediating pathway between mobile phone addiction and depressive and anxiety symptoms among Chinese college students. Preference for solitude may amplify the associations of mobile phone addiction with poorer friendship quality and elevated depressive symptoms.
Collaborative care treatment for major depressive disorder
IntroductionMajor Depressive Disorder (MDD) is a burdensome behavioral health condition that is costly and difficult to treat, particularly for patients with severe cases. The Collaborative Care Model (CoCM) has been shown to be effective for moderate depression treatment but less is known about its effectiveness for severe depression. This study analyzes the impact of CoCM treatment on outcomes for depression patients across all ranges of MDD severity at Concert Health.Materials and methodsAnalysis was completed utilizing all closed patient treatment episodes (N = 30,162) at Concert Health between 2018 and 2025. Of these patients, 5,693 began treatment with severe depression. We compare effect sizes for change between baseline and final screener scores across severity levels. Additionally, we utilize logistic regression to complete analyses to understand treatment factors and patient characteristics that are associated with treatment response and remission, as measured by changes in PHQ-9 scores.ResultsThe primary analysis showed that patients with severe depression (PHQ-9 > 20) had slightly lower odds of achieving response compared to patients with moderate depression (OR: 0.93). The treatment factors of insurance type, suicide risk, anxiety presence, and touchpoints also had significant effects on the odds of achieving response and remission.DiscussionThe results suggest that CoCM may be effective for patients with severe depression in achieving treatment response. Patients on Medicaid or with more complex conditions such as anxiety presence or elevated risk for suicide may need higher levels of engagement from the care team to achieve response and remission.
Smoking as a correlate of suicidal behavior and self-harm in adolescents with depressive disorders
Suicidal behavior and self-harm are major public health concerns among adolescents, particularly those with depressive disorders. While smoking has been linked to suicidality in general populations, its independent role in both suicidal behavior and self-harm within well-characterized clinical samples of youth with depressive disorders remains understudied. This study consecutively enrolled 2,343 adolescents (aged 12–18 years) diagnosed with unipolar depression, bipolar disorder, or depressive episode according to DSM-5 criteria at Nanhai Public Health Hospital of Foshan City and The Third People’s Hospital of Foshan between January 2025 and December 2025. Suicidal behavior (≥1 suicide attempt) and self-harm (intentional self-injury or poisoning regardless of intent) were assessed via clinical interviews. Multivariable binary logistic regression models were constructed to identify factors independently associated with each outcome, adjusting for age, sex, education, income, parental education, psychiatric diagnosis, family history of mental illness, physical disease, and smoking status. Among 2,343 participants (mean age 14.99 ± 1.65 years; 77.8% female), the prevalence of self-harm was 76.0% and suicidal behavior was 44.2%. In fully adjusted models, smoking status was the only variable significantly associated with suicidal behavior after adjustment for measured covariates: current smokers (OR = 2.74, 95% CI: 1.81–4.22, P<0.001) and past quitters (OR = 2.32, 95% CI: 1.66–3.28, P<0.001) had higher odds compared to never smokers. For self-harm, current smoking was significantly associated with increased risk (OR = 2.31, 95% CI: 1.33–4.37, P = 0.006). Education level showed a borderline association with self-harm, with each additional year of schooling corresponding to a 10% lower odds (OR = 0.90, 95% CI: 0.81–1.00, P = 0.050); however, this finding should be interpreted cautiously given the exploratory nature of the analysis. No other demographic or clinical variables, including age, sex, or psychiatric diagnosis, were independently associated with either outcome. Smoking was strongly associated with both suicidal behavior and self−harm after adjustment for measured demographic and clinical covariates. These findings underscore the importance of assessing tobacco use as a potential clinical marker of vulnerability in youth mental health settings.
Dose–response relationship of exercise interventions on sleep quality in patients with depression: a systematic review and meta-analysis
BackgroundThis meta-analysis aimed to systematically evaluate the effects of exercise interventions on sleep quality in patients with depression and to explore the dose–response relationships of key intervention parameters.MethodsA comprehensive search was conducted in PubMed, Web of Science, Embase, Scopus, and the Cochrane Library to identify randomized controlled trials (RCTs). Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and sensitivity analyses were performed to examine potential dose–response relationships.ResultsA total of 17 publications, including 19 randomized controlled trial comparisons and 1,457 participants, were included in this systematic review and meta-analysis. Pooled estimates indicated that exercise interventions significantly improved sleep quality [SMD = −0.37, 95% CI: −0.48 to −0.27]. Dose–response modeling suggested that exercise doses around 312.75 MET·min/week may be associated with greater improvements [Hedges’ g = −0.51, 95% CI: −0.71 to −0.31]. Subgroup analyses suggested that mind–body exercise [SMD = −0.49, 95% CI: −0.63 to −0.35], durations of 9–12 weeks [SMD = −0.49, 95% CI: −0.74 to −0.24], fewer than two sessions per week [SMD = −0.47, 95% CI: −0.65 to −0.29], and sessions longer than 90 minutes [SMD = −0.42, 95% CI: −0.66 to −0.18] may be associated with favorable changes.ConclusionsExercise interventions may improve sleep quality in individuals with depression, with potential benefits at low doses. These findings support individualized exercise prescriptions, but larger multicenter RCTs with long-term follow-up are needed to confirm the dose–response pattern and subgroup findings.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251105568, identifier PROSPERO (CRD420251105568).
Post-intracerebral hemorrhage depression comorbid with obstructive sleep apnea and REM sleep behavior disorder: a case report and literature review
We report a 63-year-old male with post-cerebral hemorrhage depressive disorder. Previous adequate-dose, full-course antidepressant treatment yielded no significant improvement in depression, anxiety, or sleep disturbance. Detailed history taking and polysomnography (PSG) confirmed comorbid severe obstructive sleep apnea hypopnea syndrome (OSAHS) and rapid eye movement sleep behavior disorder (RBD). Without adjusting antidepressants, the patient first received continuous positive airway pressure (CPAP) for OSAHS, followed by individualized pharmacotherapy for RBD. With the improvement of sleep architecture and respiratory events, obvious remission of depressive and anxiety symptoms and substantial recovery of daytime function were observed. This case emphasizes the bidirectional relationship between sleep and mood disorders. For post-stroke depression (PSD) poorly responsive to antidepressants, active sleep evaluation, multidisciplinary collaboration, and targeted management of comorbid sleep disorders may be crucial to enhance therapeutic efficacy.
What Are Intrusive Thoughts?
When a child confesses a frightening thought that seemed to come out of nowhere — “What if I hurt someone with this knife?” “What if mom dies in a car accident?” “What if germs get into this paper cut and I die of an infection?” — you can both find it confusing and disturbing. But in most cases these intrusive thoughts are not evidence of a problem.
Intrusive thoughts are unwanted ideas, images, or urges that pop into the mind seemingly out of nowhere. They might feel embarrassing, violent, sexual, or just plain strange — and they feel completely out of character, which is exactly why they’re so upsetting. “An intrusive thought is a lot like your brain sending junk mail,” says Theresa Welles, PhD, a clinical psychologist and director of the Bubrick Center for Pediatric OCD at the Child Mind Institute. “Just because it shows up doesn’t mean it’s important or true or something you even want.”
It also doesn’t necessarily mean that a child has OCD or another mental health disorder. Though intrusive thoughts are associated with OCD — in which unwanted thoughts (called obsessions) drive children to perform rituals (called compulsions) to alleviate them — for many children they are just fleeting thoughts. It’s only when kids become unable to let them go that they are concerning. Another way to think about it, says Dr. Welles, is that “the brain’s job is to generate thoughts, the same way an apple tree’s job is to produce apples. Not every apple is perfect — some are misshapen or wormy. And not every thought is meaningful or worth paying attention to. Having a thought is not the same as wanting it or intending to act on it.”
Who has intrusive thoughts
“Everyone who has a brain has them,” says Caitlyn Downie, LCSW, director of trauma and resilience at the Child Mind Institute. “It’s part of the human existence.” A child might suddenly imagine something terrible happening to a parent, or a teenager might have a violent or sexual thought that feels shocking or shameful. Most of the time, these pass quickly — unpleasant, but easy enough to brush aside.
That’s the key distinction: not the thought itself, but what happens after it. The concern isn’t that the thought appeared — it’s how the child responds, how often it returns, and whether it starts getting in the way of daily life.
For some children — particularly those who are anxious, perfectionistic, or who have OCD — intrusive thoughts become “sticky.” Instead of passing through, the thought snags. The child starts paying attention to it, trying to figure it out or make it go away, which only makes it feel more powerful. “Young people lack the experience to recognize that thoughts aren’t the same as intentions, desires, or actions,” Dr. Welles says. “The thoughts feel alarming. So the child pays more attention, and the more attention they give it, the more often it returns.” That loop of fear and self-doubt is what parents and clinicians need to be alert to.
When should parents be concerned?
Many children are too ashamed or frightened to describe what’s actually going on, so parents may never hear about the thought itself. Instead, changes in behavior are often the first clue. Look for signs like:
- Increased distress, irritability, or moodiness
- Avoidance of something that wasn’t previously a problem
- Trouble concentrating or sleeping
- Excessive guilt or repeated reassurance seeking
- Rituals like checking, counting, washing hands, or going through routines in a specific way
It’s worth seeking professional support when intrusive thoughts are frequent and intense, hard to shake, causing real distress, or getting in the way of school, friendships, or daily routines.
Why intrusive thoughts feel so frightening
When an intrusive thought appears, it can set off the body’s alarm system — the same ancient survival mechanism that helped people run from danger or fight it off. In anxiety and OCD, that alarm bell rings when there’s no real emergency. The child has a thought, the body reacts with panic, and the child assumes the thought must be important because it feels big and important.
Children may also fall into what clinicians call thought-action fusion. “That’s the mistaken belief that having a thought makes it more likely to happen,” explains Dr. Welles, “or that it reveals something terrible about who they are.” A child who thinks, “What if I hurt my baby brother?” may become convinced the thought means they secretly want to — but intrusive thoughts are often the precise opposite of what a child would ever want. Paradoxically, Dr. Welles says, “for most people with anxiety disorders and OCD, these thoughts are the actual opposite of what they would ever do.”
How parents can help
The first thing to do is stay calm — harder than it sounds if the thought is violent, sexual, or taboo. Children look to their parents to gauge whether something is truly dangerous, so if you look horrified, your child takes that as confirmation the thought is something to fear.
When a child shares an intrusive thought, Downie suggests responding with warmth and curiosity: “Say something like, ‘I appreciate you telling me — it sounds like that was really scary.’ It also helps to normalize it: ‘A lot of people have thoughts they don’t particularly like.’” Some other responses that can help:
- “That sounds really upsetting — I’m glad you told me.”
- “Having a thought doesn’t mean you want it or that it’ll ever happen.”
- “You don’t have to figure this out right now.”
The goal is to help your child feel less alone and less ashamed, without treating the thought like a five-alarm emergency. And do your best to avoid reassurance. Reassuring the child about the contents of a specific thought (for example, responding to a child who asks, “Are you sure I’m a good person?” with “Yes, you’re a good person”) can actually make things worse, especially in kids with OCD. They feel very temporary relief but then the thought creeps back and they need more reassurance. It becomes a cycle. Instead try: “I know this feels awful. And I know you can handle it.”
It also helps to redirect the child to something concrete: getting dressed, eating breakfast, watching a show, texting a friend. With younger kids, you might guide them in doing slow breaths or suggest they move to another room so they distract themselves from the thought. With teens, you might mean teach them to resist the urge to Google their fears or thoughts, confess, or ask the same question over and over again. “The idea,” Downie says, “is to validate the feeling without validating the fear. You’re saying: ‘I hear you, this is hard, and you can get through it.’”
What can cause intrusive thoughts?
Intrusive thoughts aren’t a diagnosis on their own — they’re a symptom that can show up across a range of conditions, or in children who have no diagnosis at all. Disorders they may be associated with include:
- OCD: The most closely associated condition. Common themes include harm, contamination, sexual thoughts, and religious or moral fears.
- Generalized anxiety: Tends to involve repetitive “what if” worries about everyday concerns — school, safety, family, the future.
- Social anxiety: Brings intrusive thoughts about embarrassment, rejection, or being judged by peers.
- PTSD: Can involve intrusive memories, images, or sensations tied to a traumatic event. “A child who has experienced trauma may worry about being harmed again or even about harming someone else,” Downie notes, “but that doesn’t mean every child with trauma will have intrusive thoughts.”
- Depression: Often involves intrusive thoughts that fit a negative self-image: I’m worthless. I’m a burden. I’m a bad person.
- Autism spectrum disorder: Repetitive thoughts often center on a special interest and aren’t typically unwanted or distressing the way OCD thoughts are — though they can look similar from the outside.
- Psychotic disorders: Young people with psychosis tend to experience intrusive thoughts as fixed and real, without the self-awareness that typically accompanies anxiety-driven ones. Psychotic disorders such as schizophrenia are rare in children, though early signs can appear in the teenage years.
How intrusive thoughts are treated
Treatment depends on what’s driving the thoughts and how much they’re disrupting the child’s life:
- For OCD, the gold-standard treatment is exposure and response prevention (ERP), a specialized form of cognitive behavioral therapy (CBT) where children practice sitting with intrusive thoughts without doing compulsions. Over time, they learn to tolerate uncertainty and discover that the thought, however uncomfortable, isn’t actually dangerous.
- For anxiety, the same treatments are helpful. CBT helps children understand the connection between thoughts, feelings, and behaviors, and ERP helps kids learn to tolerate the anxiety these thoughts generate, and it gradually diminishes.
- For trauma, treatment may include trauma-focused CBT. Mindfulness, DBT skills, and breathing exercises can also help regulate the nervous system.
- Family involvement matters a great deal. “Parents often need help learning how to respond without accidentally feeding the anxiety cycle,” Dr. Welles says. SPACE (Supportive Parenting for Anxious Childhood Emotions) is an evidence-based approach that helps parents reduce accommodation and support their child’s brave behavior instead.
- For moderate-to-severe OCD or anxiety, medication — typically an SSRI — may also be worth discussing with a psychiatrist or pediatrician.
Helping your child trust their own mind
One of the hardest things about intrusive thoughts is that they can make children afraid of their own minds — convinced that every thought needs to be examined or explained away before they can relax. But no one gets to have only pleasant, well-behaved thoughts.
What children can learn is that a thought can be upsetting without being meaningful, loud without being true, and it can pass through without becoming a verdict on who they are. As parents, the most powerful thing you can offer is a calm, steady presence — taking it seriously without treating it as a catastrophe. When your child sees you aren’t panicked, they get to borrow some of that calm for themselves.
Frequently Asked Questions
Intrusive thoughts are unwanted ideas, images, or urges that pop into your mind unexpectedly. They often feel upsetting or out of character, but they’re essentially “junk mail” from the brain — not meaningful or important.
Yes, everyone can have them. Most children (and adults) experience intrusive thoughts at times, and in many cases they pass quickly without causing problems.
They’re a normal byproduct of how the brain works, but they can become more frequent or “sticky” in kids who are anxious, perfectionistic, or dealing with conditions like OCD or trauma. Paying extra attention to the thought can also make it return more often.
No. Having an intrusive thought doesn’t mean you want to act on it or that it reflects who you are. In fact, these thoughts are often the opposite of what someone would ever want or do.
The post What Are Intrusive Thoughts? appeared first on Child Mind Institute.
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First Huntington’s Disease Patient Dosed with Neural Stem Cell Therapy
Huntington’s disease therapeutics have reached a historic milestone—the first patient has successfully received an experimental neural stem cell therapy at UCI Health. This groundbreaking dose marks the world’s first human trial of embryonic stem cell-derived neural stem cells for the devastating neurodegenerative disorder.
The treatment, performed in May at University of California Irvine (UCI) Health, represents the culmination of more than 12 years of laboratory research and eight years of clinical planning led by scientists and physicians at the University of California, Irvine. Researchers hope the treatment, known as hNSC-01, could eventually slow disease progression, protect vulnerable brain cells and potentially restore damaged neural circuits.
To date, the first participant has not reported any serious adverse effects, according to the clinical team. A second patient is expected to receive the therapy in July.
“This clinical trial highlights the important role that an interdisciplinary academic and clinical team, together with the HD families, plays in advancing medicine,” Leslie M. Thompson, PhD, clinical trial sponsor as well as the Donald Bren Professor of psychiatry and human behavior UC Irvine, told Inside Precision Medicine. “We are grateful to our patients and their incredible families for their bravery to provide hope for others with very few options.”
hNSC-01
Huntington’s disease, caused by a mutation in the huntingtin gene, destroys brain cells, causing involuntary movements, cognitive decline, and psychiatric symptoms that begin between 35 and 50 and worsen over time. Without a cure, the fatal disorder burdens patients and families emotionally, physically, and financially, often requiring daily and long-term care.
Current treatments for Huntington’s disease primarily focus on managing symptoms rather than altering the underlying disease process. Drugs such as tetrabenazine and deutetrabenazine can reduce involuntary movements known as chorea, while antidepressants, antipsychotics and mood stabilizers help address psychiatric symptoms. Physical therapy, speech therapy and occupational therapy can also improve quality of life. However, none of these approaches has been shown to slow or stop the progressive loss of neurons that drives the disease.
Over the past decade, researchers have pursued several experimental disease-modifying strategies. Among the most advanced are gene-targeting therapies designed to reduce production of the mutant huntingtin protein. These include antisense oligonucleotides (ASOs), which are delivered through repeated spinal injections, as well as RNA-targeting and gene-editing approaches intended to suppress or correct the faulty gene. While these strategies directly target the genetic cause of Huntington’s disease, clinical results have been mixed, and questions remain about long-term effectiveness, safety and the need for lifelong treatment.
The hNSC-01 neural stem cell therapy being tested at UCI Health takes a different approach. Rather than targeting the mutant gene itself, the therapy aims to protect vulnerable neurons, replace lost cells, rebuild damaged neural circuits and provide supportive factors that promote brain health.
The UCI researchers believe stem cell-based therapies may offer a new approach by addressing multiple aspects of the disease simultaneously. The experimental treatment, hNSC-01, consists of pluripotent neural stem cells derived from embryonic stem cells and manufactured through the UC Davis Good Manufacturing Practice facility.
Preclinical studies in animal models suggested the cells could perform several functions relevant to Huntington’s disease, including protecting existing neurons, replacing cells that have been lost, rebuilding damaged neural networks and releasing beneficial proteins such as brain-derived neurotrophic factor (BDNF). The cells were also shown to reduce harmful protein accumulations associated with neurodegeneration and demonstrated long-term safety in mice.
Unlike conventional drug therapies, the stem cells are delivered directly into the brain. During the approximately six-hour procedure, performed under general anesthesia, patients lie face down within an MRI scanner while neurosurgeons use a specialized stereotactic navigation and delivery system to implant the cells into the striatum, a deep brain structure heavily affected by Huntington’s disease.
The striatum plays a central role in motor control, decision-making, motivation and learning. Degeneration of this region contributes significantly to the hallmark symptoms of the disorder. The first intervention was delivered by UCI Health neurosurgeon Jefferson W. Chen, MD, and a multidisciplinary surgical team.
Tracking treatment impact
As a Phase Ib/IIa study, the trial’s primary objective is to evaluate safety. However, researchers will also track biomarkers and clinical indicators that may provide early clues about whether the treatment is affecting disease progression.
When asked which biomarkers would help identify how the therapy is working in patients, Thompson emphasized that current measurements are focused more on assessing treatment impact than revealing biological mechanisms. “We will be including HD relevant clinical endpoints and biomarkers, including NfL in plasma and NfL and PENK in CSF; however, these are geared to understanding whether the treatment is having a benefit to these outcome measures versus informing the mechanism of action,” Thompson said.
One of the most important early indicators will be whether disease-related biomarkers remain stable rather than continuing their expected decline. “The earliest sign first and foremost is safety in this initial trial,” Thompson said. “Initial signs that the therapy could be meaningfully altering disease progression would be if the blood-based or CSF-based biomarkers do not show progression.”
Reaching the point of treating the first patient required overcoming a series of scientific, manufacturing and logistical hurdles. According to Thompson, selecting the optimal cell line was among the most significant challenges, testing multiple cell lines in vitro and in vivo.
Researchers also had to establish quality-control standards for the final therapeutic product and create Good Manufacturing Practice cell banks following extensive testing in Huntington’s disease mouse models. The COVID-19 pandemic introduced additional delays. “Disruptions caused by COVID-19, in particular the safety and tumorigenicity studies, delayed the timeline,” Thompson explained.
Another major undertaking involved creating the clinical infrastructure necessary for a first-of-its-kind procedure. Thompson said that it’s not really a challenge, but getting the overall procedural pipeline in place is the first study of this kind at the UCI Health–Irvine hospital in the MRI suite.
Despite the complexity of the project, Thompson said interactions with regulators proceeded smoothly. “We actually had a very good experience in terms of regulatory activities. A very helpful pre-pre-IND, pre-IND and relevant feedback from the FDA on the clinical trial.”
Scalability and competitive landscape
Whether hNSC-01 will ultimately compete with or complement emerging gene-targeting therapies remains unclear. Gene-silencing approaches may be easier to distribute because they do not require brain surgery, but repeated administrations over many years could result in substantial cumulative costs. In contrast, hNSC-01 involves a specialized MRI-guided neurosurgical procedure that may initially be limited to major medical centers, but it is designed as a one-time treatment whose long-term costs could compare favorably with chronic therapies if benefits prove durable.
Thompson believes the infrastructure requirements may be less of a barrier than many assume. “Yes, major medical centers can eventually offer it, and several medical centers are now using this system for other indications,” she said. “The other aspect is this would be a one-time administration so an individual could even travel to a medical center that offers the procedure.”
The REGEN4HD trial plans to enroll 21 adults aged 18 to 65 with early-stage Huntington’s disease. Twelve participants will be included in a Phase Ib dose-escalation cohort, while nine additional participants will be enrolled in a Phase IIa expansion group. The study is funded through a $12 million grant from the California Institute for Regenerative Medicine and coordinated through the UC Irvine Alpha Clinic, one of nine state-supported regenerative medicine clinical research centers.
Even if the therapy proves safe and beneficial, researchers caution that it remains unclear whether stem cell transplantation alone will be sufficient to combat Huntington’s disease over the long term. “At this point we do not know whether this will be sufficient alone or will need to be delivered with other disease-modifying therapies,” said Thompson. “For example, ones that specifically target an HD mechanism such as somatic repeat instability,” Thompson said. “However, these cells also have the potential to exert therapeutic effects directly while serving as vehicles for the delivery of additional interventions.”
For families affected by Huntington’s disease, the first successful treatment in the REGEN4HD trial represents more than a scientific milestone. It marks the beginning of a new chapter in regenerative medicine—one that researchers hope could eventually transform the outlook for a disease that has long remained untreatable.
The post First Huntington’s Disease Patient Dosed with Neural Stem Cell Therapy appeared first on Inside Precision Medicine.
Treating ADHD With Methylphenidate (Ritalin, Concerta)
Methylphenidate is a stimulant medication used to treat symptoms of ADHD. It helps the brain regulate attention, focus, and impulsive behaviors.
It’s one of the two stimulants widely used in ADHD medications. Methylphenidate is the active ingredient in Ritalin and Concerta, among others. The other commonly used stimulant, amphetamine, is the active ingredient in Adderall and Vyvanse, among others. Both stimulants work by increasing levels of dopamine and norepinephrine, chemicals in the brain that control attention, focus, and impulsivity. If a child doesn’t do well on the first stimulant medication they try, they may respond better to a different formulation of that type or the other type of stimulant.
How is methylphenidate different from amphetamine?
Methylphenidate is somewhat less powerful than amphetamine and tends to have milder side effects.
If your child is under 12 and has just been diagnosed with ADHD, a doctor is likely to prescribe a methylphenidate medication first, to see how well the medication reduces their ADHD symptoms, and whether the side effects are problematic.
Methylphenidate is also many doctors’ first choice for younger children because it has been used to treat ADHD much longer than amphetamine. Ritalin (methylphenidate-based) was FDA approved in 1955, while Adderall (amphetamine-based) wasn’t approved until 1996. In countries outside the United States, amphetamine-based ADHD medications are less widely approved than those based on methylphenidate.
How methylphenidate works vs amphetamine
The two stimulants target the same brain chemicals but work slightly differently, says Paul Mitrani, MD, PhD, a child and adolescent psychiatrist at the Child Mind Institute. Methylphenidate increases the levels of dopamine and norepinephrine by blocking what’s called reuptake — the process by which nerve cells reabsorb these chemicals after they’ve been released. As Dr. Mitrani describes it, methylphenidate “enhances” the norepinephrine and dopamine the brain naturally releases by making the chemicals stay around longer. It boosts the stimulation the brain is already getting from whatever activity the child is engaged in.
Amphetamine, on the other hand, not only blocks reuptake but stimulates the release of more dopamine and norepinephrine, which is why it’s considered stronger. “Adding stimulation with amphetamine sometimes helps,” he notes. “But sometimes that added stimulation is too much, and it increases side effects the child experiences.”
Kids vary in how they respond to methylphenidate vs amphetamine
There is individual variation in how children respond to the two stimulants. So if methylphenidate doesn’t give the desired symptom relief or produces problematic side effects, it’s recommended practice to try amphetamine, or vice versa. Research shows that 70 percent of children with ADHD respond to a trial of methylphenidate. More than 90 percent will have a beneficial response to one of the stimulants if both methylphenidate and amphetamine are tried. Studies also show that approximately 41 percent respond equally well to both types of stimulant.
Children can also vary in their response to different formulations of the same stimulant, which affect the rate at which the medication goes into the bloodstream. For instance, a short-acting form of Ritalin will kick in quickly and last for 3-4 hours, while Concerta, a delayed-release formula, lasts as long as 10-12 hours. It’s very common for kids to try several before finding the best fit.
What are the side effects of stimulant medications?
Methylphenidate and amphetamine have the same side effects, though they may be less intense with the former.
Appetite suppression
The most common side effect of stimulants is appetite suppression. It can be especially concerning with long-acting forms of the medication, which are often preferred to get better coverage through the school day. Kids who take a long-acting stimulant in the morning tend to lose their appetite for lunch and may not be interested in eating until after dinnertime.
When this is a problem, Dr. Mitrani notes that taking a shorter-acting form of the medication can help. “For instance, Concerta is a methylphenidate medication that lasts for a long time and can suppress appetite for 10–12 hours.” An alternative might be a medication that lasts for 6–8 hours, such as Metadate CD or Ritalin LA. Some children with more pronounced problems with appetite will do better on a short-acting dose in the morning and then another after lunch, he adds, since it gives them a break during the day where they can eat better.
Sleep issues
Kids who take stimulant medication can have trouble falling asleep. This can happen when a long-acting medication or an afternoon dose of a short-acting medication wears off and they get restless or hyperactive around bedtime. Difficulty falling asleep can get better after a few weeks, but if it doesn’t, it may be helpful to change either the timing or the type of the medication that is given. It’s also important to explore whether there are other contributors to sleep challenges, such as worry, screen time too close to bedtime, or lack of a consistent evening routine that helps kids calm down.
Irritability
Stimulant medications can generate agitation and irritability, which can be especially problematic in kids who are already anxious. For children with anxiety, this can be another reason to start treatment with methylphenidate, because amphetamines can feel more activating.
But Dr. Mitrani notes that treating ADHD can also reduce anxiety: “Some kids are so stressed about school — because they can’t pay attention or arealways getting in trouble — that when you treat the ADHD, they are better able to manage the demands of school and become less anxious.”
That reduction in school anxiety can also affect what happens when they get home from school. “When there is anxiety, it’s like kids are holding it together at school, and then they come home after a stressful day and just let it out,” he says. “So if the school day is less stressful, you may also see that come down at the end of the day.”
Mood changes
Some children report that stimulant medications seem to dull their personality. Dr. Mitrani suggests that this may be connected to the medication stimulating the prefrontal cortex, the part of the brain that not only manages attention and focus, but also helps regulate emotions and impulse control in other brain areas. “Enhanced control of the emotional part of the brain can cause this feeling of dullness,” he notes. “Some people will even say they feel depressed, that they’re just not like themselves because they don’t have the same energy or personality.”
If this happens to a child on methylphenidate, Dr. Mitrani will recommend trying an amphetamine or a non-stimulant medication.
Rebound effects
Some families report that their child is irritable or emotional after school or at the end of the day, when the stimulant medication is wearing off. Dr. Mitrani notes that this can coincide with the child being hungry after missing lunch. It can also be connected to the medication level dropping too quickly, and strategies that create a more gradual decrease may help take it away. For example, he might suggest adding a small dose of short-acting form of the stimulant a half hour before the morning medication wears off.
Starting children on methylphenidate
Dr. Mitrani usually starts a child on a short-acting form of methylphenidate for two reasons: as a quick test to see if the child will experience side effects and to have an opportunity to try it twice in a day, to have more chances to assess for positive changes.
He recommends starting the medication on a weekend or a break from school and giving the child some tasks that are challenging for them because of their ADHD, like reading or something else that requires concentration, such as cleaning their room or doing household chores. “After lunch you want to try it again, to have another time point to check on. Because if you only give one dose of the medication, you don’t know if the child’s behavior was a result of the medication or some other factor. The more data points that we have, or more trials, the more information we get.”
He recommends keeping the child on short-acting doses for at least several days before trying a longer-acting formula.
Starting children on a low dose
Practice guidelines for psychiatrists recommend starting children on a low dose to assess any side effects the child might experience and gradually increasing it over 1-2 weeks with careful monitoring of response until you reach the minimum dose that will give the best symptom relief.
There is a great deal of variation in how children respond to these medications, so starting with an “average” effective dose, even adjusted by body weight, would be under-medicating some kids and overmedicating others.
For instance, for a 6- or 7-year-old child, a common starting dose of a short-acting medication might be about 2.5 mg, going up to 5 mg if more is needed for symptom relief and side effects are not an issue, Dr. Mitrani says.
Liquid versions of either stimulant have an advantage when it comes to getting exactly the right dose, he notes: “You can do, 1 milliliter, 1.5, 1.6, depending on the syringe.”
Long-acting formulations that come in capsules can be especially frustrating, he adds — since they come in set doses and can’t be opened and divided effectively, because the beads inside are made to be triggered at different time periods.
Trying different formulations
Dr. Mitrani stresses that small differences in the formulation of a medication can make a difference in a child’s reaction.
For instance, Focalin (dexmethylphenidate) is a refined form of methylphenidate. Standard methylphenidate medications contain two mirror-image forms, or isomers, but most of the benefit comes from one of them. Focalin contains only this more active isomer. For some children, it works better, causes fewer side effects, or feels smoother.
He also notes that variations in the release patterns among long-acting formulations can affect a child’s experience. “Take Concerta, which has a unique mechanism for the extended release,” he explains. “There are three phases: a really immediate phase, then a regular Ritalin kind of phase and, then a slow extrusion of the remaining methylphenidate throughout the day that helps it last as long as 12 hours.”
By contrast, he describes Ritalin LA, which tends to last for 6-8 hours, as “50-50” — 50 percent of the dose is immediate released and the other half is delayed release. Other formulations are “40-60” or “30-70.” “These subtle differences can result in some kids responding better to one than the other, while other kids can do well on any of them.”
So even within the methylphenidate group, there may be reason to try a child on number of different formulations to get the best fit. And, of course, other reasons for trying different versions are limits on what insurance covers —which can change suddenly — and what’s available because of shortages. “And that can be really frustrating for families,” he says. “What I hear is, ‘My child was on Concerta or on Metadate CD and they made me switch to this one and now my kid’s not doing as well.’ “
When families cannot get a medication that has been working, finding another medication that’s available, that’s effective, and that insurance will approve can be a lot of hoops to jump through, he adds.
The post Treating ADHD With Methylphenidate (Ritalin, Concerta) appeared first on Child Mind Institute.
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