Ritalin long term effects

Long-term use of Ritalin is defined as more than 2 weeks of daily dosing. Using Ritalin can result in a number of negative side effects, including motor tics, headache, seizures, or numbness, pain, or sensitivity of the extremities. More here on adverse effects caused by long-term use of Ritalin.

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Reviewed by: Dr. Dili Gonzalez, M.D. Dr. Juan Goecke, M.D.

ARTICLE OVERVIEW: Ritalin, the brand name for methylphenidate, is a drug like amphetamine. It is a stimulant that can affect the body like speed. Negative side effects can include behavioral changes that are drug-induced such as aggression, paranoia, or nervousness. Long-term effects of Ritalin use may be psychiatric in nature, as well. 


Ritalin cannot make you smarter, nor is it necessarily effective for those who are not diagnosed with ADD or ADHD.

How Ritalin Works

Ritalin is a trade name for the prescription drug, methylphenidate, and is a central nervous system stimulant. Ritalin is medically prescribed to treat persons (mostly children) who are diagnosed with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). It is also used in the treatment of a sleep disorder called narcolepsy.

Additionally, Ritalin is abused for the stimulant effects it produces, including appetite suppression, wakefulness, euphoria, and increased focus and attentiveness. Its effects are similar to, but more potent than, caffeine and less potent than amphetamine. Users, who take it recreationally to improve their performance in school, often, refer to Ritalin as a “smart drug”. [1] [2]

However, it has not been proven that Ritalin can make you smarter, nor is it necessarily effective for those who do not have ADD or ADHD.
More on the Myths about ADHD Drugs from NIDA, the National Institute on Drug Abuse, here. But how does the drug work in the brain? [3]

All stimulants work by increasing dopamine levels in the brain; dopamine is a neurotransmitter associated with pleasure, movement, and attention. The mode of action is not completely understood, but Ritalin presumably activates the brain stem arousal system and cortex to produce its stimulant effect. Still, there is no specific evidence which clearly establishes the mechanism whereby Ritalin produces its mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system.

Therapeutic Effect

The therapeutic effect of stimulants is achieved by slow and steady increases of dopamine, which are similar to the way dopamine is naturally produced in the brain. It “may help increase attention and decrease impulsiveness and hyperactivity” in people diagnosed with ADHD. This is why the doses prescribed by physicians start low and increase gradually until a therapeutic effect is reached. According to the FDA-approved medication guide for Ritalin, doctors adjust doses and occasionally may even stop treatment in order to achieve therapeutic effect. [4]

Ritalin suppresses appetite, promotes wakefulness, and increases focus and attention. For this reason, prescription stimulants such as Ritalin can be abused for purposes of weight loss or performance enhancement. In fact, Ritalin is commonly abuse to help study or boost grades in school. Nevertheless, studies have found that the medication does not significantly enhance learning or thinking ability when taken by people who do not actually have ADHD. In addition, research has shown that students who abuse prescription stimulants actually have lower GPAs in high school and college than those who do not.

Side Effects

According to this 2016 study published in the medical journal, Neuropsychiatric Disease and Treatment, a metastudy of methylphenidate reactions reported the most commonly reported side effects to be:

  • Anxiety.
  • Euphoria.
  • Irritability.
  • Nail biting.
  • Prone to crying.
  • Sadness.
  • Staring.
  • Talking less.

Among studies with adult participants, the most commonly recorded symptoms were drowsiness and nervousness. Some people treated with methylphenidate can develop severe side effects, such as mania, paranoia, crying, fear, or aggression. Symptoms ceased once treatment was discontinued. [5]

Methylphenidate may also cause any one of these side effects:

  • Diarrhea.
  • Decreased sexual desire.
  • Difficulty falling asleep or staying asleep.
  • Dry mouth.
  • Dizziness.
  • Heartburn.
  • Headache.
  • Loss of appetite.
  • Muscle tightness.
  • Nausea.
  • Numbness, burning, or tingling in the hands or feet.
  • Restlessness.
  • Stomach pain.
  • Uncontrollable movement of a part of the body.
  • Vomiting.

Serious Side Effects

Some side effects can be serious. The most potentially serious effects of methylphenidate include:

  1. Heart-related problems.
  2. Psychiatric problems.
  3. Circulation problems in the fingers and toes.

If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment:

  • Abnormally excited mood.
  • Agitation.
  • Believing things that are not true.
  • Blistering or peeling skin.
  • Changes in vision or blurred vision.
  • Chest pain.
  • Depression.
  • Difficulty breathing or swallowing.
  • Erection that lasts longer than 4 hours.
  • Excessive tiredness.
  • Fainting.
  • Fast, pounding, or irregular heartbeat.
  • Feeling unusually suspicious of others.
  • Fever.
  • Frequent, painful erections.
  • Hallucinating (seeing things or hearing voices that do not exist).
  • Hives.
  • Hoarseness.
  • Itching.
  • Mood changes.
  • Motor tics or verbal tics.
  • Numbness, pain, or sensitivity to temperature in the fingers or toes.
  • Rash.
  • Seizures.
  • Shortness of breath.
  • Skin color change from pale to blue to red in the fingers or toes.
  • Slow or difficult speech.
  • Swelling of the eyes, face, lips, mouth, tongue, or throat.
  • Unexplained wounds on the fingers or toes.
  • Weakness or numbness of an arm or leg.

Methylphenidate may cause sudden death in children and teenagers, especially children or teenagers with heart defects or serious heart problems. This medication also may cause sudden death, heart attack or stroke in adults, especially adults with heart defects or serious heart problems. Furthermore, methylphenidate may slow children’s growth or weight gain.

Short-Term Effects

At least initially and in the short-term, Ritalin can produce the following effects:

  • Decreased blood flow.
  • Feelings of euphoria.
  • Increased alertness and activity.
  • Increased breathing.
  • Increased blood sugar.
  • Opened-up breathing passages.
  • Suppressed appetite.
  • Talkativeness.

At high doses, prescription stimulants can lead to a dangerously high body temperature, an irregular heartbeat, heart failure, and seizures.

Long-Term Effects

The effectiveness of Ritalin for long-term use (more than 2 weeks of daily dosing), has not been systematically evaluated in controlled trials. Therefore, physicians who decide to prescribe Ritalin for extended periods should periodically re-evaluate the long-term usefulness of the drug for individual persons.
Prolonged use of Ritalin can lead to a number of long-term effects in the brain, such as:

  • Damage to the brain including strokes and possibly epilepsy.
  • Dizziness.
  • Excessive tiredness.
  • Headache.
  • Permanent damage to blood vessels in the brain.
  • Slurred or difficult speech.
  • Ritalin does not only affect the brain, but the whole body. Effects on the body from long-term use may include:
  • Motor and/or verbal tics.
  • Muscle tightness.
  • Numbness, burning, or tingling in the hands or feet.
  • Numbness, pain, or sensitivity to temperature in the fingers or toes.
  • Seizures.
  • Uncontrollable movement of a part of the body.
  • Weakness or numbness of arms or legs.

Persons who use Ritalin for legitimate medical reasons experience lower addiction potential. While they may not be facing the risk of developing addiction as quickly as people who abuse it, addiction is still a possibility.


Risk of Addiction

When taken as directed by a physician to treat a legitimate medical condition, Ritalin has proven to be a safe and effective medication. Medical studies have shown that persons who have ADHD and who take Ritalin orally in proper dosages do not become addicted to the drug. However, taking Ritalin for performance enhancement or recreational use can lead to addiction. How?

Euphoria from stimulants is generally produced when pills are crushed and then snorted or mixed with water and injected. However, Ritalin user experience the same addictive dangers and potential as cocaine. This is because the reward pathway of the brain is hard-wired to reproduce pleasurable experiences. When we take Ritalin and get high…we tend to repeat the behavior until, eventually…

Addiction occurs when you use Ritalin compulsively, regardless of the negative consequences to health, social, or work life.

A person who abuses Ritalin can develop a psychological dependence on the drug. Likewise, people who abuse the drug often binge, triggering psychotic episodes, cardiovascular complications, and severe psychological addiction. A person can also develop a physical tolerance to the drug that requires an increased dosage to attain the same results. Ritalin dependence can lead to drug cravings and panic attacks if the drug is not available.

The long-term consequences of Ritalin addiction are not too different from the negative effects of other substance use problems, like:

  • Health state.
  • Financial stability.
  • Studies and career path.
  • Social relationships (family, friends, loved ones).
  • Criminal record.

If you’re struggling with Ritalin…know that you are not alone. The National Survey on Drug Use and Health reported in 2016 that an estimated 1.7 million people aged 12 or older, or 0.6 percent of this population, were current misusers of stimulants. In fact, stimulant drugs like Ritalin were the 3rd most popular misused drugs in that year. The Drug Abuse Warning Network reported that in 2010, half of ADHD stimulant medication-related ED visits involved nonmedical use of pharmaceuticals and nearly one third involved adverse reactions. [6] [7]

2010 DAWN Report Graph of Emergency Department Visits Caused by Stimulant Medications:

People who are addicted to Ritalin cannot stop taking it without outside intervention, and they should not attempt to do so on their own because they could put their health at risk. According to the Substance Abuse and Mental Health Services Administration, a quality health assessment at the start of treatment can help persons evaluate how and why they began using Ritalin, explore any underlying medical issues, and screen for other mental health issues, so appropriate treatment and any necessary aftercare can be provided.[8]

Can Ritalin Damage You Permanently?

Possibly, yes. Ritalin can cause permanent damage to the body.

There is no body of evidence available from controlled trials to indicate how long an ADHD person should be treated with Ritalin. It is generally agreed, however, that pharmacological treatment of ADHD may be needed for extended periods, and for as long as there is a legitimate need. One general rule is that Ritalin can be useful for as long as the benefits of the medication outweigh the potential risks.

However, there are some reported cases that describe how Ritalin has caused permanent damage to blood vessels of heart and brain (including strokes and possibly epilepsy), high blood pressure leading to heart attacks, strokes and death.

Ritalin Risk

Ritalin is risky when it interacts with other drugs. Always report the use of the following medications to your doctor when considering therapy with Ritalin:

  • Antidepressants including MAOIs (socarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine).
  • Blood pressure medications.
  • Blood thinners.
  • Cold or allergy drugs that contain decongestants.
  • Seizure drugs.

Furthermore, anyone who takes Ritalin should avoid drinking alcohol. Alcohol can decrease the effectiveness of methylphenidate or lead to harmful interactions.
Anyone who injects the drug risks further complications because insoluble fillers in Ritalin tablets can block small blood vessels. Injection users also place themselves at risk of contracting HIV (human immunodeficiency virus), hepatitis B and C, and other blood-borne viruses.

Signs of Overdose

Stimulant overdose can be deadly. If you recognize any of the following symptoms and signs in you or someone you know to have an addiction or abuse problem, call for emergency medical help immediately:

  • Crushing chest pain and shortness of breath.
  • Dryness of the mouth or nose.
  • Extremely flushed skin and elevated body temperature.
  • Loss of consciousness.
  • Markedly dilated pupils that are unreactive to light.
  • Rapid heartbeat.
  • Seizure and convulsions.
  • Severe hallucinations.
  • Uncontrolled vomiting.

Your Questions

Do you still have questions about the long-term effects of Ritalin treatment? Please post them in the designated section at the end. We try to answer all relevant inquiries personally and promptly. In case we do not know the answer to your question, we will gladly refer you to professionals who can help.

Reference Sources: [1]: NIH: Methylphenidate
[2]: NCBI: Smart Drugs And Synthetic Androgens For Cognitive And Physical Enhancement: Revolving Doors Of Cosmetic Neurology
[4]: FDA: Ritalin
[5]: NCBI: Changes In Behavior As Side Effects In Methylphenidate Treatment: Review Of The Literature
[6]: SAMHSA: Results From The 2016 National Survey On Drug Use And Health
[7]: SAMHSA: Emergency Department Visits Involving Attention Deficit/Hyperactivity Disorder Stimulant MedicationsA:
[8]: SAMHSA: Screening tools
Brookhaven National Laboratory: How Ritalin works
Department of Justice: Ritalin fast facts
FDA: Ritalin
MedlinePlus: Methylphenidate
NCBI: Long-term effects of methylphenidate on neural networks associated with executive attention in children with ADHD: results from a longitudinal functional MRI study
NIH: NIDA Study shows that methylphenidate (Ritalin) causes neuronal changes in brain reward areas
NIH: Stimulant ADHD medications – Methylphenidate and amphetamines
OASES NY: Addiction medicine – Ritalin
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
Medical Reviewers
Dr. Dili Gonzalez, M.D. is a general surgeon practicing women's focused medici...
Dr. Goecke is a medical doctor and general surgeon with personal experience of...

All of the information on this page has been reviewed and verified by a licensed medical professional.


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  1. Have been on Ritalin or adderall at exceptionally high doses (200-400mg) for 12 years. Had genetic testing I’m a rapid metabolizer and I’m a bypass -gastric patient. Long term depression high adderall or Ritalin was added to help chronic fatigue and depression. I’m now 35 and think life is over. I look forward to nothing and have everything. I’m sick everyday from the meds bc I think I developed ulcers but it seems to be kryptonite in my mind so in order to keep a job I must take it. I have no friends, I have gained 70lbs that’s right gained not lost, I’m a shell of what I was well not even a shell. I have to relationships with anyone I always am paranoids I’m going to lose my job and I sleep
    Like a baby on the meds. My question is, I don’t have high blood pressure no dilated pupils no euphoria no tachycardia but my memory is gone along with me. I have no reason to get out of bed without this little bit this med does. Is this the med or is it the long term Xanax/Ativan use since I was 18….not very high doses but higher than normal. Also Prozac for 20 some odd years? I’m not in a position for getting help as my father is ill my mom is ill my brother hates me no friends and enormous student loans from all the work I did to get to where I am. Is there any hope? Is there any online referrals seeing as though I can’t go to inpatient…I am holding the family up…am I going to smile again?

  2. My husband has a long time friend from college who started ritalin when he was 40 he has been on it 23 years and we notice he is hard to understand when he talks, he repeats words and takes forever to get a sentence out. He takes a long term dose and 3 additional pills a day. He came to visit us and forgot his ritalin. (Seems that if it was so important he would have remembered it since the ritalin is suppose to help him think clearly.) He began going into withdrawal while at our house and I view him as an addict. He was not the doddering fool that he has become since he has been on the meds. I think that his daily need for this stuff is not because it helps him think clearly but because he goes into withdrawal without it. I think it has, after 23 years, damaged his brain. He will never be allowed to visit in our home again.

  3. never ever give or take Ritalin i am now 28 years old and suffered all my life cause of this dangerous savage drug!!!believe me now as i know only to well what it does and makes u feel!!granted it might work for a bit but that is not good enough!!i am now struggling with major depression! i never asked to be this way or to feel like this….all i want and ever wanted was to be normal and think normally….it can be controlled but people need to understand it rather than masking it!! i am getting better with age and understanding myself and the world

  4. Phambili, speaking as a mother of a an 8 yr old with severe ADHD and borderline ODD I can say that it is very important to keep your child on a regular schedule with ADHD meds. Going on and off of them can really mess a kid up and have severe mood side effects. Don’t experiment with these on a young kid, just follow the Rx or talk to the dr if you think an adjustment is needed

  5. My son is 8 years old, I had him on Retolin because of his attention deficiency. I have not given him for the last 2 months (he was on school holiday) and he seem to be moody and depressed now than when he was taking it. Could it be the long term effects of the drug, will he get better when he is back on it?

I am ready to call
i Who Answers?