Withdrawal Timelines for Concerta
Methylphenidate is the active ingredient in various medications, including Ritalin and Concerta. Methylphenidate is classified as a Schedule II controlled substance by the United States Drug Enforcement Administration (DEA). This classification contains numerous drugs that are believed to be very high candidates for abuse, but also have significant medicinal uses.
What Is Concerta?
One of the primary medicinal uses of methylphenidate is for the treatment and control of the mental health disorder of attention deficit hyperactivity disorder (ADHD). Ritalin is the immediate-release form of methylphenidate, whereas Concerta is the extended-release form. The extended-release form allows for ease of administration, as a child who is taking methylphenidate can simply take the drug once in the morning. Other than this difference, Ritalin and Concerta are basically the same medication.
Methylphenidate is a stimulant drug that blocks the transporter cells for the neurotransmitters dopamine and norepinephrine. It works by not allowing these neurotransmitters to be reabsorbed by neurons and results in increased concentration of these neurotransmitters in the central nervous system. This accounts for its effects on the treatment of ADHD and other disorders, and it also explains why the drug can produce mild feelings of stimulation, increased energy, talkativeness, and decreased need for sleep, decreased need for appetite, etc., when the drug is taken in doses that are much larger than their medicinal dose by individuals who do not have ADHD. Stimulant drugs have demonstrated some effectiveness in treating various forms of ADHD because it is theorized that these disorders may result from a lack of these neurotransmitters, and this leads to individuals shifting their attention, moving about, etc., as a means to self-medicate for the lack of neural stimulation they experience.
Methylphenidate and similar types of drugs are more often abused by younger individuals who are looking to increase their academic performance, and stay up late and party longer. These drugs are also abused by individuals who are looking for a “pick me up,” often related to their job.
The majority of those who abuse drugs like Concerta are males who are under the age of 30.
Abuse of Concerta typically consists of an individual grinding up the tablets and either snorting them, mixing the powder with a liquid and drinking or even injecting the substance, and using it with other drugs of abuse. Individuals with prescriptions for Concerta are at a relatively low risk to abuse the drug. Most individuals who abuse the drug either purchase it illegally, get it from a friend or relative who has a prescription, or steal it from someone.
Is Concerta Addictive?
Because methylphenidate is a controlled substance and classified in a relatively high level of controlled substances, it is generally believed to be a drug that can lead to significant abuse (frequent use of the drug for nonmedicinal purposes), and it has the potential to produce physical dependence (displaying both the syndromes of tolerance and withdrawal).
Stimulant drugs are significant drugs of abuse. According to the Substance Abuse and Mental Health Services Administration, in 2015, approximately 979,000 individuals reported misusing methylphenidate products like Concerta.
Withdrawal from Concerta
- Alterations of mood: The most common symptoms of withdrawal from methylphenidate are psychological symptoms, such as marked depression, apathy, anxiety, restlessness, and irritability. Use of these drugs result in massive increases in levels of dopamine and norepinephrine in the central nervous system that can account for the euphoric effects the drugs may produce when they are abused at high levels. The effects are short-lived, and individuals may often binge on the drug to maintain euphoria; however, the initial “high” is the most intense, and any subsequent psychoactive effects associated with continued bingeing decrease in their intensity. When the levels of these neurotransmitters are depleted after the person stops using the drug, individuals often experience opposite effects (e.g., depression, anxiety, etc.).
- Physiological letdown: In conjunction with decreased mood, individuals often begin to experience fatigue, lethargy, an increased need for sleep, and issues with attention and concentration.
- Appetite changes: Use of stimulant drugs most often results in decreased feelings of hunger; after the drug’s effects wear off, individuals often experience increased appetite and may experience weight gain.
- Other physiological effects: Mild physiological effects may be experienced by some individuals, including muscle cramps, nausea, jitteriness, headaches, and even mild tremor.
- Psychosis: In rare cases, individuals may experience hallucinations and/or paranoid delusions.
- Seizures: Seizures that occur as a result of withdrawal from stimulant medications are most often the result of mixing the medication with some other drug, such as alcohol. Seizures as a result of the withdrawal from methylphenidate products are extremely rare.
The American Psychiatric Association (APA) lists the formal diagnostic criteria for stimulant withdrawal, which would include withdrawal from Concerta. The symptoms include:
- Abrupt stoppage: The abrupt discontinuation of the drug or significantly reducing the amount one has been taking must trigger the symptoms.
- Dysphoria: Dysphoria involves unpleasant or negative mood states. Dysphoria can occur within a few hours to several days after using the drug. Dysphoria may consist of anxiety, depression, apathy, etc.
- At least two of several other symptoms: In order for a formal diagnosis of stimulant withdrawal to be made, the individual must also display two or more of the following:
- Sleep difficulties that can include insomnia or sleeping excessively
- Vivid and unpleasant dreams
- Psychomotor retardation (decreased reflexes, feeling weighed down, etc.) or psychomotor agitation (feeling jittery, nervous, irritable, etc.)
- Increased appetite
Individual must also experience impairment in their functioning or significant distress as a result of their symptoms, and the symptoms cannot be better explained by some other medical issue or mental health disorder.
Potential Withdrawal Timeline
Withdrawal from stimulant medications, including withdrawal from methylphenidate, is itself not considered to be potentially dangerous; however, individuals may be at risk for accidents or complications due to poor judgment, or it can lead to emotional distress that can result in physical or mental harm.
Individuals who are experiencing withdrawal from methylphenidate can present with quite variable symptoms, and the withdrawal timeline may also be relatively variable from person to person. However, methylphenidate has a very short half-life, and the withdrawal period from the drug is most often relatively short.
In research studies that looked at symptoms associated with discontinuing methylphenidate in children who had been using the drug for the treatment of ADHD, the findings indicated that symptoms like daytime sleepiness, decreased appetite, mild depression, etc., were limited to a three-day period over all of the participants in the study. Individuals who abuse the drug would obviously be taking higher doses and more likely to be taking it at far more frequent intervals than individuals using the drug for medicinal purposes.
Research studies investigating the withdrawal timeline for methylphenidate in these individuals suggests the following timeline:
- Onset: The onset of withdrawal symptoms appears to occur about 6-12 hours after the individual has stopped using the drug. Initial symptoms are primarily psychological in nature and will consist of cravings, depression, apathy, decreased motivation, anxiety, lethargy, fatigue, increased appetite, and sleepiness. Some individuals may display physical signs like sweating, mild fever, chills, nausea, headache, and increased irregular heartbeat. Cravings for the drug will appear rapidly after discontinuation and will increase once the symptoms are present. The symptoms will lead to problems with attention and concentration, and even issues with memory for some individuals.
- Duration: The symptoms will dissipate relatively rapidly, and within 1-5 days, individuals will notice a peak in the intensity of their symptoms and then a significant reduction in intensity. As the symptoms begin to decrease in intensity, individuals may still experience increased appetite, sleepiness, fatigue, cravings, and mild issues with mood.
- After the first week: The majority of individuals will not experience any significant symptoms 7-10 days after they discontinue the drug. Residual symptoms, such as sleepiness, increased appetite, weight gain, mild issues with mood, and occasional cravings, may continue. It is rare that intense symptoms continue following seven days after discontinuation unless the individual has a history of issues with depression or some other mental health issue.
- Polysubstance abuse: People who have consistently mixed Concerta with other drugs of abuse, such as alcohol, other stimulants, benzodiazepines, narcotic pain medications, etc., may experience significantly more complicated withdrawal syndromes that reflect the withdrawal syndrome associated with these drugs of abuse. Mixing Concerta with other drugs of abuse is a common practice for abusers of the drug.
Because the symptoms that occur with discontinuation are primarily psychological in nature and consist of depression, lethargy, increased appetite, sleepiness, etc., individuals are often driven to satisfy cravings for the drug to decrease these negative symptoms. If the drug is readily available, this makes discontinuation extremely hard for many individuals who have abused the drug over a lengthy period of time because they often experience the most intense withdrawal symptoms following discontinuation, and simply taking the drug again will rapidly relieve these symptoms.
Withdrawal Management (Medical Detox)
Individuals who have chronically abused any controlled substance should consult with a physician if they wish to discontinue use of the drug. Discontinuing these drugs may lead to complicated issues that include cravings, mood swings, physical withdrawal symptoms, etc., that often drive individuals who are attempting to remain abstinent from them to relapse. Individuals who relapse have often lost some of their tolerance to the drug due to abstinence or may binge on the drug. Either these situations can result in an increased probability that the individual could overdose on one or more drugs during a relapse.
Because the implementation of a physician-assisted withdrawal management program (often alternatively referred to as a medical detox program) can significantly reduce or eliminate withdrawal symptoms and cravings, this is a strategy that should at least be considered by anyone discontinuing any drug of abuse. Moreover, individuals who go through continuous cycles of abstinence, relapse, and a return to regular drug abuse often begin to accept the attitude that they are unable to stop using their drug of abuse (this is not true) or begin to rationalize that their drug of abuse represents a positive need for them in spite of numerous negative effects of their drug use (this is also not true).
The implementation of a withdrawal management program for Concerta abuse would not include a tapering strategy (administering Concerta to the individual at decreasing doses to wean them off the drug). Instead, physicians would adopt a strategy of symptom management. Physicians would prescribe specific medications to eliminate or significantly reduce the effects of the symptoms the individual experiences. This could include the use of a mild stimulant medication to address lethargy and sleepiness, medications to address issues with nausea, and behavioral strategies to address issues with depression and anxiety.
In most cases, the use of antidepressant medications or anti-anxiety medications would not be used unless the individual has chronic issues with depression and anxiety that occurred in conjunction with their use of drugs. Most antidepressant medications take at least several weeks to exert their effects, and the majority of anti-anxiety medications are potentially addictive. The use of these drugs would be tightly supervised by a physician when they are used to address withdrawal symptoms associated with Concerta use.
Because the timeline associated with withdrawal from Concerta is relatively short, withdrawal management could be performed on an outpatient basis, but for individuals with severe withdrawal, co-occurring disorders, or environments that make them particularly vulnerable to relapse in the early stages of withdrawal, a residential or inpatient treatment program should be considered.
Withdrawal management is only the first step in recovery. Once individuals have successfully negotiated the withdrawal syndrome from Concerta, they require comprehensive treatment for their substance use disorder. Long-term aftercare programs are generally recommended, and they consist of continued medical management as needed, therapy for substance abuse and other co-occurring mental health conditions, support (family support and social support group participation), and other interventions that are appropriate in the specific situation. Individuals who do not become involved in an aftercare program will relapse at rates that are near 100 percent.