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Withdrawal Timelines for Concerta

Concerta is one of the brand names for the prescription stimulant medication, methylphenidate. Ritalin is another—and probably the most well-known—brand name for methylphenidate. A Schedule II controlled substance, Concerta has legitimate medicinal use but the potential for abuse and dependence is considered to be high.1,2Quitting Concerta may result in a set of withdrawal symptoms that, while not physically dangerous, can be uncomfortable.1

What Is Concerta?

Concerta is prescribed for the treatment of Attention Deficit Hyperactivity Disorder (ADHD).1Concerta is an extended-release formulation of methylphenidate, meaning that rather than releasing the medication all at once (immediate release), it remains therapeutic over a longer period of time.

An extended-release version can have many benefits, including having to take fewer doses throughout the day; however, misuse of an extended-release medication can be very dangerous as bypassing the intended gradual-release mechanism can result in intensified side effects and the potential for overdose.1,3,4

Concerta may cause insomnia

Is Concerta Addictive?

Concerta has therapeutic value for those who need it and take it as prescribed; however, it can be misused. Unfortunately, abuse of stimulants like Concerta are common. In 2017, more than 900,000 people misused methylphenidate medications in the United States.5 When Concerta is misused—for example, intranasally (crushed and snorted)—it can produce effects akin to cocaine and it has a similar addictive potential.6

Concerta use can result in the development of physical dependence, an adaptation of the body to a substance wherein quitting results in a withdrawal syndrome. Concerta withdrawal symptoms may be similar to those seen during withdrawal from illicit stimulants.6,7

Withdrawal from Concerta

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the formal diagnostic criteria for stimulant withdrawal, which would include withdrawal from Concerta.

Acute stimulant withdrawal symptoms include:8

The Concerta label also indicates that severe depression may result from Concerta withdrawal.1

Stimulant abuse often takes place in a binge and crash fashion, meaning the individual will use many doses in a row in a binge and then experience a “crash,” or early withdrawal. This is likely to bring on symptoms such as severe fatigue, hypersomnia (excessive sleeping), lack of energy, and depressed mood.8

Concerta Withdrawal Timeline

  • Stimulant withdrawal is marked by the development of symptoms within a few hours to several days of either a complete cessation of use or a significant drop in the normal dose.8
  • Symptoms may intensify in the first several days or may fluctuate in severity over several weeks. Drug cravings and a general feeling of dissatisfaction with life (anhedonia) may persist for longer periods.9
  • The exact timeline of withdrawal and the severity of symptoms may vary from person to person and may depend on factors such as how much Concerta was being taken and for how long and the presence of underlying mental health issues such as depression.9
  • Withdrawal from stimulant medications, including withdrawal from methylphenidate, may not result in immediate or direct harm to individual health; however, the depression and anhedonia that a person in withdrawal may experience could result in suicidal ideation or suicide attempts, arguably the biggest risks associated with stimulant withdrawal.8
  • Individuals dependent on other substances that have more severe withdrawal syndromes may experience a much more complicated and threatening physical withdrawal symptoms. These substances include alcohol and benzodiazepines, both substances that are commonly abused alongside stimulants to combat the undesired effects of intoxication or cope with the crash.9

Withdrawal Management

  • Individuals who have chronically abused any controlled substance should consult with a physician or addiction treatment professional 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.
  • Polysubstance users may be at further risk of harm, since there could be multiple withdrawal syndromes at play. Depending on which drugs the individual has become physically dependent, the withdrawal period could be life-threatening. Stimulant withdrawal is not particularly dangerous physically (though there are dangers associated with severe depression), but someone who is also dependent on benzodiazepines, for example, may be at risk for seizures and other problems that require immediate medical attention.10
  • Someone who has been abusing Concerta only may not require the full intensity of an inpatient medical detox and may fare well withdrawing on an outpatient basis, whereas someone who suffers from polysubstance dependence may require the 24-hour supervision of such a program.
  • Some form of support should be considered due to the risk of relapse, even if it is in the form of outpatient treatment or a “social detox” program (where no medication is provided but the individual has a substance-free, supportive place to withdraw). Because stimulant withdrawal can result in exhaustion from sleeplessness, a depressed mood, and an inability to experience pleasure, it may be all too easy to relapse when attempting to detox alone at home.10
  • There are no medications approved to treat stimulant withdrawal; however, some medications may be useful in treating some of the specific symptoms of withdrawal. For example, Benadryl may help to relieve insomnia.10

“Withdrawal management is only the first step in recovery.”

Concerta addiction should be addressed in professional treatment

Withdrawal management is only the first step in recovery. After the withdrawal phase ends, further addiction treatment (whether outpatient therapy or inpatient rehabilitation) may be beneficial for continued abstinence, since any issues that contributed to the misuse of Concerta in the first place are likely to remain and could promote relapse if not addressed.10

Treatment may include some or all of the following:

  • One-on-one therapy for substance abuse and other co-occurring mental health conditions.
  • Group therapy.
  • Participation in 12-step or other recovery support groups.
  • Drug education classes.
  • Skills-building.

Our program at Greenhouse Treatment Centers incorporates all of the above to help individuals struggling with addiction and co-occurring disorders achieve lasting sobriety. Our program offers a full continuum of care from medical detox to sober housing to provide you with an array of options as you navigate your journey to recovery from Concerta addiction.

References:

  1. Alza Corporation. (n.d.). CONCERTA® (methylphenidate HCl) Extended-release Tablets CII.
  2. S. Drug Enforcement Administration. (n.d.). Drug Scheduling.
  3. Andrade, Chittaranjan. (2015). Sustained-Release, Extended-Release, and Other Time-Release Formulations in Neuropsychiatry. J Clin Psychiatry, 76(8), e995–e999.
  4. Sansom, Lloyd N. (1999). Oral extended-release products. Aust Prescr, 22, 88-90.
  5. Center for Behavioral Health Statistics and Quality. (2018). 2017 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
  6. Morton, W. A., & Stockton, G. G. (2000). Methylphenidate Abuse and Psychiatric Side EffectsPrimary care companion to the Journal of clinical psychiatry2(5), 159–164.
  7. National Institute on Drug Abuse. (2018). Prescription Stimulants.
  8. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  9. Center for Substance Abuse Treatment. Treatment for Stimulant Use Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 33.) Chapter 5—Medical Aspects of Stimulant Use Disorders.
  10. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.

 

About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More