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October 21, 1988

Behavior Disorders and the Ritalin Controversy

Author Affiliations

University of Vermont College of Medicine Burlington

University of Vermont College of Medicine Burlington

JAMA. 1988;260(15):2219. doi:10.1001/jama.1988.03410150067026

To the Editor.—  I would like to respond to your MEDICAL NEWS & PERSPECTIVES story on methylphenidate hydrochloride (Ritalin) in the May 6 issue.1 For years, American child psychiatry has emphasized the environmental causation of behavior disorders. This in turn has led to much wasted research effort and the sad state of pharmacotherapy for behavior disorders. Methylphenidate is a short-acting drug. Since improved self-control is the goal, we need drugs that can produce an even result over 24 hours. Many clinicians have been using small doses of imipramine, desipramine, amitriptyline hydrochloride, and trazodone with great success. The different antidepressants are not interchangeable and one cannot predict which patient will respond to which drug. Ninety percent of patients will respond to twice-a-day dosage, without side effects, at doses well below those that might produce unwanted cardiac effects. Methylphenidate should be a drug of last resort.2-7We published our first