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ADHD Medication Meta-analysis
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Visual Abstract

Methylphenidate but not atomoxetine or citalopram modulates inhibitory control and response time variability

Ritalin, reaction time, and response inhibition in healthy adults

L Sanjay Nandam, Robert Hester, Joe Wagner, Tarrant D R Cummins, Kelly Garner, Angela J Dean, Bung Nyun Kim, Pradeep J Nathan, Jason B Mattingley, Mark A Bellgrove
Summarized by:
Charles Li, MD
April 23, 2023
study source
Biol Psychiatry
May 2011
🔎
What they studied
Researchers conducted a study on the effect of medication on impulsiveness and our ability to inhibit ourselves.
👨‍🔬
What they found
Methylphenidate, the generic form of Ritalin, was uniquely effective in improving performance and reducing impulsivity on a cognitive task.
💡
What this means
One of the mechanisms behind stimulants' effectiveness in ADHD is their ability to reduce impulsiveness and improve attention.

Ritalin, reaction time, and response inhibition in healthy adults
Methylphenidate but not atomoxetine or citalopram modulates inhibitory control and response time variability

Objectives

Response inhibition plays a pivotal role in conditions such as ADHD. It refers to our ability to stop ourselves from following every impulse. It is a part of executive function that allows us to step back and think about things.

We know that ADHD medication can dramatically improve ADHD symptoms. But it’s still not entirely clear how they work.

This study aimed to help further understand how medications affect response time. Doing so helps us understand how ADHD medications work.

Study Quote
Nandam et al. 2011

Response inhibition is a prototypical executive function of considerable clinical relevance to psychiatry. Nevertheless, our understanding of its pharmacological modulation remains incomplete.

Methods

Researchers conducted a small clinical trial comparing the generic forms of Ritalin, Strattera, and Celexa.

To test the effects of the medication, researchers performed a stop signal inhibition test, a cognitive test used to evaluate response inhibition.

Study Quote
Nandam et al. 2011

We used a randomized, double-blind, placebo-controlled, crossover design to examine the effect of an acute dose of methylphenidate (MPH) (30 mg), atomoxetine (ATM) (60 mg), citalopram (CIT) (30 mg), and placebo (PLAC) (dextrose) on the stop signal inhibition task in 24 healthy, right-han...

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Results

The results showed that methylphenidate was uniquely effective in improving response inhibition.

In this test, participants were rated on their ability to respond to stop signals, which those with ADHD and impulsivity struggle to do.

Participants who were given Ritalin showed a significant improvement in their ability to inhibit themselves.

“
The stop-signal reaction-time (SSRT) task measures inhibition of a response that has already been initiated, that is, the ability to stop. Human subjects classified as "impulsive," for example, those with attention deficit and hyperactivity disorder, are slower to respond to the stop signal.
Eagle, Baunez, et al. Cereb Cortex. 2008

They also showed less variability in their results, an effect that is linked to better attention:

“
At the cognitive level, RTV likely reflects impairments in information processing and, more specifically, a dysfunction related with a failure to maintain attentional control...RTV might be a sensitive marker for the efficiency of top-down attention control.
Reaction Time Variability in ADHD: A Review

Of note, those on Ritalin didn’t necessarily work faster overall; they were just better at responding to stop signals.

This suggests that the effects of Ritalin don’t necessarily come from speeding up our brains. Rather, it helps us inhibit our impulses, a key challenge for those with ADHD.

A small clinical trial found that Ritalin was particularly effective in improving response inhibition. It reduced the time to produce the correct response and reduced the variability of the timing, a measure of attention.

Study Quote
Nandam et al. 2011

Methylphenidate led to a reduction in both response time variability and stop-signal reaction time (SSRT), indicating enhanced response inhibition compared with all other drug conditions. Crucially, the enhancement of response inhibition by MPH occurred without concomitant changes in ove...

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Conclusions

This study tells us more about the mechanism behind Ritalin’s effectiveness. Medications like Strattera are also effective, but their mechanisms are different.

In the case of Ritalin and possibly Adderall, these data tell us that improving our ability to control our impulses and reactions is a key part of how they work.

Study Quote
Nandam et al. 2011

An acute dose of MPH but not ATM or CIT was able to improve SSRT and reduce response time variability in nonclinical participants. Improvements in response inhibition and response variability might underlie the reported clinical benefits of MPH in disorders such as attention-deficit/hype...

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