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Difference between DEXAMPHETAMINE & METHYLPHENIDATE in ADHD | ADDERALL | RITALIN | DR REGE EXPLAINS

Posted on October 26, 2022 By
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DEXAMPHETAMINE and METHYLPHENIDATE are medications used to treat Attention-deficit Hyperactivity Disorder (ADHD).

Consultant psychiatrist today i’ll be touching on   methylphenidate this was a request from one   of our viewers and i thought this was a really  really great question so i’ll be covering the   psychopharmacology of these two agents now both  dexamphetamine and methylphenidate are used in   adhd attention deficit hyperactivity

Disorder  on adhd the evaluation of that condition  now when we think about the amphetamine   versus methylphenidate the main thing that both of  these agents are doing to assist in adhd is this   focus here on the prefrontal cortex because the  prefrontal cortex is really the seat of cognition   all of those things that can

Be affected in   adhd organization etc so in the prefrontal cortex  dopamine receptors noradrenaline and the alpha-2   presynaptic and post-synaptic receptors are the  main ones that we’re looking to target in the   treatment so today what i’m going to be focusing  on is dopamine and noradrenaline because those are  

The main neurotransmitters that these two agents  increase in the extracellular space so that they   those benefits to treat adhd so let’s firstly   comes in many trade names um there is the   immediate version ritalin there is a long acting  version ritalin long acting and there’s also   concerta so there are different

Formulations and  the different formulations are there’s immediate   release that only lasts for a short period of  time you know uh onset of action is about 20 to   60 minutes and might last for maybe three four  hours um about that much whilst when we look at   concerto that’s pushing further lasting for much  longer about

12 13 14 hours somewhere and then   is basically a non-competitive inhibitor of   and dopamine transporter by inhibiting it  it prevents the uptake of noradrenaline   into the presynaptic neuron it prevents the uptake  of dopamine into the presynaptic neuron therefore   there’s lots of noradrenaline and lots of dopamine 

Available in this synaptic cleft to act on those   receptors uh in the postsynaptic aspect to provide  those benefits so that’s what methylphenidate does   there’s some evidence that it also acts on the  alpha-2 receptors providing that further benefit   on clonidine and prazosin so you can have a   are that’s sort of the

Main aspect block that  blocked that increased levels of both enter   amphetamine of course we’re going to talk about  dexamphetamine but we know there’s methamphetamine   so and there’s less dexamphetamine which we’ll   be talking about as well but essentially what  this agent does is it also blocks nat and that  

Additional benefits that come beyond that so   by blocking nat and dat there’s increase in orange  adrenaline and dopamine just like methylphenidate   second it is a competitive inhibitor of   the vesicular monomine transporter is situated   dopamine into vesicles so what amphetamine does   will actually fall out of those

Vesicles so it  will basically remain in this cytosolic space   remember there’s already lots of dopamine here   right but it’s doing extra it’s competitively  inhibiting vmat and then what it’s doing   function of that is to uptake dopamine this one   does the reverse so what amphetamine will do it  will actually act

As a reverse dat inhibitor which   means it will push instead of taking it up as a  data inhibitor it’s a reverse that inhibitor which   means it will push dopamine out further so you can  see there are these triple whammy effects not only   blocking that and nats so you get non-adrenal and  dopamine but then compete with vmat

Push it under   the cytosolic space displace it and then further  through reverse dopamine transporter inhibition   you push it out further lots more dopamine into  the synaptic cleft what does that tell us it tells   us that this that’s why the euphoric effect is  there as well because of this super extra release  

Amphetamine or amphetamines are much more potent   think about dexamphetamine we have the short  dexamphetamine again onset very very quick and   lasts maybe three to four hours but there is the  longer acting version such as lisdexamphetamine   uh which is known as vivants um and what that does  is when you when it’s taken they it’s

Cleaved into   cleaved and that’s when the absorption um is   it this way so therefore it’s a long-acting   is that we need optimal doses so we think about  using a short acting or a long acting whatever it   preferred in a sec but essentially the aim is to   provide an optimal level of dopamine or adrenaline  because

Too little results in symptoms of adhd   too much can actually result in not only side  effects but actually rigidity inflexibility of the   prefrontal lobe so we need a real optimum level  of these agents and generally we want to consider   long-acting agents because you see short-acting  agents provide sort of pulsatile dopamine

Release  longer-acting so think about it this way right which mimics  more substance use or using say amphetamines   tonic firing of dopamine that’s nice and rhythmic   because that is more adaptive hence why longer  acting agents may be considered beneficial so   non-competitive inhibitor you get dopamine you  

Get noradrenaline with amphetamines you get these  three-pronged effect that nat one two competitive   v-mat inhibitor so release of dopamine into this  cytosol and then reverse dopamine um inhibition   uh dopamine transporter inhibition so release  all of that dopamine from the cytosol into   so i hope that this gives you an

Idea about   it useful if you liked the video leave us a   like and i hope to see you in another edition of  you

Transcribed from video
Difference between DEXAMPHETAMINE & METHYLPHENIDATE in ADHD | ADDERALL | RITALIN | DR REGE EXPLAINS By Dr Sanil Rege’s Hub – Psychiatry Simplified

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