Ritalin for fatigue??

ritalin
Here in the UK we are much more strict about prescribing and really ritalin is only used in ADHD and has proven efficacy in well diagnosed ADHD (doesn't solve behavioural problems caused by crap parenting though!). We wouldn't use it in this context but I did find an interesting article written by a doctor with cancer who used it and he describes his experience and some of the evidence for its use. Have pasted below. Interested to hear how it goes for you.

steve



After requesting the medication, however, I researched the use of psychostimulant medication to treat fatigue in people with cancer. While I found no study using methylphenidate or other psychostimulants for generalized cancer-related fatigue, I did find several interesting studies. First, I found a recent prospective study of 11 individuals with cancer treated with methylphenidate. All had advanced disease. The study asked 11 consecutive patients to agree to a trial of methylphenidate. The authors reported that eight of nine individuals showed a rapid onset of benefit from methylphenidate, even in the presence of anemia [2]. Methylphenidate also demonstrated benefits for hospitalized patients with cancer [3].

I also found reports of studies using psychostimulants in three other conditions; narcotic-induced sedation in children and adults, HIV/AIDS, and multiple sclerosis. First, methylphenidate and other psychostimulants were reported to safely counteract general narcotic-induced sedation in children [4] and adults [5], though with some limited benefit. Second, psychostimulant medication had recently proved effective in decreasing daily fatigue in individuals with HIV/AIDS [6]. Treatment not only reduced fatigue and provided increased energy for individuals with HIV, but also had a dramatic impact on measures of quality of life and psychological well-being, thus confirming that fatigue is a globally restricting condition, while tiredness presents as just one of its symptoms. The authors of this study concluded that the ability to adequately resolve even one common and distressing symptom for individuals with HIV appeared “worthwhile and necessary.” Finally, psychostimulants were reported as a safe and effective treatment of fatigue in individuals with multiple sclerosis [7].

Benefits
I started taking methylphenidate in the morning. My wife noted almost immediate benefits. She was overjoyed with my improved energy and enthusiasm. She was particularly happy with my increasing desire to go for walks, spend time with friends, go out at night—after work!—and just talk at the end of the day. She said my appearance was the most surprising change. I now didn’t look like I had cancer. On a couple of early occasions when I had forgotten to take the stimulant, she would invariably ask what was wrong, whether I was feeling okay.

Others shared her recognition of this change. My children expressed their joy at having their father back. I believe they saw me as less fragile, throwing off the ill-fitting veil of the victim, the sufferer, and the cancer patient, and instead emerging as their father, friend, and biggest fan. My liberation was apparent to them as well, my face and movements were clear evidence that while I had clearly recently stumbled, or more accurately crashed, and my body had perhaps absorbed a mortal blow, I was now the person with whom they could once again share their victories (large and small), as well as their challenges, their daily activities (from the mundane to the profound), and their concerns about me, all due to my replenished supply of emotional resources.

Though I did not notice the full degree of the changes in myself as quickly as my wife and others with whom I shared a close relationship, I did recognize having greater energy, more enthusiasm, less irritability, and better endurance. At work, I could once again fully engage in the developmental evaluations of young children. I was thrilled to again extract a response from even the most challenging of children, a furtive glance, an engaging smile, and a wondrous giggle. I could again maintain color in my face and air in my lungs while playing hide and seek, throwing a little boy in the air (and often catching him), roughhousing, and playing tickling games—their first experience with a contact sport—with these little beings. I even enjoyed their asking what happened to my hair, and their uninhibited laughter when we would search the clinic room for my former topping. We often concluded that I probably left it at home. No child agreed to my request to share their hair.

While the energy gains were real, they were occasionally tenuous. I noticed that the “crashes”—best explained as the feeling that a vacuum pump had rapidly and without warning instantaneously drained me of energy—still occurred. Now, however, the timing of these fog-inducing events was at least somewhat predictable. The first event occurred regularly at between 2:20 and 2:30 p.m.. After a while, I didn’t even need to check the clock. The second was a continuation of my late afternoon decline, coming with equal regularity, at 5:20-5:30. When I recognized that the first event marked the declining level of the medication, my oncologist agreed to add a second dose. Taking that dose at around 2:00 p.m. maintained a more constant medication level thereby quickly and efficiently solving not only that mid-afternoon problem but the latter one as well.

I also realized that I could adjust the medication dose, timing, and duration according to my personal needs. For example, taking the second dose later in the day—around 3:00-4:00 p.m.—might provide more ability to enjoy an evening out. Perhaps I could now plan the previously unheard of post-cancer diagnosis feat, dinner and a movie, or stay awake at a friend's house past 8:30. I could also tell my children they could again call late, as I would probably be watching “stupid people tricks” on The David Letterman Show.

I am considering changing my current medication to an even longer acting preparation. This change would likely provide continuous benefit throughout the day and even into the early evening. This effect could eliminate the necessity of the mid-afternoon dose, but perhaps eliminate the movie as well. The point is that I can design, with considerable flexibility, a regimen that works best for my family and me. I am now able to mobilize my own energy resources more frequently and with more predictability. I no longer feel defenseless against the physically and emotionally disabling cancer forces. While my oncologist thoughtfully chooses the heavy artillery, I now command some troops of my own. I feel that taking command has given me power perhaps to stop or at least help modify the assault. I now have control over an additional weapon. I have me.

Conclusion
A careful and thorough consideration of conditions diminishing a person's quality of life is an essential strategy for the comprehensive treatment of people with cancer. Recruiting our available physical, emotional, and spiritual energy can be key to our ability to maintain our quality of life. It may also restore some balance and, thus, keep us in the battle, providing the physical and emotional energy to combat the uninvited and unwelcome invader.

Psychostimulant medication has been effective in treating my cancer-related fatigue. Further, I believe starting the medication before being dulled by opiates or becoming overcome by depression or end-stage disease increased my potential to combat fatigue. While studies to critically evaluate the efficacy of psychostimulants for children and adults are clearly needed, their proven success treating fatigue in other medical conditions, as well as recognized benefits for use in end-stage disease, and most importantly, their record of safety—undoubtedly the safest, most effective, and most studied medication prescribed by pediatricians—strongly support the need for oncologists to discuss and support this treatment option with all adults with cancer, with children who are mature minors and can give assent to their own treatment, and with parents of children over 6 years of age. Further, these discussions should begin when individuals with cancer and their families are told about the probability of fatigue. Learning that they may have a weapon against this disabling side effect may enhance their resolve and their recognition that their oncologist wants them to join the battle.