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Concerta, which is one of the brand names for a drug called Methylphenidate, is a commonly prescribed treatment for ADHD. The drug is also marketed as Daytrana, Methylin, Ritalin, and Aptensio. These drugs are also used in treating cocaine addiction and in preserving memory function in people who have brain tumors. Scientists are just beginning to realize that the combination of Concerta (or any of the other brands of Methylphenidate) with Prozac (fluoxetine) probably can have lifelong consequences for people given these drugs in their teens. Laboratory studies suggest that giving someone both this drug for ADHD and an SSRI for depression decreases "latency to immobility."

In other words, the combination of these drugs turns you into a couch potato. When you are faced with challenges, your natural response is to sit down and eat something. This isn't a personality disorder or a character flaw (although those are also possible). It's due to specific changes in the brain.

Methylphenidate has another nasty side effect. It makes the brain less "plastic." It helps control impulsive behavior, but it also keeps the brain from adapting to new situations. You've probably heard of the chemicals dopamine and norepinephrine. Dopamine is the brain's pleasure chemical. Norepinephrine is one of the brain's stimulant chemicals.

In a healthy brain, the more dopamine it makes, the more rewarded you feel. The more epinephrine it makes, the more motivated you feel. If you have been using Concerta or similar drugs for a long time, however, there is a distortion of this relationship. In people are treated for ADHD, a little dopamine makes you feel better but a lot of dopamine makes you feel worse. A little norepinephrine makes you feel more motivated but a lot of norepinephrine makes you feel tired. 

In real life, the way this works out is that the highs get lower. You can have a good time, maybe winning a game of tiddlywinks will make you feel better, but you can't have a really good time, winning the lottery makes you feel sad. You can be a little motivated, you get a promotion at McDonald's, but you can't be highly motivated, despite your IQ of 247 you don't finish your application for MIT.

There are very serious ramifications for long-term treatment with Methylphenidate. Unfortunately, in American society, people aren't going to do anything unless maybe it has a connection with weight loss. That's what they get concerned about, not ruining their whole lives. However, there are things one can do at least to lose weight without resorting to taking ADHD drugs.

Concerta and similar drugs cause weight loss because of their chemical similarity to methamphetamine. They cause the body to burn sugar at an accelerated rate so that carbs are burned before they become fat. If you take just Concerta, you may lose weight. If you take both Concerta and antidepressant, you won't gain weight as fast.

The solution for people who gain 20 pounds, 40 pounds, 60 pounds or more while they are on antidepressants isn't to start taking a stimulant, particularly one that has the paradoxical effect of discouraging physical activity. The solution is to manage depression without taking a medication that causes weight gain.

If you need to be on antidepressants, then it may be better to be on Wellbutrin (bupropion). Sustained-release forms of Wellbutrin not only are useful in treating some cases of depression, they limit appetite and encourage weight loss. You need to be completely up front with your doctor (don't switch doctors just to get a different prescription), and change antidepressants under supervision to do it safely. But don't take one drug to speed you up and another to slow you down just to manage your weight. Rely on diet and exercise and keep medication to a minimum so you get the full payoff of your hard work at losing weight.


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