Pharmacological Sleep Deprivation Countermeasures

Methylphenidate is marketed in the United States under the prescription names Concerta, Metadate, Methylin, and Ritalin (26). It is available in immediate and sustained-release formulations for the treatment of attention deficit/hyperactivity disorder (ADHD) and the symptomatic management of narcolepsy (a disorder characterized by excessive daytime sleepiness). 

A piperidine derivative, methylphenidate facilitates the release of catecholamines and blocks their reuptake and degradation (27). It is considered to be a mild central nervous system (CNS) stimulant, which appears to stimulate brain structures in a manner similar to amphetamines (26). A strongly favored treatment for ADHD, methylphenidate prescriptions account for over 90% of prescription stimulants used in the United States (28). Both children and adults who have been diagnosed with ADHD have been treated with methylphenidate with a high degree of success (29,30). A review of the studies in which stimulants were used by children with ADHD indicated significant evidence for improvement in hyperactivity, inattention, and impulsivity (28). 

Clinically, methylphenidate also is used for the treatment of daytime sleepiness associated with narcolepsy. It is a mainstay treatment for this problem and has a long record of efficacy in alleviating the sleepiness symptoms (31) and maintaining alertness and performance in narcoleptic patients (32,33). 

Methylphenidate also has been used to treat other medical conditions. For example, it has been used as a short-term treatment for depression in the medically ill, as an adjunct to conventional antidepressants for patients with major depressive disorder, and in combination with opiates for pain control. Methylphenidate has been prescribed to reduce apathy in patients with dementia or other brain diseases (28,34,35). 

For the treatment of narcolepsy in adults, the usual dosage is 10 mg 2-3 times per day. Because of individual differences in responsiveness to the medication, some patients require 40-60 mg per day while others require only 10-15 mg per day (37). 

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