U.S. DEPT. OF JUSTICE: Ritalin Shares Same Abuse Potential as Amphetamines

“Of particular concern is that ADHD literature prepared for public consumption does not address the potential or actual abuse of methylphenidate. Instead, methylphenidate is routinely portrayed as a benign, mild substance that is not associated with abuse or serious side effects. In reality, however, the scientific literature indicates that methylphenidate [Ritalin] shares the same abuse potential as other Schedule II stimulants. Further, case reports document that methylphenidate abuse can lead to tolerance and severe psychological dependence.”

ABOVE: Drug Enforcement Administration, US Department of Justice. “Methylphenidate, A Background Paper,” NCJRS (National Criminal Justice Reference System) Abstract, NCJ 166349 (1995): www.ncjrs .gov/App/ publications/ abstract.aspx?ID=163349.
According to most estimates, more than 75 percent of Ritalin prescriptions are for children. Boys are about four times as likely to take Ritalin as girls.

Ritalin Side Effects and Warnings

Schedule II Substance

  • Generic Name: methylphenidate hci (hydrochloride)

Ritalin (methylphenidate) is an amphetamine-like prescription stimulant commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children and adults.

Were you fully aware of all the “warnings,” “drug dependency risks,” “precautions,” and “adverse reactions” related to the use of RITALIN?

Required “Black Box” Warning Label

Ritalin is a “Schedule II Substance” which means it has a “high potential for abuse” and “may lead to severe psychological or physical dependence,” and so the federal government sets limits on the amount that may be manufactured each year. (21 USC Sec. 812)

The Food and Drug Administration (FDA) requires the following “black box” warning on all methylphenidate drugs, including Ritalin, which means that medical studies indicate Ritalin carries a significant risk of serious, or even life-threatening, adverse effects.




ABOVE: FDA black box warning label means that medical studies indicate the drug carries a significant risk of serious or even life-threatening adverse effects. The bold warning label appears on the manufacturer's wholesale packaging and is the strongest alert the FDA can require.

Many think Ritalin (methylphenidate) is safe, or mild, because so many children use it. However, the government classifies the psychoactive drug with cocaine and morphine because it is highly addictive.

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Used For

  • Attention deficit disorder
  • Narcolepsy

How Ritalin Works

We don't know exactly why it produces the effects it does. Methylphenidate (Ritalin) was first synthesized in 1944 in an (unsuccessful) attempt to create a stimulant that would not induce addiction or tolerance. Ritalin is very closely related to amphetamine: similar in chemical structure, metabolization and clinical effects. This close connection is the chief reason Ritalin use raises concern among patients and others.

Do Not Use If

You have high blood pressure or any form of heart disease, are very nervous or have severe insomnia, have a history of addiction to drugs or alcohol. Do not combine with monoamine oxidase inhibitors.

Common Side Effects

  • Addiction
  • Nervousness including agitation, anxiety and irritability
  • Trouble sleeping (insomnia)
  • Decreased appetite
  • Headache
  • Stomach ache
  • Nausea
  • Dizziness
  • Heart palpitations

Other Serious Side Effects Include

  • Slowing of growth (height and weight) in children
  • Seizures, mainly in patients with a history of seizures
  • Eyesight changes or blurred vision

Less Common Side Effects

  • High blood pressure
  • Rapid pulse rate (and other heart problems)
  • Tolerance (constant need to raise the dose)
  • Feelings of suspicion and paranoia
  • Visual hallucinations (seeing things that are not there)
  • Depression
  • Cocaine craving
  • Dermatoses (infected or diseased skin)
  • Urinary tract infection
  • Infection or viral infection
  • Elevated ALT enzyme levels in the blood (signaling liver damage)

FDA WARNING: Links Ritalin to Priapism and Sexual Dysfunction

In a recent drug-safety announcement, the FDA announced that drugs containing methylphenidate (Ritalin, Concerta, Daytrana, Focalin, Metadate, Methylin, Quillivant) must including warnings about the risk of priapism. It's a serious problem: priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

The FDA included an even stronger warning about atomoxetine (Strattera): “Priapism appears to be more common in patients taking atomoxetine than in patients taking methylphenidate products. Health care professionals should be cautious when considering changing patients from methylphenidate to atomoxetine (Strattera).”

The safety warning also raised concerns about links between priapism and amphetamine drugs, which include Adderall, Dexedrine, ProCentra and Vyvanse.

ABOVE: U.S. FDA Drug Safety Communication: FDA warns of rare risk of long-lasting erections in males taking methylphenidate ADHD medications and has approved label changes. (12/17/2013).

Overdose Side Effects

Methylphenidate drugs have been extensively abused. Extreme psychological dependence and severe social disability have resulted. Abuse of methylphenidate drugs may cause a sudden heart attack even in those with no signs of heart disease. Symptoms of overdose that require immediate medical assistance include:

  • Restlessness
  • Tremor
  • Aggression
  • Hallucinations
  • Panic states
  • Hyperreflexia (overactive reflexes, which can include twitching or spasms)
  • Personality changes
  • Symptoms of depression
  • Seizures or abnormal EEGs
  • High blood pressure
  • Rapid heart beat
  • Swelling of hands/feet/ankles (for example, numbing of the fingertips)
  • Delusions
  • Sweating
  • Vomiting
  • Dehydration
  • Unexplained muscle pain
  • Lower abdominal pain
  • Rhabdomyolysis and kidney damage
  • Chronic abuse can manifest itself as psychosis, often indistinguishable from schizophrenia

What to Do About Side Effects

  1. The last dose of the drug every day should be taken several hours before bedtime to prevent insomnia.
  2. Nervousness usually goes away and appetite often returns so that weight loss is rarely dangerous.
  3. If high blood pressure, rapid pulse, paranoia, or tolerance becomes a problem, the drug is usually stopped.
  4. Nothing can be done about the addiction except to remember not to stop taking any type of methylphenidate abruptly.

Ritalin is a Schedule II Substance (along with opium, cocaine and amphetamines), which means Ritalin has a “high potential for abuse” that “may lead to severe psychological or physical dependence.”

ABOVE: 21 USC Sec. 812 01/22/02. Drug Enforcement Administration, US Department of Justice.

Dependence, Tolerance and Withdrawal

It is possible to build up a tolerance to methylphenidate, which means the person using the drug needs to take larger doses to achieve the same effect. Over time, the body might come to depend on methylphenidate drugs just to function normally. The person craves the drug and their psychological dependence makes them panic if access is denied, even temporarily.

Withdrawal symptoms can include tiredness, panic attacks, crankiness, extreme hunger, depression and nightmares. Some people experience a pattern of “binge crash” characterized by using continuously for several days without sleep, followed by a period of heavy sleeping.

If It Doesn't Work

The drug should be stopped gradually. Withdrawal symptoms are psychological and stopping suddenly can cause extreme fatigue and severe, even suicidal, depression in adult patients.

Abrupt cessation of stimulant drugs such as Ritalin can cause extreme fatigue and severe, even suicidal, depression in adult patients.

ABOVE: The Essential Guide to Psychiatric Drugs—Rev. and updated (2007).

If It Does Work

“Also, in addition to increasing heart rate and blood pressure, causing insomnia and weight loss, and sometimes causing psychotic symptoms, the stimulant medications used for ADHD (methylphenidate and amphetamines) may cause heart disease if taken for a long time. The latter problem led to a debate within the FDA, well covered by newspapers, about whether to issue a special warning to doctors. In the end, the FDA decided not to do this, but the risk remains,” reports Jack M. Gorman, M.D., professor of psychiatry at Columbia University and deputy director of the New York State Psychiatric Institute. Ritalin “is a very powerful drug that undoubtedly works for ADHD, but there are alternatives with less abuse potential that should be tried first.”

A review of 20-years-of scientific literature on using stimulant medications, including Ritalin, to treat children with ADD and ADHD found a consensus: there is no documented long-term benefit (academic achievement or pro-social behavior) in using psychoactive drugs.

ABOVE: Swanson, J.M., et al. “Effect of stimulant medication on children with attention deficit disorder: a review of reviews,” Exceptional Children, 60:154-62, 1993.

What is the Difference Between Ritalin LA and Ritalin SR?

Ritalin LA releases two peak levels of methylphenidate per day:

  1. first a rapid onset and
  2. another release about four hours later.

Ritalin SR delivers methylphenidate into the blood more slowly and continuous over a 6-8 hour period.

Ritalin LA Dosage Conversion Table

Methylphenidate or Ritalin SR

Ritalin LA

10 mg methylphenidate twice-per-day 20 mg Ritalin LA once-per-day
20 mg Ritalin SR twice-per-day 20 mg Ritalin LA once-per-day
15 mg methylphenidate twice-per-day 30 mg Ritalin LA once-per-day
20 mg methylphenidate twice-per-day 40 mg Ritalin LA once-per-day
40 mg Ritalin SR twice-per-day 40 mg Ritalin LA once-per-day
30 mg methylphenidate twice-per-day 60 mg Ritalin LA once-per-day
60 mg Ritalin SR twice-per-day 60 mg Ritalin LA once-per-day
ABOVE: National Association of Chain Drug Stores, NACDS Chain Pharmacist Practice Memo (July 2002): nacdsfoundation .org.

“Physiological effects of oral cocaine and methylphenidate (Ritalin) were similar.”

ABOVE: Rush, C.R., et al. “Behavioral pharmacological similarities between methylphenidate and cocaine in cocaine abusers,” Exp. Clin. Psychopharmacol: Feb;9(1):59-73(2001).

Harmful Reactions to Stimulant Drugs: Ritalin, Dexederine, Adderall, Concerta, Metadate

Brain and Mind Reactions

Obsessive-compulsive behavior
Zombie-like (robotic) behavior with loss of emotional spontaneity
Drowsiness 'dopey,' reduced alertness
Abnormal movements, tics, Tourette’s
Nervous habits (picking at skin, pulling hair)
Mania, psychosis, hallucinations
Agitation, anxiety, nervousness
Irritability, Hostility, Aggression
Confusion, mental impairments (decreased cognition and learning)
Depression, emotional, sensitivity, easy crying, social withdrawal
Stimulant addiction and abuse

Cardiovascular Reactions

Abnormal heart beat
Cardiac Arrest

Other Reactions

Blurred vision
Hair Loss
Hypersensitivity reaction with rash

Withdrawal and Rebound Reactions

Excessive sleep
Evening crash
Rebound worsening of ADHD-like symptoms
Over-activity and irritability

Endocrine and Metabolic Reactions

Pituitary dysfunction, including growth hormone and prolactin disruption, Growth suppression
Weight loss
Disturbed sexual function

Gastrointestinal Reactions

Anorexia, Nausea, vomiting, bad taste
Stomach ache, Cramps, Dry Mouth, Constipation, diarrhea, Liver dysfunction
ABOVE: Breggin, P.R. Talking back to Ritalin: what doctors aren't telling you about stimulants and ADHD, revised ed. Cambridge, MA: Perseus Books Group, (table 1, p. 32) 2001: cited references include: Breggin, P. “Psychostimulants in the treatment of children diagnosed with ADHD: Risks and mechanism of action.” Intl Journal of Risk and Safety in Medicine, 12, 3-35, 1999. Breggin, P. “Psychostimulants in the treatment of children diagnosed with ADHD: Part I: Acute risks and psychological effecs.” Ethical Human Sciences and Services, 1, 13-33, 1999. Arnold, L.E. and Jensen, P.S. Attention-deficit disorders, in H.I. Kaplan and Sadock, B. (Eds.). Comprehensive Textbook of Psychiatry, VI (table 38-5 p. 2306, table 38-7, p 2307), Baltimore: Williams & Wilkins, 1995. Drug Enforcement Administration (DEA), Methylphenidate (a background paper). Washington DC: Drug and Chemical Evaluation Section, Office of Diversion Control, DEA, U.S. Department of Justice, p. 23, 1995. Dulcan, M. “Treatment of children and adolescents,” in R. Hales, Yudofsky, S. and Talbot, J. (Eds.), The American Psychiatric Press textbook of psychiatry, (Second Edition) (table 35-6, p. 1217), Washington DC: American Psychiatric Press, 1994. Maxman, J.S. and Ward, N.G. Psychotropic drugs fast facts, second edition. New York: W.W. Norton (1995). Food and Drug Administration (1997).

Emergency room visits by children ages 10-14 involving Ritalin intoxication or overdoses have now reached the same level as those for cocaine—indicating escalating abuse of the addictive drug.

ABOVE: Diller, L.H. Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill; Bantam Doubleday Dell Pub. Group, Inc. (1998); citing Feussner, G. “Actual Abuse Issues,” Conference Report: Stimulant Use in the Treatment of ADHD, Drug Enforcement Administration, US Department of Justice, Washington DC, Dec. 1996.

Ritalin Side Effects from The Essential Guide to Psychiatric Drugs


Depression may also be treated with drugs called psycho-stimulants. Use of such drugs is reserved for only two situations: (1) patients who have failed to respond to at least two other antidepressants and psychotherapy and who are seriously depressed, and (2) patients with serious and usually terminal medical illnesses such as cancer or AIDS who are depressed and too sick to take other kinds of antidepressants.The reason for these restrictions is that the stimulant drugs are addictive. They include amphetamines (Adderall), sometimes called “speed” or “uppers,” methylphenidate (Ritalin).

The drugs produce a short-term mood elevation even in people who are not depressed. College students take them to stay awake all night and finish term papers.In most people the effects of these stimulant drugs are short-lived and there is often a letdown or “crash” after they wear off. During this “crash” the patient can feel very depressed, sleepy, and sluggish.

Furthermore...stimulant drugs have the potential to induce “tolerance.” People who abuse amphetamines and other stimulants (usually in attempts to lose weight or stay awake for prolonged periods) often find that a dose that had worked for a while is suddenly ineffective and they need a higher dose. They then become “tolerant” to the higher dose and have to increase the dose again. Soon, the person is addicted to the drug.

Stopping the drug suddenly leads to a severe withdrawal reaction characterized by bad depression and extreme fatigue. Suicides have been reported in people who suddenly stop taking amphetamines.

Given all these problems, why even mention the stimulant drugs for use in depression? Simply because they are the only drugs that work for some depressed patients. A very small group of usually chronically depressed patients seems to be resistant to every other treatment for depression. These people usually function at a fairly low level relative to their ability and they feel sad and blue all of the time. They complain of fatigue, low interest in life, and inability to concentrate. Many say they have been depressed since childhood. Another small group of patients with very serious medical problems also develops depression. Sometimes the medical problems they have make other antidepressant drugs unsafe, or the medical problems so magnify the side effects of the other antidepressants that the dying patient is made even more uncomfortable. Stimulant drugs may actually be the safest choice in this situation. For these two groups of patients stimulant drugs may be the only answer, even though the patient will probably become addicted. This is not to be taken lightly. The decision to place a patient on a stimulant drug for depression is serious and must be done only after all other efforts are declared either unsafe or ineffective. The patient must understand that he will probably become addicted to the medication and that he should never stop taking it abruptly.

Ritalin: The People's Pharmacy

(1976:) Some health professionals fear that these medications may end up being over prescribed. Dr. Carl Kline, an expert in the field of learning disabilities from the University of British Columbia, had this to say:

It is my belief that if these drugs were outlawed, children would not be at all deprived of essential medication, but that doctors would be forced to make more accurate diagnoses and seek better means of handling the hyperactive behavior of a certain small percentage of their little patients.

Do these drugs make a difference in the long-term outcome?

Until recently, the most important question concerning Ritalin or amphetamine administration has not been asked. Do these drugs make a difference in the long-term outcome? A comprehensive examination of this subject carried out at the Montreal Children's Hospital discovered a startling fact. At the end of five years, hyperactive children who received Ritalin did not differ significantly from children who had not received. Although it appeared that hyperactive kids treated with Ritalin were initially more manageable, the degree of improvement and emotional adjustment was essentially identical at the end of five years to that seen in a group of kids who had received no medication at all.

Parents might want to consider another approach.

Street names for Ritalin include: rits, rids, west coast, jif, mph, diet coke, kiddie coke, kiddie cocaine, vitamin R, R-ball, poor man's cocaine, skippy, skittles, smarties and the smart drug.

ABOVE: U.S. Department of Justice, National Drug Intelligence Center. “Ritalin Fast Facts,” NDIC Product No. 2003-L0559-026 (2003).
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Concerta methylphenidate hydrochloride (HCI)
[extended release]
Daytrana methylphenidate
film, transdermal
[extended release]
Focalin dextro-methylphenidate
(or, dexmethylphenidate) hydrochloride (HCI)
[instant release]
Focalin XR dextro-methylphenidate hydrochloride (HCI)
or dexmethylphenidate hydrochloride (HCI)
[extended release]
Metadate CD methylphenidate hydrochloride (HCI)
[extended release:
Metadate ER methylphenidate hydrochloride (HCI)
[extended release:
TWO- or THREE-a-day]
Methylin methylphenidate hydrochloride
[instant release]
Methylin ER methylphenidate hydrochloride
[extended release]
Quillivant XR methylphenidate hydrochloride
[extended release; liquid]
Ritalin methylphenidate hydrochloride (HCI)
[instant release]
Ritalin LA methylphenidate hydrochloride (HCI)
[extended release:
one-a-day, rapid onset with two peak levels]
Ritalin SR methylphenidate hydrochloride (HCI)
[extended release:
one-a-day, slower onset with more continuous delivery]
Attenta† methylphenidate hydrochloride (HCI)
[instant release]; AU
Biphentin† methylphenidate hydrochloride (HCI)
[extended release]; CA
Equasym† methylphenidate hydrochloride (HCI)
[instant release]; EU
Equasym XL† methylphenidate hydrochloride (HCI)
[extended release]; EU
Motiron† methylphenidate hydrochloride (HCI)
[instant release]; EU
Rubifen† methylphenidate hydrochloride (HCI)
[instant release]; NZ
†Not sold in U.S.

“Ritalin and amphetamine both produce gross reductions in blood flow to the brain, thereby creating the conditions for stroke.”

ABOVE: Breggin, P.R. The Ritalin Fact Book: what your doctors won't tell you about ADHD and stimulant drugs; Cambridge, MA: Perseus Books Group, 2002.

What is the most important information I should know about RITALIN-SR?

The following have been reported with use of RITALIN-SR and other stimulant medicines.

1. Heart-related problems:

  • sudden death in patients who have heart problems or heart defects
  • stroke and heart attack in adults
  • increased blood pressure and heart rate

Tell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems. Your doctor should check you or your child carefully for heart problems before starting RITALIN-SR.

Your doctor should check you or your child's blood pressure and heart rate regularly during treatment with RITALIN-SR.

Call your doctor right away if you or your child has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking RITALIN-SR.

2. Mental (Psychiatric) problems:

All Patients

  • new or worse behavior and thought problems
  • new or worse bipolar illness
  • new or worse aggressive behavior or hostility

Children and Teenagers

  • new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptoms

Tell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression.

Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking RITALIN-SR, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.

ABOVE: Ritalin-SR Medication Guide, rev. 4/2007.

Long-Term Effects of Ritalin: Changes in Brain Development

Ongoing research shows early-life use of Ritalin (methylphenidate) has complex effects that endure later into life. A study published in Biological Psychiatry suggests that exposure of Ritalin in youth may later disrupt development of brain cells in the hippocampus, region of the brain critical to memory, spatial navigation, and behavioral inhibition and resulting in memory problems, disorientation and depression in adulthood.

The same damage can be seen in Alzheimer's disease where the hippocampus is one of the first areas of the brain to suffer damage and so memory problems and disorientation appear among the first symptoms.

ABOVE: Lagace, D.C., et al. Juvenile administration of methylphenidate attenuates adult hippocampal neurogenesis. Biol Psychiatry 60:1121-1130, 2006. Wang L., et al. Changes in hippocampal volume and shape across time distinguish dementia of the Alzheimer type from healthy aging. NeuroImage vol. 19, 2003. Zhao Z. et al. Hippocampus shape analysis and late-life depression. Plos One 3(3): e1837, 2003.

NY Times: Children's A.D.D. Drugs Don't Work Long-Term

The NY Times, in an op-ed article by L. Alan Sroufe, a professor emeritus of psychology at the University of Minnesota's Institute of Child Development:

“Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects...

“Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work. But the behavior worsens because the children's bodies have become adapted [because the drugs are habit-forming] to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.”

ABOVE: L. Alan Sroufe, “Ritalin Gone Wrong: Children's A.D.D. Drugs Don't Work Long-Term,” New York Times, pg SR1, NY ed, 1/28/2012.

Children Diagnosed with ADHD up to Three Times More Likely to Use or Abuse Drugs

Children diagnosed with attention deficit hyperactivity disorder (ADHD) are up to three times more likely than other kids to use, abuse or become dependent on substances such as nicotine, cocaine and marijuana in adolescence and as young adults, according to new research published in Clinical Psychology Review.

ABOVE: Lee, S.S., et al. “Prospective Association of Childhood Attention-deficit/hyperactivity Disorder (ADHD) and Substance Use and Abuse/Dependence: A Meta-Analytic Review.” Clinical Psychology Review, 2011 Apr;31(3):328-41. doi: 10.1016/ j.cpr. 2011.01.006. Epub 2011 Jan 20. As reported in: Terbush, S. “Kids with ADHD more likely to use drugs, analysis finds,” USA Today, 4/25/2011.

“All major classes of psychiatric drugs—antipsychotics, antidepressants, benzodiazepines, and stimulants for ADHD—can trigger new and more severe psychiatric symptoms in a significant percentage of patients.”

ABOVE: Whitaker, R. “Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America,” Ethical Human Psychology and Psychiatry, Vol. 7 No. 1, 2005.

Surge in ADHD Diagnoses Gets a Red Flag

Doctors sounded a warning in the British Medical Journal over a rise in ADHD diagnoses, saying some children may be needlessly taking powerful drugs intended to correct a poorly understood disorder.

The analysis found Ritalin and other drugs were meant to be used only for “severe” ADHD symptoms, which according to research data only occur among about 14 percent of children with the condition.

Yet “about 87 percent of children diagnosed with ADHD in the US in 2010 subsequently received medication,” it said, warning of “unnecessary and possibly harmful medication treatment.”

ABOVE: “Surge in ADHD diagnoses gets a red flag,” France 24 International News, Nov. 6, 2013:
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