Adult ADHD Medication in the UK
In the UK, the NHS has guidelines for diagnosing ADHD in adults. During the pandemic, referrals to the adult ADHD clinic quadrupled.
The medications used to treat ADHD include stimulants as well as non-stimulants. Methylphenidate, dexamfetamine and Lisdexamfetamine are three amphetamine-based drugs which help to manage ADHD symptoms.
Stimulants
Stimulants are the most common treatment for ADHD in adults. They work by enhancing activity in the parts of the brain responsible for the behavior and attention. They are quick-acting and are frequently the first choice considered by GPs. Methylphenidate is also known as Ritalin, is the most commonly prescribed stimulant for adults as well as children.
This medication increases the amount of neurotransmitters in the brain, improving concentration and decreasing impulsivity and hyperactivity. It can also reduce anxiety and depression, which can co-occur with ADHD.
In the past, stimulant drugs were used to boost cognition, motivation and performance. These include nicotine and caffeine amphetamines, cocaine, methylphenidate and modafinil. They are also used as appetite suppressants and energy boosters. They may have significant physical and psychological adverse effects when used in excess.
There are a variety of different drugs used to treat adults with ADHD and psychiatrists will usually carefully titrate the doses on each person they visit. They'll also consider any other medical conditions that a patient may be suffering from, and the effects of the medication on sleep patterns. They will also examine the effects of the medication on the diet of a patient and lifestyle.
A large network meta analysis, conducted by NIHR Oxford Health Biomedical Research Centre (NIHR Oxford Health Biomedical Research Centre) and Stichting Eunethydis has found that Lisdexamfetamine, more commonly referred to as Adderall, is more effective than other stimulant in reducing symptoms of ADHD. It is recommended by NICE and is available for prescription in the UK.
Despite the positive evidence that supports it, there is a certain stigma associated with the use of medications to treat ADHD and other disorders, with unhelpful frames that refer to it as child abuse, and even comparisons to controlled substances. This may make some people not want to request an assessment, or to consider taking medications for their condition.
The number of adult patients treated for ADHD increased as the number of people referred to NHS psychiatry increased during the COVID-19 epidemic. In fact, adult ADHD referrals have now surpassed those for children. Boys are more likely to be referred, but the number of women seeking treatment for ADHD has quadrupled over the past two years.
Unlicensed Medication
A range of medicines are licensed for treating ADHD in children and adults, with stimulant drugs such as methylphenidate and sometimes the newer amphetamine based medication lisdexamfetamine being prescribed. These are classified as controlled drugs due to the fact that they can be addictive and abused. Your consultant psychiatrist will only prescribe these medications if he or believes that they are the most effective option for your treatment. You will be provided with a written prescription which you can pick up at your local pharmacy. It is for a month's supply of the drug and your pharmacist will be able to explain it to you.
In certain instances, your doctor may decide that the medicines that are available to them aren't suitable for you, and may recommend an unlicensed drug. This is a decision that will be made on a case-by-case basis. Your doctor should only prescribe non-licensed drugs as a last resort. Keep in mind that while medication is an essential component of treating ADHD, talking therapy also plays a significant role. medication for inattentive adhd can change your coping mechanisms and behaviour patterns. Treatment with medication can alleviate your symptoms.
The medication used to treat ADHD in adults must be licensed in the UK with a license known as marketing authorisation (MA) which will state the specific health conditions it is approved for. This will include the ages of people who can be treated and how the medication should be taken. The MHRA will evaluate any IMP prior to its launch and the manufacturer is only permitted to promote it under their MA, except if they have a specific license to market paediatric medicines.
This is when a medication has been approved for a child but a psychiatrist believes it's appropriate to prescribe it for an adult. This is also called off label prescribing. It is also possible to create"manipulated" products - in which the pharmacist creates the formulation for a specific patient by mixing ingredients, for instance when they are unable to swallow tablets. There is an unpopularity around using unlicensed medications to treat ADHD in adults, with some psychiatrists criticising the over-prescribing of psychoactive medications for mental health problems.
Licensing
In the UK there are a variety of medicines are available to treat ADHD among adults. This includes a variety of stimulant medicines such as methylphenidate (Ritalin) and the newest amphetamine-based medication Lisdexamfetamine (Elvanse). They are usually prescribed to patients who have been diagnosed with the condition by psychiatrists. The treatment is usually prescribed in capsules and patients are closely monitored by their doctor to ensure that the right dosage is determined.
There are other methods to manage and treat the condition, in addition to medication. For instance, behavioural therapies can assist patients in understanding the causes of symptoms and develop strategies to overcome these. In addition, environmental modifications are also helpful in helping people deal with the impact of their symptoms on daily activities. This could include making seating arrangements at school or work and distributing cards that read "I Need a Break" and arranging frequent movement breaks and making sure that there is less noise and distraction.
The drugs that have been licensed in the UK to treat ADHD among adults are not intended to be a cure, but they can enhance the quality-of-life for many people. However, they are not an instant cure, and should only be used as a part of a holistic care plan that includes psychoeducation and psychiatric care.
It is essential that any patient of childbearing potential takes a pregnancy test prior to beginning medication, and that they inform their GP immediately in the event that they become pregnant or wish to become pregnant. Patients should also speak to their GP in the event of any side effects or if they don't think they are gaining.
On the 27th September 2023, a nationwide patient safety alert was issued in relation to the lack of extended-release guanfacine tablets, lisdexamfetamine tablets, and methylphenidate tablets. On May 8, 2024 a Medicine Supply Notification was issued that lifted the restrictions on prescribing Elvanse capsules.
It is a Schedule 2 controlled drug so it is prescribed by a registered practitioner and is subject to the Misuse of Drugs Regulations 2001. The guidelines recommend that an ADHD patient be assessed every year by a healthcare professional who has the expertise and experience in managing the disorder. This can be done in primary care or secondary care, based on local arrangements. This review should include monitoring of blood pressure and heart rate, a discussion on the need to continue treatment, and ongoing evaluation and monitoring of symptom improvement.
Side Effects
ADHD medication is generally well tolerated and safe by adults. However, it does not cure this condition. It can reduce behavioural symptoms and improve the quality of life for people. It can also assist with learning, work and relationships.
It is crucial that those who are beginning treatment be aware of any possible adverse effects. They should discuss them with their physician prior to taking the medication. Some side effects include headaches, insomnia and an increase in appetite. Certain medications can raise your heart rate. This is generally harmless and not harmful but it's important to tell your doctor if you have a history of heart disease or issues.
Stimulants increase levels of norepinephrine and dopamine in the brain. This alters the way the brain sends and receives messages and improves concentration and attention. They are regarded as the first line treatment for adults with ADHD. Atomoxetine and Buproprion, which are medications that do not stimulate are more complex in their action on the brain. They also take longer to begin working. The latter works by blocking dopamine reuptake in nerve cells and assists with concentration.
Research suggests that half of children diagnosed with ADHD get rid of their symptoms as they grow older. This could be due to the fact that they are able to manage their symptoms or because they are less active. A significant number of them struggle with a society that is not designed to meet their needs. That's why Nice recommends doctors prescribe ADHD medications only when they are appropriate and to keep a close eye on patients.
There are a number of other ways to help with ADHD symptoms, such as psychoeducational therapies and lifestyle changes. These therapies can be used together with medications to decrease the need to refer adults who have ADHD to specialist services.
Many adults are hesitant to reveal to their family, friends or employers that they take ADHD medication because of the stigma associated with it. There is growing evidence that talking openly about the condition can help to break down barriers for treatment.