Adult ADHD Medication in the UK
In the UK, the NHS has guidelines for diagnosing ADHD in adults. Referrals to the adult ADHD specialist clinic quadrupled during the pandemic.
Non-stimulants and stimulants are both used to treat ADHD. Methylphenidate is the most common medication to treat the symptoms of ADHD as are two amphetamine-based drugs known as dexamfetamine and Lisdexamfetamine.
Stimulants
Stimulants are the most commonly used treatment for ADHD in adults. They increase activity in parts of the brain that regulate the behavior and attention. They are quick-acting and are frequently the first choice of GPs. Methylphenidate (also known as Ritalin) is the most commonly prescribed stimulant for adults and children.
The drug boosts neurotransmitter levels in the brain. It increases the quality of attention, and reduces the amount of impulsivity and hyperactivity. It can also reduce depression and anxiety, which may co-occur with ADHD.
In the past, stimulants were used to enhance cognitive function, motivation, and performance. These include caffeine and nicotine, amphetamines modafinil, methylphenidate, cocaine and methylphenidate. These substances are used to reduce appetite and increase energy. However, they may cause severe psychological and physical effects if taken in excess.
There are a variety of different medications used to treat adults with ADHD, and a psychiatrist will typically be careful to adjust the doses of each patient they see. They will take into account any other medical issues a patient may be suffering from, as well as the effects of the medication on their sleeping patterns. They will also look at the impact of the medication on the diet of a patient and lifestyle.
A massive meta-analysis of the network conducted by the NIHR Oxford Health Biomedical Research Centre and Stichting Eunethydis, has found that the drug lisdexamfetamine (commonly called Adderall) is more effective than other stimulants in reducing symptoms of ADHD. It is recommended by NICE and is available in the UK on prescription.
Despite the evidence-based evidence that support the use of drugs for ADHD is still stigmatized. Unhelpful framings compare it to child exploitation and controlled substances. This may make some people not want to request an assessment, or to think about taking medication to treat their condition.
The number of adult patients treated for ADHD increased with the increase in the number referred to NHS psychiatry increased during the COVID-19 epidemic. Adult ADHD referrals are now more than those for children. Boys are more likely to be referred, however the number of women who receive treatment for ADHD has quadrupled over the last two years.
Unlicensed Medication
A range of medicines are approved for treating ADHD in adults and children including stimulant drugs like methylphenidate and sometimes the newer amphetamine based medication lisdexamfetamine being prescribed. These are classified as controlled medications since they are prone to abuse and can be addictive. Your consultant psychiatrist will only prescribe them if they believe they are the best choice for you as part of your treatment. You will be given a written prescription that you can pick up at the local pharmacy. It is for a month's supply of the drug. Your pharmacist will be able to explain it to you.
In some cases your doctor might decide that the drugs they have available are not suitable for you and recommend an unlicensed medication. This is a choice which will be taken on a case-by-case basis. Your doctor should only use nonlicensed medications as a last resort. Be aware that although medication is an essential component of treating ADHD however, talking therapy also plays a vital role. The use of medication can help manage your symptoms but therapy can help change the long-standing negative coping mechanisms and behavior patterns.
Treatment for ADHD in adults must be licensed in the UK with a license known as marketing authorisation (MA) which will specify the health conditions it is approved for. This will include information about the age of those who are eligible to receive the medication and how it should be administered. medication for adhd and anxiety will evaluate any IMP prior to its release and the manufacturer is permitted to market it under their MA, except if they have a specific license to market paediatric medicines.
This is where a medicine has been approved for a child but a psychiatrist believes it may be appropriate to prescribe it for an adult, this is also called off label prescribing. It is also possible to get"manipulated products" - where the pharmacist creates the formulation for a specific patient by mixing ingredients, for instance if they can't swallow tablets. There's an unpopularity around the use of unlicensed drugs to treat ADHD in adults, with psychiatrists criticising the over-prescribing of psychoactive drugs to treat mental health issues.
Licensing
In the UK, a number of medications are available to treat ADHD in adults. This includes a range of stimulant medicines such as methylphenidate (Ritalin) and the newest amphetamine-based medicine called lisdexamfetamine (Elvanse). These are typically prescribed to patients who have been diagnosed with the condition by psychiatrists. The treatment is prescribed as capsules, and the patient should be closely monitored by their physician to determine the right dosage.
There are other options to manage and treat the condition, aside from medication. For example, behavioural therapies can help people understand the underlying causes of symptoms and develop strategies to deal with these. In addition, environmental modifications can also be useful in helping people cope with the effects of their symptoms on day-to-day activities. This can include organising seating arrangements at school or at work and arranging for frequent movement breaks and providing 'I need a break' cards, and making it easier to avoid the amount of distractions and noise.
The medications that are approved to treat ADHD in adults in the UK are not designed to be a cure, but they can greatly improve the quality of life for many people with the condition. However, they are not an all-purpose cure and should only be used as part of an integrated care package that includes psychiatric and psychoeducational care.
Patients with childbearing capacity should have an examination for pregnancy prior to beginning any medication. They should also inform their GP in the event that they fall pregnant or wish to fall pregnant. Patients should also speak to their GP in the event of any side effects or if they don't feel they are benefiting.
On the 27th September 2023, a nationwide patient safety alert was issued about the lack of extended-release guanfacine tablets, lisdexamfetamine tablets, and methylphenidate tablets. It was replaced by a Medicine Supply Notification (MSN) on 08 May 2024 that lifted restrictions on prescribing Elvanse capsules and urged ADHD services to resume the initiation of treatment.
It is a Schedule 2 controlled drug so it must be prescribed by a registered physician 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 is knowledgeable and trained in managing the disorder. This can be done in primary care or secondary care, depending on the local arrangements. This review should include monitoring for blood pressure and heart rate as well as a discussion on the ongoing need for treatment and ongoing monitoring and assessment of symptom improvement.
Side Effects
ADHD medication is generally well-tolerated and safe by adults. However, it does not cure the 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 possible side effects. They should discuss these with their physician prior to starting the medication. The side effects can include a change in appetite, headaches, and sleeplessness. Some medications can increase heart rate. It is usually mild and harmless, but it is worth noting to your doctor if you have any prior history of heart problems or cardiovascular disease.
Stimulants boost the levels of dopamine and norepinephrine within the brain. This alters the way the brain transmits and receives messages and improves concentration and attention. They are regarded as the first line treatment for adults with ADHD. Buproprion and Atomoxetine, which are non-stimulant drugs, have a more complex effect on the brain. They also take longer to begin working. The latter works by blocking the reuptake of dopamine into nerve cells and aids in concentration.
According to research, approximately half of children diagnosed with ADHD will grow out of symptoms in adulthood. This could be because they learn to manage their symptoms or they become less hyperactive. Many of them struggle with a world that was not designed for their needs. That's why Nice suggests that doctors prescribe ADHD drugs only where they are needed and continue to monitor patients regularly.
There are other ways to treat ADHD symptoms. These include lifestyle changes and psychoeducational therapy. These therapies can be utilized in conjunction with medication to reduce 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 due to the stigma associated with it. However, there is growing evidence that discussing the disorder and raising awareness of its symptoms can help reduce barriers to treatment.