Adult ADHD Medication in the UK
In the UK, the NHS has guidelines for diagnosing ADHD in adults. The number of referrals to the adult ADHD specialist clinic quadrupled during the pandemic.
The medications used to treat ADHD include stimulants as well as non-stimulants. Methylphenidate, dexamfetamine, and lisdexamfetamine are two amphetamine-based medications which help to manage ADHD symptoms.
Stimulants
Stimulants are the most commonly used medication used to treat ADHD in adults. These drugs work by increasing the activity in the brain regions that regulate behavior and attention. They are quick-acting and are often the first choice for GPs. Methylphenidate (also known as Ritalin) is the most frequently prescribed stimulant for adults and children.
This drug boosts the levels of neurotransmitters in the brain. It improves concentration and decreases the impulsivity and hyperactivity. It can also help reduce anxiety and depression, which may co-occur with ADHD.
Throughout history, stimulant drugs have been used medicinally and recreationally, to enhance performance, motivation, cognition and mood. These include nicotine and caffeine, amphetamines modafinil, methylphenidate, and cocaine. They also serve as appetite suppressants and energy boosters, and can have serious physical and mental negative effects when taken in excessive amounts.
There are a number of different drugs used to treat adults with ADHD and psychiatrists will usually carefully titrate the doses of each patient they see. They will also consider any other medical conditions a patient may have, and the effect of the medication on their sleeping patterns. They will also examine the effects of the medication on the diet of a patient and lifestyle.
A massive network meta analysis carried out 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 any other stimulant in reducing symptoms of ADHD. It is recommended by NICE and is available for prescription in the UK.
Despite the evidence-based findings, there is still some stigma attached to the use of medications to treat ADHD and other disorders, with unhelpful frames that make it appear like child abuse and comparisons to controlled substances. This can make many people not want to request an assessment, or to consider taking medications to treat their condition.
The number of adults treated for ADHD increased as did the number referred to NHS psychiatry during the COVID-19 epidemic. In fact, adult ADHD referrals are now surpassing those for children. Boys are more likely to receive referrals, but the number of women who receive treatment for ADHD has quadrupled in the last two years.
Unlicensed Medication
A range of medicines are approved for treating ADHD in children and adults, with stimulant drugs such as methylphenidate and sometimes the newer amphetamine based medication lisdexamfetamine being prescribed. These drugs are classed as controlled drugs because they can be open to abuse and become addictive. Your consultant psychiatrist will only prescribe these medications if he or believes that they are the most effective option for your treatment. Then, you will be given a prescription which you can go to a local pharmacy and take home. The pharmacist will explain to you that this prescription is for a monthly supply of the drug.
In some cases your doctor may feel that the medicines they have available are not suitable for you and suggest an unlicensed drug. This is a choice which will be taken on an individual basis. Your doctor should only use nonlicensed medications as a last option. It is crucial to remember that although medication is a key part of treatment for ADHD and ADD, therapy with a therapist is also vital. Medicine can aid in managing your symptoms but therapy can also help you change the long-standing negative coping mechanisms and behavioural patterns.
In the UK medications used to treat ADHD for adults requires an authorization for marketing (MA) that specifies the specific conditions for which it is approved. This will include information on the age of people who can be prescribed the medication as well as the manner in which it must be administered. The MHRA will assess any IMP before its release and the manufacturer is only permitted to market it under their MA, in the event that they do not have a special license to market paediatric medications.
This is the situation where a drug has been approved for children but a psychiatrist feels it's appropriate to prescribe it for an adult. This is also known as off label prescribing. A'manipulated product' is possible when pharmacists mix ingredients to create a formulation for a patient who can't take tablets. Some psychiatrists have voiced their displeasure at the over-prescription of psychoactive drugs to treat mental health issues, including ADHD.
Licensing
In the UK, there are various medications that are licensed to treat ADHD in adults. There are many stimulant medications such as methylphenidate (Ritalin), and the more recent amphetamine-based medication lisdexamfetamine, (Elvanse). These are typically offered to patients who have been diagnosed with the condition by a psychiatrist. The treatment is typically prescribed in the form of capsules and patients are monitored carefully by their doctor to ensure that the correct dose is found.
There are other ways to treat and manage the condition, aside from medications. For previous of behavioural therapy can help individuals to understand the causes of their symptoms and to develop strategies to overcome them. Environment-related changes can help people cope with the impact their symptoms have on their day-to-day lives. This includes arranging seating arrangements at work or school and arranging for frequent movement breaks and providing 'I need a break' cards, as well as reducing the amount of distractions and noise.
The medications that are licensed to treat ADHD in adults in the UK are not intended as an effective cure, but they can significantly improve the quality of life of many people who suffer from the condition. But, they're not an all-purpose cure and should only be used as a part of a holistic care plan that includes psychiatric and psychoeducational care.
Patients who are able to bear children should take a pregnancy test prior to beginning any medication. They should also inform their GP in the event that they fall pregnant or want to become pregnant. Patients should also consult their GP for any adverse effects or if they do not think they are gaining.
A national patient safety alert concerning the shortage of methylphenidate prolonged-release tablets, guanfacine extended release tablets and lisdexamfetamine capsules was issued on 27 September 2023. It was replaced by an Medicine Supply Notification (MSN) on 08 May 2024 that lifted restrictions on prescribing Elvanse capsules and urged ADHD services to resume initiations.
It is a Schedule 2 controlled drug so it requires the prescription of an accredited physician and is subject to the Misuse of Drugs Regulations 2001. The guidelines recommend that an ADHD patient be evaluated annually by a healthcare provider who is knowledgeable and trained in managing the disorder. This can be done in primary or secondary care, depending on the local arrangements. This review should include monitoring for heart rate and blood pressure and a discussion of the ongoing need for treatment, as well as ongoing monitoring and evaluation of symptom improvement.
Side Effects
ADHD medication is generally safe and well accepted by adults, however it does not cure the condition. It can reduce symptoms of behavioural disorders and improve quality of life. It can also help with learning, work and relationships.
It is important that anyone beginning treatment be aware of possible adverse effects. They should discuss them with their doctor prior to starting the medication. Some side effects include headaches, sleeplessness and a change in appetite. Some medications can increase heart rate. This is usually not a problem and is mild, but it is important to tell your doctor if there's any history of heart disease or problems.
The effects of stimulants increase the levels dopamine and norepinephrine within the brain. This alters the way the brain receives and transmits messages, enhancing attention and focus. They are considered to be the first-line treatment for adults suffering from ADHD. Buproprion and Atomoxetine, which are nonstimulant medications are more complex in their effect on the brain. They also take longer to begin working. The latter block the reuptake of dopamine into nerve cells, which aids in concentration.
Research suggests that around half of children who are diagnosed with ADHD grow out of their symptoms by adulthood. It may be due to how they manage their symptoms or perhaps because they are less hyperactive. Many of them struggle with a world that was not built to meet their needs. This is why Nice recommends that doctors prescribe ADHD drugs only where they are needed and keep monitoring patients on a regular basis.
There are a variety of alternatives to treat ADHD symptoms, such as lifestyle changes and psychoeducational therapies. These can be utilized in conjunction with medications to decrease the need for GPs to refer adults with ADHD to specialist services.
The stigma associated with ADHD can make it difficult to open about medication and many adults are reluctant to admit the fact that they have ADHD to family members, friends or employers. There is increasing evidence that talking about the disorder and raising awareness of its symptoms can help to reduce barriers to treatment.