Adult ADHD Medication in the UK
In the UK, there are guidelines to diagnose ADHD among adults. Referrals to the adult ADHD specialist clinic quadrupled in the course of the pandemic.
The medications used to treat ADHD include stimulants and non-stimulants. Methylphenidate is the most common medication to treat the symptoms of ADHD and is accompanied by two amphetamine-based medications called dexamfetamine and lisdexamfetamine.
Stimulants
The most common type of medication used to treat adult ADHD is a stimulant. These medications work by increasing the activity in brain areas that regulate attention and behavior. They are quick-acting and are often the first choice of GPs. Methylphenidate (also called Ritalin) is the most frequently prescribed stimulant in both children and adults.
This drug boosts the levels of neurotransmitters in the brain, which improves attention span and decreasing impulsivity and hyperactivity. It can also reduce anxiety and depression, which may co-occur with ADHD.
In the past, stimulant substances have been used medicinally and recreationally, to enhance performance, motivation, cognition, and mood. These include caffeine, nicotine amphetamines, cocaine methylphenidate, and modafinil. These substances are used to control appetite and increase energy. However, they may cause severe psychological and physical effects when taken excessively.
A psychiatrist will carefully adjust the dosages for each patient. They will also take into consideration any other medical issues a patient might be suffering from, and the impact of the medication on their sleep patterns. They will also look at the impact of the medication on the diet of a patient and lifestyle.
A large meta-analysis of networks conducted by the NIHR Oxford Health Biomedical Research Centre and Stichting Eunethydis, has found that the drug lisdexamfetamine (commonly known as Adderall) is more efficient than other stimulants in reducing symptoms of ADHD. It is recommended by NICE and is available in the UK by prescription.
Despite the positive evidence however, there's a stigma associated with the use of medications to treat ADHD and other disorders, with unhelpful frames that compare it to child abuse, and even comparisons to controlled substances. This can cause people to be reluctant to take a test or even consider taking medication to treat their condition.
As the number of people referred to NHS mental health services increased during the COVID-19 pandemic, as did the number of adults being treated for ADHD. In fact, adult ADHD referrals have now overtaken those for children. Boys are still more likely to receive ADHD treatment, but the number women receiving treatment has quadrupled in just the past two years.
Unlicensed Medication
There are a variety of medicines that can be prescribed to treat ADHD in adults and children. These include stimulant medications like methylphenidate and the more recent amphetamine-based medicine lisdexamfetamine. These are classified as controlled medications because they can be addictive and abused. Your consultant psychiatrist will only prescribe these drugs if he / believes that they are the most effective choice for your treatment. You will then be given the prescription to take to your local pharmacy and take home. It is for a month's worth of the drug and your pharmacist should be able explain the procedure to you.
In certain instances, your doctor may decide that the medications that are available to them aren't suitable for you, and may recommend an unlicensed medication. This is a decision which will be taken on an individual basis. Your psychiatrist should only prescribe non-licensed drugs as a last option. It is important to remember that although medication is a key part of treatment for ADHD however, talking therapy is also essential. Medication can help to manage your symptoms, but therapy can help change long-standing negative coping mechanisms as well as behavior patterns.
In the UK medications used to treat ADHD among adults must have an authorisation to market (MA) that specifies the conditions under which it's approved. best medication for adhd includes the ages of those who can be treated and how the medication should be administered. The MHRA will assess any IMP prior to its release and the manufacturer is only permitted to promote it under their MA, except if they have a specific licence to market paediatric medicines.
Off label prescribing happens when a psychiatrist believes it is appropriate to prescribe a drug for an adult, even though it was originally approved for use by a child. It is possible to manipulate a product, where a pharmacist mixes ingredients to make a formula for a patient that is unable to take tablets. Some psychiatrists have been critical of the over-prescription of psychoactive drugs to treat mental health issues, such as ADHD.
Licensing
In the UK there is various medicines that are approved to treat ADHD in adults. There are several stimulant drugs, 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 prescribed as capsules, and patients should be closely monitored by their doctor in order to find the proper dosage.
There are other options to manage and treat the condition, aside from medication. For instance, behavioural therapy can help patients understand the cause of their symptoms and to come up with strategies to manage these. Environmental modifications can also aid in reducing the impact that their symptoms can have on their day-to-day lives. This could include setting up seating arrangements at school or work and distributing cards that read "I Need a Break" and arranging frequent movement breaks and decreasing noise and distractions.
The medications that are licensed to treat ADHD in adults in the UK are not designed to be an effective cure, but they can greatly improve the quality of life of many people suffering from the condition. However, they are not an all-purpose cure and should only be used as a part of an integrated care package that includes psychiatric treatment and psychoeducation.
Patients who are able to bear children should undergo an examination for pregnancy prior to taking any medication. They must also inform their GP when they become pregnant or are planning to fall pregnant. Patients should also speak to their GP in the event of any adverse reactions or if they don't feel they are benefiting.
On 27 September 2023, a national patient safety alert was issued about the shortage of extended-release guanfacine tablets, lisdexamfetamine tablets and methylphenidate tablets. It was replaced by an Medicine Supply Notification (MSN) on 08 May 2024 that lifted prescribing restrictions for Elvanse capsules and advised ADHD services to resume initiations.
It is classified as a Schedule 2 drug, so it is only prescribed by a registered physician and is subject to the Misuse of Drugs Regulations of 2001. The guidelines recommend that anyone suffering from ADHD should be evaluated every year by a health professional who has training and experience in managing the disorder. This can be done in primary or secondary care based on the local arrangements. This review should include monitoring of blood pressure and heart rate as well as a discussion about the need for continued treatment, and continuous monitoring and evaluation of symptom improvements.
Side Effects
ADHD medication is safe and generally well accepted by adults, but it does not cure the condition. It can help reduce symptoms of behavioural and improve the quality of life of people. It can also aid in working, learning and relationships.
It is essential that those who are beginning treatment be aware of any possible adverse side effects. They should discuss them with their physician prior to starting the medication. Some side effects include sleeplessness, headaches and changes in appetite. Some medications can also increase the heart rate. This is usually minor and harmless, but it is worth noting to your doctor if you have a prior history of heart problems or cardiovascular disease.
Stimulants increase levels of dopamine and norepinephrine in the brain. This alters the way that the brain receives and transmits messages, improving attention and focus. They are regarded as the first line treatment for adults suffering from ADHD. Nonstimulant medicines like buproprion and atomoxetine are available, but they perform more complex effects on the brain and take longer to begin working. The latter is a drug that blocks dopamine reuptake in nerve cells and assists with concentration.
According to research, around half of the children diagnosed with ADHD will overcome their symptoms by adulthood. It could be because they manage their symptoms, or perhaps because they are less hyperactive. Many of them are still struggling with a society that is not designed to meet their needs. That's why Nice recommends doctors prescribe ADHD drugs only where they are necessary and keep a close eye on patients.
There are a variety of alternatives to treat ADHD symptoms, including psychoeducational and lifestyle modifications. These can be combined with medications to decrease the need for doctors to refer patients suffering from ADHD to specialist services.
Many adults are reluctant to reveal to their family, friends or employers that they are taking ADHD medication because of the stigma that surrounds it. There is increasing evidence that discussing the condition and raising awareness of its symptoms can help to break down barriers to treatment.