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 in the course of the pandemic.
Both stimulants and non-stimulants are used to treat ADHD. Methylphenidate, dexamfetamine, and lisdexamfetamine are two amphetamine-based medications which help to manage ADHD symptoms.
Stimulants
Stimulants are among the most popular treatment for ADHD in adults. These work by increasing activity in the parts of the brain that control the behavior and attention. They are fast-acting and are frequently the first choice that is considered by GPs. Methylphenidate is also known as Ritalin, is the most widely prescribed stimulant for adults as well as children.
This drug boosts the levels of neurotransmitters in the brain. It improves the quality of attention, and reduces the impulsivity and hyperactivity. It also helps reduce anxiety and depression, which may be a co-morbidity with ADHD.
In the past, stimulants were used to improve cognition, motivation and performance. These include caffeine, nicotine, amphetamines, cocaine, methylphenidate, and modafinil. They are also used to reduce appetite and as energy boosters. They may have significant physical and psychological adverse effects when used in excess.
There are many different medications used to treat adults suffering from ADHD and psychiatrists will typically carefully adjust the dosages for each patient they see. They will take into account any other medical conditions a patient may be suffering from, as well as the effects of the medication on their sleeping patterns. They will also take into consideration the impact of medication on the patient's diet and lifestyle.
A massive meta-analysis of the network carried out by NIHR Oxford Health Biomedical Research Centre (NIHR Oxford Health Biomedical Research Centre) and Stichting Eunethydis has found that lisdexamfetamine, commonly known as Adderall is more effective than any other stimulant at reducing the symptoms of ADHD. It is recommended by NICE and is available in the UK by prescription.
Despite evidence-based research that support the use of drugs for ADHD is still viewed as a stigma. Falsely framed arguments refer to it as child exploitation and the use of controlled substances. This makes many unwilling to seek an assessment, or even to consider taking medications for their condition.
The number of adults treated for ADHD increased as did the number of people referred to NHS psychiatry during the COVID-19 epidemic. In fact adults' ADHD referrals have now overtaken those for children. Boys are more likely to be referred, however the number of women seeking treatment for ADHD has quadrupled in the last two years.
Unlicensed Medication
There are a number of medications that are 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 since they can be open to abuse and can be addictive. Your doctor will prescribe them if they think they are the most appropriate choice for you as part of your treatment. You will be given an approved prescription in writing that you can get at the local pharmacy. Your pharmacist will be able explain to you that this is for a monthly supply of the drug.
In some cases your doctor might determine that the medications they offer aren't appropriate for you and suggest a non-licensed medication. This will be an individual decision and your doctor should only use unlicensed medication as the last option. It is important to remember that even though medication is a crucial component of treatment for ADHD however, talking therapy is equally important. Therapy can change your coping mechanisms and behaviour patterns. Medication can manage your symptoms.
The medication used to treat ADHD for adults must be licensed in the UK and have a license known as marketing authorisation (MA) that will define the health conditions it's approved for. This will include information on the age of the people who can be prescribed the medication as well as the manner in which it must be taken. The MHRA will evaluate any IMP before its release and the manufacturer is only permitted to promote it under their MA, except if they have a specific license to market paediatric medications.
Off label prescribing happens when a psychiatrist feels it is appropriate to prescribe a drug for an adult even if it was originally approved for a child. It is also possible to create"manipulated products" - where the pharmacist creates the formulation for a specific patient by mixing ingredients, as in the event that they are unable to take tablets. There can be some stigmas associated with using non-licensed medications to treat ADHD in adults, with some psychiatrists expressing concern about the over-prescribing of psychoactive drugs for mental health issues.
Licensing
In adhd stimulant medication there is a range of medications that are authorised to treat ADHD in adults. This includes a variety of stimulant medicines such as methylphenidate (Ritalin) and the newer amphetamine-based drug lisdexamfetamine (Elvanse). These are typically offered to patients who have been diagnosed with the condition by a psychiatrist. The treatment is usually prescribed in the form of capsules and patients are monitored carefully by their doctor to ensure that the correct dosage is determined.
There are other methods to treat and manage the condition, in addition to medication. For example behavioural therapy can assist people to understand the root cause of their symptoms and to come up with strategies to manage them. Environment-related changes can aid people in coping with the impact that their symptoms can have on their day-to-day lives. This can include organising seating arrangements at school or at work or at home, scheduling frequent movement breaks and providing "I need a break" cards, and making it easier to avoid distractions and noise.
The drugs that have been licensed in the UK to treat ADHD in adults aren't meant to be a cure, but can improve the quality of life for a lot of people. They are not a panacea and should be used as a component of a complete care plan that includes psychoeducation, psychiatric treatment and medications.
Patients with childbearing capacity should have an examination for pregnancy prior to starting any medication. They should also inform their GP in the event that they fall pregnant or are planning to fall pregnant. Patients should also speak to their GP in the event of any adverse effects or if they do not think they are gaining.
A national alert for patient safety regarding the shortage of methylphenidate extended-release tablets, extended-release guanfacine tablets, and lisdexamfetamine capsules was issued on 27 September 2023. It was replaced by an Medicine Supply Notification (MSN) on May 8, 2024. The MSN lifted the restrictions on prescribing for Elvanse capsules and advised ADHD services to resume initiations.
It is 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 is reviewed every year by a healthcare professional with training and expertise in managing the disorder. This can be done in primary or secondary treatment based on the local arrangement. This review should include monitoring of blood pressure and heart rate, a discussion on the need for ongoing treatment, and continuous evaluation and monitoring of symptom improvement.
Side Effects
ADHD medication is generally well tolerated and safe for adults. However, it will not cure the condition. It can ease the symptoms of behavioural and improve the quality of life for those suffering from the condition. It also helps improve working, learning and relationships.
However, it's essential for anyone who is starting treatment to be aware of the potential side effects and discuss these with their doctor prior to when they begin taking the medication. Side-effects can include an increase in appetite, headaches, and sleepiness. Certain medications can raise your heart rate. It is generally harmless and not harmful, but it is important to inform your doctor if there is an history of heart disease or heart problems.
Stimulants boost the levels of dopamine and norepinephrine in the brain. This alters the way the brain receives and transmits messages, which improves attention and focus. They are considered first-line treatments for adults suffering from ADHD. Nonstimulant medications such as buproprion and atomoxetine are also available, however they have more complex actions on the brain and take longer to start working. The latter is a drug that blocks dopamine reuptake in nerve cells and assists in enhancing concentration.
Research suggests that about half of children who are diagnosed with ADHD are able to overcome their symptoms in adulthood. This may be because they develop coping skills to manage their symptoms or they become less hyperactive. However, a large portion remain in the society that was not made specifically for them. That's why Nice recommends that doctors prescribe ADHD drugs only where they are appropriate and to keep a close eye on patients.
There are other methods to treat ADHD symptoms. These include lifestyle changes and psychoeducational therapy. These can be used alongside medication to reduce the need for doctors to refer patients suffering from ADHD to specialist services.
The stigma that surrounds ADHD can make it difficult to be open about treatment and many adults are hesitant to reveal that they take it to their friends, family or employers. There is increasing evidence that speaking out about the condition can help to break down barriers to treatment.