Adult ADHD Medication in the UK
In the UK, there are guidelines for diagnosing ADHD in adults. During the pandemic, the number of referrals to the adult ADHD clinic quadrupled.
The medications used to treat ADHD include stimulants and non-stimulants. Methylphenidate, dexamfetamine and Lisdexamfetamine are three amphetamine-based drugs that help manage ADHD symptoms.
Stimulants
The most common kind of medication used to treat adult ADHD is stimulants. They work by enhancing activity in the parts of the brain that regulate attention and behaviour. They are quick-acting and are frequently the first choice of GPs. Methylphenidate, more commonly known as Ritalin is the most frequently prescribed stimulant for adults as well as children.
This drug boosts the levels of neurotransmitters in the brain, thereby improving the quality of attention and reducing impulsivity and hyperactivity. It can also reduce anxiety and depression that can be a result of ADHD.
In the past, stimulant drugs were used to boost cognition, motivation and performance. These include nicotine, caffeine amphetamines, cocaine modafinil, methylphenidate and others. They are also used as appetite suppressants and energy boosters. They may cause significant psychological and physical negative effects when taken in excessive amounts.
There are many different medications that are used to treat adults suffering from ADHD and psychiatrists will usually carefully titrate the dosages for each patient they visit. They will also consider any other medical conditions a patient might have, and the effects of the medication on sleep patterns. They will also examine the effects of the medication on a patient's diet and lifestyle.
A large network meta-analysis carried out by the NIHR Oxford Health Biomedical Research Centre and Stichting Eunethydis, has found that the drug lisdexamfetamine (commonly referred to as Adderall) is more effective than other stimulants in reducing symptoms of ADHD. It is recommended by NICE and is available on prescription in the UK.
Despite the evidence-based research however, there's a stigma that surrounds the use of medication to treat ADHD that is based on unhelpful framings that compare it to child abuse and comparisons to controlled substances. This can make people hesitant to take a test or even think about taking medication for their condition.
As the number of people referred to NHS psychiatry grew during the COVID-19 pandemic, so too did the number of adults being treated for ADHD. In fact adults' ADHD referrals have now surpassed those for children. Boys remain more likely to be referred, however the number of women receiving treatment for ADHD has quadrupled over the past two years.
Unlicensed Medication
A range of medicines are approved for treating ADHD for children and adults including stimulant drugs like methylphenidate and sometimes the newer amphetamine-based medication lisdexamfetamine prescribed. These drugs are classified as controlled medications because they are addictive and abuse. Your consultant psychiatrist will only prescribe these drugs if he / she believes they are the most effective solution for your treatment. You will be given an official prescription which you can pick up at the local pharmacy. The pharmacist will explain to you that this prescription is for an ongoing supply of the medication.
In certain instances, your doctor may decide that the drugs that are available to them aren't suitable for you and suggest an unlicensed medicine. This is a decision that will be made on a case-by-case basis. Your doctor should only use nonlicensed medications as a last option. It is crucial to remember that although medication is a crucial component of treatment for ADHD however, talking therapy is also vital. Therapy can change your coping mechanisms as well as behavior patterns. The use of medication can help manage your symptoms.
In the UK, medication used to treat ADHD among adults must have a marketing authorisation (MA) that outlines the conditions under which it is approved. It will also include information about the age of those who are eligible to receive the medication and how it should be administered. The MHRA will provide an official assessment of any IMP before it is released, and the manufacturer is able to advertise it under its MA unless it holds a specific licence for paediatric medicine.
This is when a medication is approved for use by a child, however a psychiatrist decides it's appropriate to prescribe it to an adult, this is also called off label prescribing. It is also possible to get"manipulated" products - in which the pharmacist makes up an individual formulation for the patient by mixing ingredients, as in the event that they are unable to take tablets. Some psychiatrists have criticized the over-prescription of psychoactive medications to treat mental health issues, such as ADHD.
Licensing
In the UK, a number of medications are available to treat ADHD for adults. There are a number stimulant medications, including 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 psychiatrists. The treatment is usually prescribed in capsules, and patients should be closely monitored by their physician to ensure that the appropriate dose is found.
There are other ways to treat and manage the condition, in addition to medication. For instance, behavioural therapy can help people to understand the root cause of their symptoms and to develop strategies to overcome the symptoms. In addition, environmental modifications can be beneficial in helping people cope with the impact of their symptoms in daily activities. This can include organising seating arrangements at work or school, arranging for frequent breaks for movement and providing 'I need a break' cards, as well as cutting down on the amount of distractions and noise.
The medications that are licensed to treat ADHD in adults in the UK are not designed to be a cure, but they can greatly improve the quality of life of many people with the condition. They are not a cure-all and should only be a part of a comprehensive care plan that includes psychoeducation, psychiatric treatment, and medications.
Patients with childbearing capacity should have a pregnancy test prior starting 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 feel they are benefiting.
On the 27th of September, 2023, a nationwide patient safety alert was issued about the shortage of extended-release guanfacine tablets, lisdexamfetamine tablets, and methylphenidate tablets. On 8 May 2024, a Medicine Supply Notification was issued, which lifted the restrictions on prescribing Elvanse capsules.
It is a Schedule 2 controlled drug so it requires the prescription of an authorized practitioner and is subject to the Misuse of Drugs Regulations 2001. The guidelines recommend that an ADHD patient is evaluated annually by a healthcare professional who has the expertise 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 for blood pressure and heart rate, a discussion about the continued need for treatment and ongoing monitoring and evaluation of symptom improvement.
Side Effects
ADHD medication is generally well tolerated and safe for adults. However, medication for autism and adhd does not cure this condition. It can help reduce symptoms of behavioural disorder 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 side effects. They should discuss them with their doctor prior to starting the medication. The side effects can include changes in appetite, headaches or sleeplessness. Certain medications can raise your heart rate. This is usually mild and harmless, but it is worth noting to your doctor if there is a previous history of heart issues or cardiovascular disease.
Stimulants boost the levels of dopamine and norepinephrine that are present in the brain. This changes the way the brain receives and sends messages, enhancing attention and focus. These are the first-line treatment of adult ADHD. Nonstimulant medications such as buproprion and atomoxetine also available, but they perform more complex effects on the brain and take longer to begin working. The latter block dopamine reuptake by nerve cells, and aids in the improvement of concentration.
Research suggests that half of children who are diagnosed with ADHD are able to overcome their symptoms by adulthood. It could be because they manage their symptoms, or perhaps because they are less active. A large portion of them continue to struggle with a society that is not built to meet their needs. This is why Nice recommends doctors prescribe ADHD drugs only when they are appropriate and to keep a close eye on patients.
There are many alternatives to treat ADHD symptoms, including psychoeducational and lifestyle modifications. These can be used alongside medication to reduce the need for doctors to refer people suffering from ADHD to specialist services.
The stigma that surrounds ADHD can make it difficult to open about the medication. Many adults are reluctant to disclose that they are taking it to family members, friends or employers. But, there is growing evidence that discussing the disorder and promoting awareness of its symptoms can help break down barriers to treatment.