Adult ADHD Medication in the UK
In the UK, the NHS has guidelines for diagnosing ADHD in adults. During the pandemic, referrals to the adult ADHD clinic quadrupled.
Both stimulants and non-stimulants are used to treat ADHD. Methylphenidate is the most commonly used medication to treat the symptoms of ADHD, along with two amphetamine-based drugs called dexamfetamine and lisdexamfetamine.
Stimulants
Stimulants are the most common medication used to treat ADHD in adults. These medications work by increasing the activity in the brain regions that control attention and behavior. They are fast-acting and are often the first option to be considered by GPs. Methylphenidate, more commonly known as Ritalin is the most widely prescribed stimulant for adults as well as children.
The drug boosts neurotransmitter levels in the brain. It improves attention span, and decreases the amount of impulsivity and hyperactivity. It also helps to reduce anxiety and depression that may be associated with ADHD.
Through time, stimulant drugs have been used both medicinally as well as recreationally to improve cognition, motivation, performance and mood. They include nicotine and caffeine amphetamines modafinil, methylphenidate, cocaine and methylphenidate. They also serve for appetite suppressants and energy boosters. They can have significant physical and psychological negative effects when taken in excess.
There are a variety of different medications used to treat adults suffering from ADHD, and a psychiatrist will usually carefully titrate the doses of each patient they see. They will also consider any other medical conditions patients may have, as well as the impact of the medication on their sleep patterns. They will also consider the effects of medication on the patients' lifestyle and diet.
A large network meta-analysis carried out by the NIHR Oxford Health Biomedical Research Centre and Stichting Eunethydis, has found that the drug called lisdexamfetamine (commonly referred to as Adderall) is more effective than other stimulants in decreasing symptoms of ADHD. It is recommended by NICE and is available in the UK on prescription.
Despite positive evidence, the use of medication for ADHD is still viewed as a stigma. Ineffective framings refer to it as child abuse and controlled substances. This can make people hesitant to seek an assessment or to even consider taking medication to treat their condition.
my response of adult patients treated for ADHD increased with the increase in the number referred to NHS psychiatrists during the COVID-19 epidemic. Adult ADHD referrals now surpass those for children. Boys are still more likely to receive ADHD treatment, but the number women who receive it has quadrupled over the last two years.
Unlicensed Medication
There are many medicines that can be prescribed to treat ADHD in children and adults. These include stimulant medications such as methylphenidate, and occasionally the more recent amphetamine-based medicine lisdexamfetamine. These drugs are classed as controlled drugs because they are prone to abuse and addictive. Your consultant psychiatrist will only prescribe these medications if he or 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. This will be for a month's supply the drug. Your pharmacist should be able explain it to you.
In certain instances your doctor might determine that the medications they offer aren't right for you and will suggest a non-licensed medication. This is a decision that will be made on an individual basis. Your psychiatrist should only use nonlicensed medications as a 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 behavior patterns. The use of medication can help manage your symptoms.
In the UK the medication used to treat ADHD for adults requires an authorization for marketing (MA) that specifies the specific conditions for which it is approved. This includes the ages of the people who are treated and the method by which the medication should be taken. The MHRA will review any IMP prior to its launch and the manufacturer is permitted to promote it under their MA, unless they have a special license to market paediatric medications.
This is when a medication has been approved for children but a psychiatrist feels it's appropriate to prescribe it for an adult. This is also called off label prescribing. It is possible to manipulate a product, where a pharmacist mixes ingredients to make a formula for a patient who can't swallow tablets. There can be a stigma around using non-licensed medications to treat ADHD in adults, with psychiatrists criticising the over-prescribing of psychoactive drugs to treat mental health issues.
Licensing
In the UK there are various medicines that are approved to treat ADHD in adults. These include a number of stimulant medicines such as methylphenidate (Ritalin) and the newest amphetamine-based medicine called lisdexamfetamine (Elvanse). Typically, these are offered to patients diagnosed with the condition after consulting with a psychiatrist. The treatment is usually prescribed in the form of capsules and patients are monitored carefully by their doctor to ensure that the appropriate dosage is determined.
In addition to these drugs however, there are a myriad of other ways that the illness can be treated and managed. For example, behavioural therapies can aid patients in understanding the root causes of their symptoms and devise strategies to deal with these. In addition, environmental modifications can also be useful in helping people to cope with the effects of their symptoms on daily activities. This could include setting up seating arrangements at work or school, providing cards that say "I Need a Break" and scheduling frequent breaks for movement and making sure that there is less noise and distraction.
The medications that are licensed to treat ADHD in adults in the UK are not intended as a cure, but they can greatly improve the quality of life of many people who suffer 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 psychoeducation and psychiatric care.
It is crucial that any patient with the potential of becoming pregnant undergoes a pregnancy test before starting medication, and that they inform their GP immediately when they become pregnant or wish to become pregnant. It is also recommended that patients consult their GP when they experience significant side-effects or do not feel that they are benefiting from the medication.
On the 27th September 2023, a national safety alert was issued in relation to the lack of extended-release guanfacine tablets, lisdexamfetamine tablets and methylphenidate tablets. This was replaced by an Medicine Supply Notification (MSN) on May 8, 2024. It lifted prescribing restrictions for Elvanse capsules and advised ADHD services to resume the initiation of treatment.
It is a Schedule 2 controlled drug so it is prescribed by an accredited doctor and is subject to the Misuse of Drugs Regulations 2001. The guidelines suggest that people suffering from ADHD should be evaluated every year by a health professional who has training and experience in managing the disorder, either in primary or secondary care based on the local arrangement. This review should include monitoring for blood pressure and heart rate, a discussion about the need for ongoing treatment and ongoing monitoring and evaluation of symptom improvement.
Side Effects
ADHD medication is safe and generally tolerated by adults, but it does not cure the condition. It can help to reduce behavioural symptoms and improve people's quality of life. It can also enhance working, learning and relationships.
Having said that, it's crucial for anyone considering treatment to be aware of possible adverse effects and to discuss them with their doctor before they start taking the medicine. Some side effects include sleeplessness, headaches and changes in appetite. Certain medications can increase heart rate. It is usually mild and harmless but is something to mention to your doctor if you have a 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 receives and transmits messages, enhancing concentration and attention. They are regarded as the first line treatment for adults with ADHD. Buproprion and Atomoxetine, which are medications that do not stimulate have a more intricate action on the brain. They also take longer to start working. The latter is a drug that blocks dopamine reuptake into nerve cells, and helps in enhancing concentration.
According to research, around half of children diagnosed with ADHD will overcome their symptoms by adulthood. It may be due to how they manage their symptoms, or because they become less active. But a significant number remain in a society which is not made specifically for them. Nice suggests doctors prescribe ADHD medication only when they are absolutely necessary and check on their patients frequently.
There are many other options to treat ADHD symptoms. These include psychoeducational therapy and lifestyle changes. These can be combined with medications to decrease 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 treatment and many adults are reluctant to disclose that they are taking it to their family, friends or employers. There is growing evidence that talking openly about the disorder can help to break down barriers to treatment.