Adult ADHD Medication in the UK
In the UK there are guidelines to diagnose ADHD among 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 is the most common medicine to help manage symptoms of ADHD and is accompanied by two amphetamine-based medications known as lisdexamfetamine and dexamfetamine.
Stimulants
The most commonly used 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 option that is considered by GPs. Methylphenidate is more commonly referred to as Ritalin is the most frequently prescribed stimulant for adults and children.
This drug boosts the levels of neurotransmitters in the brain, thereby improving the quality of attention and reducing hyperactivity and impulsivity. It can also reduce depression and anxiety that may be associated with ADHD.
In the past, stimulants were used to improve cognition, motivation, and performance. These include nicotine, caffeine amphetamines, cocaine modafinil, methylphenidate and others. They also serve for appetite suppressants and energy boosters. They can have significant physical and psychological adverse effects when used in excess.
A psychiatrist will take care to adjust the dosages for each patient. They will also consider any other medical conditions a patient might have, as well as the effect of the medication on sleep patterns. They will also take into consideration the effects of medications on the patient's diet and lifestyle.
A large network meta analysis, conducted 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 other stimulant at reducing the symptoms of ADHD. It is recommended by NICE and is available on prescription in the UK.
Despite the positive evidence, there is still some stigma that surrounds the use of medications to treat ADHD that is based on unhelpful framings that refer to it as child abuse and compare it to controlled substances. This may make some people unwilling to seek an assessment, or to consider taking medications for their condition.
As the number of people referred to NHS psychiatry grew during the COVID-19 epidemic, also did the number of adults receiving treatment for ADHD. In fact, adult ADHD referrals have now surpassed those for children. Boys are still more likely to be referred for ADHD treatment, but the number women receiving it has quadrupled in the past two years.
Unlicensed Medication
There are many medications that are prescribed to treat ADHD in adults and children. These include stimulant drugs such as methylphenidate, and occasionally the more recent amphetamine-based drug Lisdexamfetamine. These drugs are classified as controlled medications due to the fact that they can be addictive and abuse. Your doctor will prescribe them if they believe they are the best choice for you as part of your treatment. You will be provided with an approved prescription in writing that you can get at the local pharmacy. Your pharmacist will explain to you that this prescription is for a monthly supply of the drug.
In some instances, your doctor might decide that the medicines that are available to them aren't suitable for you and suggest an unlicensed medication. It's an individual decision and your psychiatrist should only prescribe unlicensed medications as the last option. Keep in mind that while medication is a crucial component of treating ADHD, talking therapy also plays a significant role. Medication can help to manage your symptoms but therapy can also help you change long-standing negative coping mechanisms as well as behaviour patterns.
Medication used to treat ADHD for adults must be licensed in the UK with a license known as marketing authorisation (MA) which will state the specific health conditions it is approved for. This will include the ages of those who can be treated and the method by which the medication should be taken. The MHRA will provide an official assessment of any IMP before it is made available and the manufacturer is able to advertise it under its MA or if it has a special license for paediatric medicine.
Off label prescribing happens when a psychiatrist believes it is appropriate to prescribe a medicine for an adult even though it was prescribed for use by a child. It is also possible to have"manipulated products" - where the pharmacist makes up a formulation for an individual patient by mixing ingredients, as in the event that they are unable to take tablets. There can be a stigma around using non-licensed medications to treat ADHD in adults, with some psychiatrists expressing concern about the over-prescribing of psychoactive medications for mental health problems.
Licensing
In the UK there are a variety of medicines are available to treat ADHD among adults. There are many stimulant medications such as methylphenidate (Ritalin) and the more recent amphetamine-based medication lisdexamfetamine (Elvanse). They are usually prescribed to patients who have been diagnosed with the condition by a psychiatrist. The treatment is given in capsules, and patients must be closely monitored by their doctor to determine the right dosage.
There are other options to manage and treat the condition, in addition to medication. For instance the use of behavioural therapy can help patients understand the cause of their symptoms as well as develop strategies to overcome the symptoms. In addition, environmental modifications are also helpful in helping people deal with the effects of their symptoms on daily activities. This can include organising seating arrangements at work or school, arranging for frequent breaks in movement, and distributing '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 intended as a cure, but they can significantly improve the quality of life of many people with the condition. They aren't a cure-all and should be used as a component of a comprehensive care package that includes psychoeducation, psychiatric treatment, and medication.
It is crucial that anyone with pregnant potential undergoes a pregnancy test prior to beginning medication and inform their GP immediately in the event that they are pregnant or plan to become pregnant. Patients should also talk to their GP if there are any adverse effects or if they don't feel they are benefiting.
A national patient safety alert regarding the shortage of methylphenidate extended-release tablets, guanfacine extended release tablets, and lisdexamfetamine capsules was issued on 27 September 2023. On May 8, 2024 a Medicine Supply Notification was issued that lifted the prescribing restrictions on Elvanse capsules.
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 anyone suffering from ADHD should be evaluated every year by a health professional with training and expertise in managing the disorder, either in primary or secondary treatment based on the local arrangement. This review should include a check for blood pressure and heart rate and a discussion of the ongoing need for treatment, and continuous monitoring and evaluation of symptom improvement.
Side Effects
ADHD medication is generally safe and well tolerated by adults, but it is not a cure for the condition. It can help reduce symptoms of behavioural disorder and improve quality of life. adhd medication can also help with learning, work and relationships.
Having said that, it's essential for anyone who is starting treatment to be aware of potential side effects and discuss these with their doctor prior to when they start taking the medicine. Some of the side effects include headaches, insomnia and an increase in appetite. Certain medications may also increase the heart rate. This is usually minor and harmless, but is worth mentioning to your doctor if you have any prior history of heart problems or cardiovascular disease.
The effects of stimulants increase the levels dopamine and norepinephrine that are present in the brain. This alters the way that the brain sends and receives messages, and increases concentration and attention. They are considered first-line treatments for adult ADHD. Buproprion and Atomoxetine, which are medications that do not stimulate have a more intricate effect on the brain. They also take longer to start working. The latter block the reuptake of dopamine into nerve cells and aids in concentration.
Research suggests that around half of children who are diagnosed with ADHD get rid of their symptoms as they grow older. This may be because they develop coping skills to manage their symptoms or they become less hyperactive. A significant number of them continue to struggle with a society not designed to meet their needs. That's why Nice recommends doctors prescribe ADHD drugs only when they are appropriate and to keep monitoring patients on a regular basis.
There are many other methods to alleviate ADHD symptoms, such as psychoeducational therapies and lifestyle changes. These therapies can be utilized alongside medication to reduce the need to refer people who suffer from ADHD to specialist services.
Many adults are reluctant to reveal to their family, friends or employers that they use ADHD medication due to the stigma that comes with it. But, there is growing evidence that talking about the condition and raising awareness of its symptoms can help reduce barriers to treatment.