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.
Non-stimulants and stimulants can both be used to treat ADHD. Methylphenidate, dexamfetamine, and lisdexamfetamine are two amphetamine-based medications which help to manage ADHD symptoms.
Stimulants
Stimulants are the most commonly used medication used to treat ADHD in adults. They increase the activity of parts of the brain responsible for the behavior and attention. They are fast-acting and are often the first choice of GPs. Methylphenidate is more commonly referred to as Ritalin is the most frequently prescribed stimulant for adults and children.
This drug increases neurotransmitter levels in the brain. It improves concentration and decreases the impulsivity and hyperactivity. It can also decrease depression and anxiety which can co-occur with ADHD.
In the past, stimulants were used to boost cognition, motivation and performance. These include nicotine and caffeine amphetamines modafinil, methylphenidate, cocaine and methylphenidate. These substances are used to reduce appetite and increase energy. However, they can also have serious physical and psychological effects if taken in excess.
There are many different drugs used to treat adults with ADHD and psychiatrists will typically be careful to adjust the doses on each person they see. They will consider any other medical issues a patient may have, and the effect of the medication on their sleeping patterns. They will also take into consideration the effects of medications 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 efficient than other stimulants in reducing symptoms of ADHD. It is recommended by NICE and is available in the UK with a prescription.
Despite the evidence-based findings however, there's a stigma associated with the use of medication to treat ADHD, with unhelpful framings that compare it to child abuse and 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 so too did the number of adults being treated for ADHD. Adult ADHD referrals now surpass those for children. Boys are still more likely to be referred for ADHD treatment however the number of women receiving treatment has quadrupled in just the past two years.
Unlicensed Medication
A range of medicines are licensed for treating ADHD in adults and children, with stimulant drugs like methylphenidate and sometimes the newer amphetamine-based drug lisdexamfetamine being prescribed. These are classified as controlled drugs because they are susceptible to abuse and addictive. Your doctor will prescribe them if they think they are the most appropriate choice for you as part of your treatment. You will then be given an order to visit your local pharmacy and pick up. This will be for a month's supply the drug. Your pharmacist should be able to explain the procedure to you.
In some instances, your doctor may decide that the medicines available to them are not suitable for you and recommend an unlicensed medication. This is a choice that will be made on an individual basis. Your doctor should only use nonlicensed medications as a last resort. Be aware that although medication is a crucial component of treating ADHD and related disorders, therapy plays a crucial role. Medication can help to manage your symptoms but therapy can also help you change long-standing negative coping mechanisms as well as behavioural patterns.
In the UK medications used to treat ADHD among adults must have an authorization for marketing (MA) that specifies the conditions under which it is approved. This will include information about the age of people who are eligible to receive the medication and the method by which it should be taken. The MHRA will provide an official evaluation of any IMP before it is released, and the manufacturer can only advertise it under its MA, unless it has a specific license for paediatric medicine.
This is the situation where a drug 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. A "manipulated product" is a possibility in the event that a pharmacist mixes ingredients to create a formulation for a patient who is unable to take tablets. There's some stigmas associated with the use of unlicensed drugs to treat ADHD in adults, with psychiatrists complaining about the excessive prescribing of psychoactive drugs to treat mental health problems.
Licensing
In the UK there is various medications that are authorised to treat ADHD in adults. This includes a variety of stimulant medicines such as methylphenidate (Ritalin) and the more recent amphetamine-based medicine Lisdexamfetamine (Elvanse). These are typically prescribed to patients who have been diagnosed with the condition by a psychiatrist. The treatment is given in capsules and the patient must be closely monitored by their physician to determine the right dosage.
In addition to these drugs however, there are a myriad of other methods by which the disease can be treated and managed. For example the use of behavioural therapy can help individuals to understand the causes of their symptoms as well as come up with strategies to manage them. In addition, environmental modifications can also be useful in helping people deal with the effects of their symptoms in daily activities. This includes making seating arrangements at work or at school and distributing cards that read 'I Need a Break' and scheduling frequent breaks for movement as well as making sure that there is less noise and distraction.
The medications that have been licensed in the UK to treat ADHD in adults aren't intended to cure, but they can enhance the quality of life for many. They are not a panacea and should only be a part of a complete care plan that includes psychoeducation, psychiatric treatment and medications.
Patients who are able to bear children should take a pregnancy test prior to taking any medication. They should also inform their GP if they fall pregnant or want to become pregnant. It is also recommended that patients visit their GP if they experience any significant side-effects or do not believe they are getting the benefits from the medication.
A national patient safety alert concerning the shortage of methylphenidate prolonged-release tablets, guanfacine extended release tablets, and lisdexamfetamine capsules was issued on 27 September 2023. On May 8, 2024, an Medicine Supply Notification was issued, which lifted the restrictions on prescribing Elvanse capsules.
adhd stimulant medication is an Schedule 2 drug, so it is only prescribed by a licensed physician and is subject to the Misuse of Drugs Regulations of 2001. The guidelines suggest that a person with ADHD should be reviewed every year by a health professional with training and expertise in managing the disorder, whether in primary or secondary care based on the local arrangements. This review should include monitoring for heart rate and blood pressure, a discussion about the need for ongoing treatment, and continuous evaluation of symptoms and monitoring improvement.
Side Effects
ADHD medication is safe and generally well accepted by adults, but it doesn't cure the condition. It can help reduce symptoms of behavioural and improve the quality of life for people. It can also help with working, learning and relationships.
It is crucial that anyone who is beginning treatment be aware of possible side effects. They should discuss them with their physician prior to beginning the medication. Side-effects can include an increase in appetite, headaches, and sleeplessness. Some medications can also raise the heart rate. It is usually mild and harmless, but it is something to mention to your doctor if there is a 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 the brain processes and transmits messages, enhancing concentration and attention. They are considered first-line treatments for adults suffering from ADHD. Buproprion and Atomoxetine, which are non-stimulant drugs, have a more complex effect on the brain. They also take longer to begin working. The latter works by blocking the reuptake of dopamine by nerve cells and helps with concentration.
Research suggests that around half of children who are diagnosed with ADHD get rid of their symptoms by adulthood. It could be due to the fact that they manage their symptoms or simply because they become less active. A significant number of them continue to struggle with a society that is not designed to meet their needs. Nice recommends that doctors prescribe ADHD medication only when they are needed and to continue to check on their patients frequently.
There are a variety of other ways to help with ADHD symptoms, such as lifestyle changes and psychoeducational therapies. These therapies can be used together with medications to decrease the need to refer adults who suffer from ADHD to specialist services.
Many adults are hesitant to reveal to their family, friends or employers that they take ADHD medication because of the stigma that comes with it. There is growing evidence that talking openly about the disorder can help to break down barriers to treatment.