Adult ADHD Medication in the UK
In the UK there are guidelines for diagnosing ADHD among adults. During the pandemic, referrals to the adult ADHD clinic quadrupled.
Medications used to treat ADHD include stimulants and non-stimulants. Methylphenidate is the most commonly used medication to treat the symptoms of ADHD and is accompanied by two amphetamine-based medicines known as lisdexamfetamine and dexamfetamine.
Stimulants
The most commonly used type of medication used to treat adult ADHD is stimulants. These drugs work by increasing the activity in brain areas that control attention and behavior. These are fast-acting, and are often the first choice for GPs. Methylphenidate, more commonly known as Ritalin, is the most frequently prescribed stimulant for adults and children.
This drug boosts the levels of neurotransmitters in the brain. It increases attention span, and decreases the impulsivity and hyperactivity. It also helps to reduce anxiety and depression that can be a result of ADHD.
Through time, stimulant drugs have been used medicinally and for recreational purposes, to enhance cognitive function, motivation, performance, and mood. These include caffeine, nicotine amphetamines and cocaine, modafinil, methylphenidate and others. These substances are used to control appetite and increase energy. However, they may also cause serious physical and psychological effects if taken in excess.
Iam Psychiatry will be careful to adjust the doses for each patient. They will also consider any other medical conditions that patients may have, as well as the impact of the medication on their sleeping patterns. They will also consider the effects of the medication on a patient's diet as well as lifestyle.
A massive network meta analysis, conducted by NIHR Oxford Health Biomedical Research Centre (NIHR Oxford Health Biomedical Research Centre) and Stichting Eunethydis has found that the drug lisdexamfetamine, also known as Adderall, is more effective than other stimulant at reducing the symptoms of ADHD. It is recommended by NICE and is available in the UK with a prescription.
Despite the positive evidence however, there's a stigma that surrounds the use of medications to treat ADHD, with unhelpful framings that compare it to child abuse and compare it to controlled substances. This can make many people not want to request an assessment, or to think about taking medication to treat their condition.
The number of adults treated for ADHD increased with the increase in the number referred to NHS psychiatry increased during the COVID-19 epidemic. In fact the number of adult ADHD referrals have now overtaken those for children. Boys are still more likely to be referred for ADHD treatment, but the number women receiving treatment has quadrupled over the last two years.
Unlicensed Medication
A variety of medications are licensed for treating ADHD in adults and children with stimulant drugs like methylphenidate, and occasionally the more recent amphetamine-based medication lisdexamfetamine prescribed. These are considered 'controlled' medications because they are prone to abuse and addictive. Your doctor will prescribe these drugs if he or she believes they are the most effective solution for your treatment. You will then receive an order to visit your local pharmacy and take home. The pharmacist will explain to you that this is for an ongoing supply of the medication.
In certain instances, your doctor may decide that the drugs they have available are not suitable for you and recommend an unlicensed medication. This is a choice that is made on a case-by-case basis. Your psychiatrist should only recommend non-licensed medications as a last resort. Keep in mind that while medication is an important part of treating ADHD, talking therapy also plays a significant role. Therapy can alter your coping mechanisms as well as behavior patterns. The use of medication can help manage your symptoms.
In the UK medications used to treat ADHD for adults requires a marketing authorisation (MA) that outlines the conditions under which it's approved. This includes the ages of those who can be treated and the method by which the medication should be administered. The MHRA will provide an official evaluation of any IMP before it is released and the manufacturer is able to advertise it under its MA, unless it has a special license for paediatric medicine.
This is where a medicine has been approved for children but a psychiatrist believes it is appropriate to prescribe it for an adult. This is also known as off label prescribing. It is also possible to get a'manipulated product' - where the pharmacist creates the formulation for a specific patient by mixing ingredients, for example in the event that they are unable to take tablets. There is an unpopularity around using non-licensed medications to treat ADHD in adults, with some psychiatrists criticising the over-prescribing of psychoactive drugs for mental health issues.
Licensing
In the UK There are many treatments are available to treat ADHD for adults. This includes a variety of stimulant medicines such as methylphenidate (Ritalin) and the newest amphetamine-based medicine called lisdexamfetamine (Elvanse). They are usually prescribed to patients who have been diagnosed with the condition by a psychiatrist. The treatment is typically prescribed in the form of capsules and patients are closely monitored by their physician to ensure that the right dose is found.
There are other ways to manage and treat the condition, in addition to medication. For instance, behavioural therapy can help individuals to understand the causes of their symptoms as well as come up with strategies to manage them. Environment-related changes can aid people in coping with the impact their ailments have on their day-to-day lives. This can include setting up seating arrangements at work or school, providing cards that say 'I Need a Break' and arranging frequent movement breaks as well as reducing noise and distractions.
The medications that are licensed to treat ADHD in adults in the UK are not intended as a cure, but can significantly improve the quality of life for many people who suffer from the condition. But, they're not an all-purpose cure and should only be used as part of an integrated care package that includes psychoeducation and psychiatric care.
It is important that anyone with pregnant potential undergoes an examination for pregnancy prior to starting medication and inform their GP immediately when they become pregnant or want to become pregnant. It is also recommended that patients should see their GP if they experience any significant side-effects or do not believe they are getting the benefits from the medication.
A national alert for patient safety concerning the shortage of methylphenidate extended-release tablets, guanfacine extended-release tablets, and lisdexamfetamine capsules was issued on 27 September 2023. This was replaced by a Medicine Supply Notification (MSN) on May 8, 2024. The MSN lifted prescribing restrictions for Elvanse capsules and advised ADHD services to resume initiations.
It is a Schedule 2 controlled drug so it must be prescribed by a registered doctor and is subject to the Misuse of Drugs Regulations 2001. The guidelines suggest that people suffering from ADHD is reviewed every year by a health professional who has training and experience in managing the disorder, either in primary or secondary care depending on local arrangements. This review should include a check for heart rate and blood pressure, a discussion about the continued need for treatment, and continuous evaluation of symptoms and monitoring improvement.
Side Effects
ADHD medication is generally safe and well accepted by adults, however it does not cure the condition. It can reduce behavioural symptoms and improve the quality of life for those suffering from the condition. It also helps improve the quality of work, relationships and learning.
It is important that anyone who is beginning treatment be aware of possible adverse side effects. They should discuss these with their physician prior to starting the medication. Some of the side effects include an increase in appetite, headaches or sleeplessness. Certain medications can raise your heart rate. It is usually mild and harmless but is something to mention to your doctor if you have any previous history of heart issues or cardiovascular disease.
Stimulants increase the levels of dopamine and norepinephrine in the brain. This changes the way the brain receives and sends messages, improving concentration and attention. They are considered first-line treatments for adults suffering from ADHD. Non-stimulant drugs like buproprion and atomoxetine are available, but they have more complex actions on the brain and take longer to begin working. The latter block dopamine reuptake by nerve cells and assists in the improvement of concentration.
According to research, about half of the children diagnosed with ADHD will grow out of symptoms by adulthood. This could be due to the fact that they learn to manage their symptoms or they become less hyperactive. Many of them struggle with a society not designed for their needs. This is why Nice recommends that doctors prescribe ADHD drugs only where they are necessary and keep monitoring patients on a regular basis.
There are many alternatives to treat ADHD symptoms, such as psychoeducational therapies and lifestyle changes. These therapies can be used together with medication to reduce the need to refer adults who suffer from ADHD to specialist services.
The stigma that surrounds ADHD can make it difficult to speak openly about medication and many adults are reluctant to admit that they are taking it to their family, friends or employers. There is growing evidence that revealing the existence of the disorder can help break down barriers to treatment.