Adult ADHD Medication in the UK
In the UK there are guidelines to diagnose ADHD among adults. During the pandemic, referrals to the adult ADHD clinic quadrupled.
The medicines used to treat ADHD comprise stimulants and non-stimulants. Methylphenidate, dexamfetamine and Lisdexamfetamine are three amphetamine-based drugs that aid in managing ADHD symptoms.
Stimulants
Stimulants are the most common treatment for ADHD in adults. They increase the activity of parts of the brain that regulate the behavior and attention. They are quick-acting and are frequently the first choice considered by GPs. Methylphenidate is more commonly referred to as Ritalin, is the most commonly prescribed stimulant for adults as well as children.
adhd medication increases the levels of neurotransmitters in the brain, thereby improving attention span and decreasing impulsivity and hyperactivity. It also helps reduce depression and anxiety, which can co-occur with ADHD.
Through time, stimulant drugs have been used medicinally and for recreational purposes, to enhance cognitive function, motivation, performance, and mood. They include nicotine and caffeine, amphetamines modafinil, methylphenidate, cocaine and methylphenidate. These substances are used to suppress appetite and boost energy levels. However, they can also have severe psychological and physical effects if taken in excess.
There are many different drugs used to treat adults suffering from ADHD, and a psychiatrist will usually carefully titrate the dosages for each patient they see. They will consider any other medical conditions that the patient might have, and the effect of the medication on their sleep patterns. They will also consider the impact of medication on the patient's diet and 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 Lisdexamfetamine, more commonly referred to as Adderall, is more effective than other stimulant at reducing the symptoms of ADHD. a fantastic read is recommended by NICE, and it is available on prescription in the UK.
Despite the evidence-based research however, there's a stigma associated with the use of medication to treat ADHD that is based on unhelpful framings that make it appear like child abuse and comparisons to controlled substances. This may make some people unwilling to seek an assessment, or to consider taking medication for their condition.
As the number of people referred to NHS psychiatry grew during the COVID-19 pandemic as did the number of adults being treated for ADHD. In fact adults' ADHD referrals are now surpassing those for children. Boys are still more likely to receive ADHD treatment however, the number of women receiving it has quadrupled over the last two years.
Unlicensed Medication
A variety of medications are approved for treating ADHD for children and adults including stimulant drugs such as methylphenidate and sometimes the newer amphetamine-based medication lisdexamfetamine prescribed. These drugs are classified as 'controlled medications' due to the fact that they can be addictive and abused. Your psychiatrist will only prescribe these drugs if he / she believes they are the most effective option for your treatment. You will be given a written prescription that you can get at your local pharmacy. This will be for a month's supply the drug. Your pharmacist should be able to explain the procedure to you.
In certain instances, your doctor may determine that the medications they have available are not suitable for you and recommend a medication that is not licensed. This is a decision that is made on a case-by-case basis. Your doctor should only use nonlicensed medications as a last resort. Keep in mind that while medication is an essential component of treating ADHD, talking therapy also plays a significant role. Therapy can change your coping mechanisms and behaviour patterns. Treatment with medication can alleviate your symptoms.
Treatment for ADHD for adults must be licensed in the UK with a license known as marketing authorisation (MA) that will define the specific health conditions it is approved for. This will include the ages of those who can be treated and how the medication is to be used. The MHRA will review any IMP prior to its release and the manufacturer is allowed to promote it under their MA, unless they have a special licence to market paediatric medicines.
This is when a medication has been approved for a child but a psychiatrist feels it's appropriate to prescribe it for an adult, this is also called off label prescribing. A'manipulated product' is possible in the event that a pharmacist mixes ingredients to create a formulation for a patient who can't swallow tablets. Some psychiatrists have criticized the over-prescription of psychoactive drugs to treat mental health issues, including ADHD.
Licensing
In the UK there are a range of medicines that are approved to treat ADHD in adults. This includes a range of stimulant medicines such as methylphenidate (Ritalin) and the more recent amphetamine-based drug lisdexamfetamine (Elvanse). Typically, they are given to patients who have been diagnosed with the condition following consultation with a psychiatrist. The treatment is given in capsules and the patient should be closely monitored by their physician to determine the appropriate dosage.
There are other methods to manage and treat the condition, aside from medications. For instance, behavioural therapy can assist patients in understanding the causes of their symptoms and devise strategies to overcome these. Additionally, changes to the environment are also helpful in helping people deal with the effects of their symptoms in daily activities. This could include arranging seating arrangements at work or school or at home, scheduling frequent movement breaks and providing "I need a break" cards, as well as reducing distractions and noise.
The medications that are approved to treat ADHD in adults in the UK are not intended to be a cure, but they can significantly improve the quality of life of many people with the condition. They are not a cure-all and should only form part of a complete care package that includes psychoeducation, psychiatric treatment, and medication.
It is crucial that anyone with pregnant potential undergoes a pregnancy test before starting medication and inform their GP immediately in the event that they become pregnant or want to become pregnant. Patients should also speak to their GP if there are any side effects or if they do not think they are gaining.
A national alert for patient safety 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, which lifted the restrictions on prescribing Elvanse capsules.
It is a Schedule 2 controlled drug so it is prescribed by an accredited practitioner and is subject to the Misuse of Drugs Regulations 2001. The guidelines recommend that an ADHD patient is evaluated every year by a healthcare professional who is knowledgeable and trained in managing the disorder. This can be done in primary care or secondary care, depending on local arrangements. This review should include monitoring for blood pressure and heart rate, a discussion about the need for ongoing treatment, as well as ongoing monitoring and assessment of symptom improvement.
Side Effects
ADHD medication is generally well-tolerated and safe by adults. However, it will not cure this condition. It can reduce behavioural symptoms and improve people's quality of life. It can also assist with working, learning and relationships.
It's crucial for anyone considering treatment to be aware of the potential side effects and discuss these with their physician prior to when they begin taking the medication. Some of the side effects include an increase in appetite, headaches, and sleepiness. Some medications can also raise the heart rate. It is usually not a problem and is mild but it's worth telling your doctor if there's an history of heart disease or issues.
Stimulants increase the levels of dopamine and norepinephrine within the brain. This alters the way that the brain sends and receives messages, which improves concentration and attention. These drugs 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 start working. The latter is a drug that blocks dopamine reuptake by nerve cells, and aids with concentration.
Research suggests that around half of children who are diagnosed with ADHD are able to overcome their symptoms in adulthood. It may be due to how they manage their symptoms, or because they become less hyperactive. But many struggle to cope with the society that was not specifically designed specifically for them. Nice suggests doctors prescribe ADHD medication only when they are necessary and to continue to monitor their patients on a regular basis.
There are many other methods to alleviate ADHD symptoms, such as lifestyle changes and psychoeducational therapies. These can be utilized in conjunction with medications to decrease the need for GPs to refer people suffering from ADHD to specialist services.
The stigma attached to ADHD can make it difficult to be open about the medication. Many adults are hesitant to reveal that they take it to family members, friends or employers. There is increasing evidence that talking openly about the condition can help break down barriers to treatment.