Adult ADHD Medication in the UK
In the UK In the UK, the NHS has guidelines for diagnosing ADHD in adults. In the course of the pandemics, referrals to the adult ADHD clinic quadrupled.
Non-stimulants and stimulants can both be used to treat ADHD. Methylphenidate is the most common medicine to help manage symptoms of ADHD as are two amphetamine-based medicines called dexamfetamine and lisdexamfetamine.
Stimulants
The most commonly used kind of medication used to treat adult ADHD is stimulants. They work by enhancing activity in the parts of the brain that regulate the behaviour and attention. They are quick-acting and typically the first option to be that is considered by 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 the quality of attention, and reduces the amount of impulsivity and hyperactivity. It also helps to reduce depression and anxiety that may occur with ADHD.
In the past, stimulants were used to boost cognition, motivation and performance. They include nicotine and caffeine, amphetamines modafinil, methylphenidate, and cocaine. These substances are used to reduce appetite and increase energy levels. However, they may also cause severe psychological and physical effects when taken excessively.
A psychiatrist will carefully adjust the dosages for each patient. They will also consider any other medical conditions a patient may have, as well as the effects of the medication on their sleep patterns. They will also consider the effects of the medication on a patient's diet as well as lifestyle.
A massive network meta analysis carried out 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 in reducing symptoms of ADHD. It is recommended by NICE and is available in the UK on prescription.
Despite the evidence-based research, there is still some stigma that surrounds the use of medication to treat ADHD that is based on unhelpful framings that make it appear like child abuse, and even comparisons to controlled substances. This makes many reluctant to ask for an assessment or to consider taking medications to treat their condition.
As the number of referrals to NHS mental health services increased during the COVID-19 pandemic, also did the number of adults receiving treatment for ADHD. In fact, adult ADHD referrals have now surpassed those for children. Boys remain more likely to be referred, but the number of women receiving treatment for ADHD has quadrupled in the past two years.
Unlicensed Medication
A range of medicines are approved to treat ADHD in adults and children, with stimulant drugs like methylphenidate and, sometimes, the newer amphetamine-based medication lisdexamfetamine prescribed. These are considered controlled medications since they can be open to abuse and addictive. Your doctor will prescribe these medications if he or believes that they are the most effective solution for your treatment. You will then be given a prescription which you can take to your local pharmacy and take home. Your pharmacist will be able explain to you that this prescription is for a monthly supply of the drug.
In certain instances, your doctor may determine that the medications they offer aren't right for you and will recommend a medication that is not licensed. This is a choice that is made on a case-by-case basis. Your doctor should only recommend non-licensed medications as a last resort. Remember that while medication is a crucial component of treating ADHD and related disorders, therapy plays a vital role. The use of medication can help manage your symptoms, but therapy can also help you change long-standing negative coping mechanisms as well as behavioural patterns.
In the UK, medication used to treat ADHD among adults must have a marketing authorisation (MA) that outlines the specific conditions for which it's approved. This will include the age of those who can be treated and the method by which the medication is to be used. The MHRA will review any IMP prior to its launch and the manufacturer is only allowed to promote it under their MA, except if they have a specific license to market paediatric medicines.
This is the situation where a drug is approved for a child but a psychiatrist believes it may be appropriate to prescribe it for an adult. This is also called off label prescribing. It is possible to manipulate a product when a pharmacist mixes ingredients to create a formula for a patient who can't take tablets. Some psychiatrists have voiced their displeasure at the over-prescription of psychoactive medications to treat mental health problems, including ADHD.
Licensing
In the UK there is several medications that are authorised to treat ADHD in adults. There are a number stimulant medications such as methylphenidate (Ritalin) and the newer amphetamine based medication lisdexamfetamine, (Elvanse). They are typically offered to patients diagnosed with the condition following consultation with a psychiatrist. The treatment is prescribed in capsules, and the patient should be closely monitored by their doctor to determine the right dosage.
There are other ways to treat and manage the condition, aside from medication. For instance, behavioural therapy can aid patients in understanding the underlying causes of their symptoms and devise strategies to overcome these. Changes in the environment can also aid people in coping with the impact that their symptoms can have on their day-to-day lives. This can include organising seating arrangements at work or school or at home, scheduling frequent movement breaks and providing "I need a break" cards, as well as cutting down on the amount of distractions and noise.
The medicines that have been approved in the UK to treat ADHD among adults are not intended to cure but can improve the quality of life for many. However, they aren't a magic bullet and should only be used as part of a comprehensive care package that includes psychiatric treatment and psychoeducation.
Patients who are pregnant should have a pregnancy test prior to beginning any medication. They must also inform their GP when they become pregnant or want to become pregnant. Patients should also talk to their GP for any adverse effects or if they do not feel they are benefiting.
A national alert for patient safety regarding the shortage of methylphenidate prolonged-release tablets, guanfacine extended-release tablets and lisdexamfetamine capsules was released on September 27, 2023. This was replaced by an Medicine Supply Notification (MSN) on 08 May 2024 that lifted the restrictions on prescribing for Elvanse capsules and urged ADHD services to resume the initiation of treatment.
It is a Schedule 2 controlled drug so it is prescribed by an authorized doctor 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 has the expertise and experience in managing the disorder. This can be performed in primary care or secondary care, depending on the local arrangement. This review should include monitoring of heart rate and blood-pressure as well as a discussion about the need for continued treatment, and ongoing evaluation and monitoring of symptom improvement.
Side Effects
ADHD medication is generally well-tolerated and safe for adults. However, it does not cure the condition. It can help reduce symptoms of behavioural and improve the quality of life for those suffering from the condition. It can also improve the quality of work, relationships and learning.
It is crucial that anyone beginning treatment be aware of any possible adverse side effects. They should discuss these with their physician prior to taking the medication. Some side effects include headaches, sleeplessness and an increase in appetite. Some medications can increase heart rate. This is usually minor and harmless, but is worth mentioning to your doctor if there is a history of heart problems or cardiovascular disease.
Stimulants increase the levels of dopamine and norepinephrine in the brain. This alters the way that the brain receives and transmits messages, enhancing attention and focus. These are the first-line treatment of adult ADHD. Nonstimulant medications such as buproprion and atomoxetine are available, however they have more complex effects on the brain and take longer to start working. The latter works by blocking dopamine reuptake by nerve cells, and aids with concentration.
Research suggests that about 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 simply because they become less hyperactive. Many of them struggle with a society not designed to meet their needs. Nice suggests doctors prescribe ADHD medication only when they are necessary and keep track of their patients frequently.
There are other ways to treat ADHD symptoms. These include psychoeducational therapy and lifestyle changes. These therapies can be utilized together with medication to reduce the need to refer adults with ADHD to specialist services.
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