Adult ADHD Medication in the UK
In the UK, there are guidelines to diagnose ADHD in adults. During the pandemic, the number of referrals to the adult ADHD clinic quadrupled.
Medications used to treat ADHD comprise stimulants and non-stimulants. Methylphenidate and dexamfetamine as well as lisdexamfetamine are two amphetamine-based medications that aid in managing ADHD symptoms.
Stimulants
Stimulants are the most common treatment for ADHD in adults. These drugs work by increasing the activity of brain regions that regulate behavior and attention. They are quick-acting and are often the first choice for GPs. Methylphenidate (also known as Ritalin) is the most commonly prescribed stimulant in both adults and children.
This drug boosts the levels of neurotransmitters in the brain. It improves attention span, and decreases the amount of impulsivity and hyperactivity. It also helps reduce anxiety and depression that may be associated with ADHD.
In the past, stimulant substances have been used medicinally and for recreational purposes, to enhance cognitive function, motivation, performance, and mood. These include nicotine, caffeine amphetamines and cocaine, methylphenidate, and modafinil. They also serve as appetite suppressants and energy boosters, and can have serious physical and mental adverse effects when used in excess.
There are a number of different medications that are used to treat adults suffering from ADHD, and a psychiatrist will typically carefully adjust the doses on each person they visit. They will consider any other medical conditions a patient may have, as well as the impact of the medication on their sleep patterns. They will also take into consideration the impact of medication on the patient's lifestyle and diet.
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, commonly known as Adderall is more effective than any other stimulant at reducing the symptoms of ADHD. It is recommended by NICE and is available in the UK with a prescription.
Despite positive evidence that supports the use of medications for ADHD is still viewed as a stigma. Unhelpful framings refer to it as child exploitation and the use of controlled substances. This may make some people reluctant to ask for an assessment, or to consider taking medication to treat their condition.
As the number of patients referred to NHS psychiatry grew during the COVID-19 pandemic so too did the number of adults receiving treatment for ADHD. In fact the number of adult ADHD referrals are now surpassing those for children. Boys are still more likely to receive referrals, but the number of women seeking treatment for ADHD has quadrupled over the last two years.
Unlicensed Medication
A variety of medications are approved for treating ADHD in children and adults with stimulant drugs such as methylphenidate, and occasionally the more recent amphetamine based medication lisdexamfetamine being prescribed. These are considered controlled drugs because they are susceptible to abuse and addictive. Your doctor will prescribe them if they feel they are the best choice for you as part of your treatment. You will receive an approved prescription in writing that you can get at your local pharmacy. I Am Psychiatry will explain to you that this prescription is for a monthly supply of the medication.
In certain instances your doctor might decide that the medications they offer aren't right for you and will recommend an unlicensed medication. This is an individual decision and your psychiatrist should only recommend unlicensed medication as the last option. It is important to keep in mind that, while medication is a key part of treatment for ADHD however, talking therapy is equally important. Medicine can aid in managing your symptoms, but therapy can help change longstanding negative coping mechanisms and behavior patterns.
In the UK, medication used to treat ADHD in adults must be accompanied by an authorization for marketing (MA) that outlines the specific conditions for which it is approved. This will include the age of people who can be treated and the method by which the medication should be taken. The MHRA will provide an official evaluation of any IMP before it is made available and the manufacturer is able to promote it under its MA unless it holds a special licence for paediatric medicine.
This is the situation where a drug is approved for a child but a psychiatrist feels it is appropriate to prescribe it to an adult, this is also called off label prescribing. It is also possible to have a'manipulated product' - where the pharmacist makes up an individual formulation for the patient by mixing ingredients, for instance when they are unable to swallow tablets. There's some stigmas associated with using unlicensed medications to treat ADHD in adults, with psychiatrists criticising the over-prescribing of psychoactive drugs to treat mental health issues.
Licensing
In the UK there are several medicines that are approved to treat ADHD in adults. There are several stimulant drugs, such as methylphenidate, (Ritalin) and the newest amphetamine-based medication lisdexamfetamine, (Elvanse). Typically, they are given to patients diagnosed with the condition following consultation with a psychiatrist. The treatment is prescribed in capsules, and patients must be closely monitored by their physician in order to find the appropriate dosage.
In addition to these medications, there are a number of other methods by which the disease can be managed and treated. For example, behavioural therapies can help people understand the root causes of their symptoms and devise strategies to combat these. In addition, environmental modifications can be beneficial in helping people deal with the impact of their symptoms on daily activities. This could include arranging seating arrangements at school or work, providing cards that say "I Need a Break" and arranging frequent movement breaks as well as decreasing noise and distractions.
The medicines that are licensed to treat ADHD in adults in the UK are not designed to be a cure, but can significantly improve the quality of life for many people with the condition. But, they're not a magic bullet and should only be used as a part of a holistic care plan that includes psychoeducation and psychiatric care.
Patients who are able to bear children should take an examination for pregnancy prior to taking any medication. They must also inform their GP in the event that they fall pregnant or wish to fall pregnant. It is also recommended that patients should visit their GP if they experience any significant side-effects or do not feel that they are benefiting from the medication.
On 27 September 2023, a national safety alert was issued regarding the shortage of extended-release Guanfacine tablets, lisdexamfetamine tablets, and methylphenidate tablets. On 8 May 2024, an Medicine Supply Notification was issued that lifted the prescribing restrictions on Elvanse capsules.
It is an Schedule 2 drug, so it is only prescribed by a registered doctor and is subject to the Misuse of Drugs Regulations of 2001. The guidelines recommend that an ADHD patient is evaluated every year by a healthcare professional with expertise and training in managing the disorder. This can be done in primary care or secondary care, based on local arrangements. The review should include a monitoring of blood pressure and heart rate as well as a discussion about the need for continued treatment, and ongoing monitoring and evaluation of symptoms improvements.
Side Effects
ADHD medication is safe and generally tolerated by adults, but it does not cure the condition. It can ease the symptoms of behavioural, and improve the quality of life of people. It can also help with learning, work and relationships.
It's important for anyone starting treatment to be aware of possible side effects and discuss these with their doctor before they begin taking the medication. Some side effects include headaches, sleeplessness and a change in appetite. Certain medications can raise your heart rate. It is usually harmless and mild, but it is important to tell your doctor if there's an history of heart disease or issues.
Stimulants boost the levels of dopamine and norepinephrine that are present in the brain. This changes the way the brain receives and transmits messages, improving focus and attention. These drugs are the first line treatment of adult ADHD. Buproprion and Atomoxetine which are medications that do not stimulate, have a more complex action on the brain. They also take longer to start working. The latter block dopamine reuptake by nerve cells, and aids with concentration.
According to research, approximately half of children diagnosed with ADHD will overcome their symptoms in adulthood. This could be because they are able to manage their symptoms or they are less hyperactive. However, a large portion continue to struggle in an environment that isn't designed to accommodate them. That's why Nice suggests that doctors prescribe ADHD medications only when they are appropriate and to keep monitoring patients on a regular basis.
There are many other options to treat ADHD symptoms. These include psychoeducational therapy and lifestyle changes. These can be utilized in conjunction with medication to reduce the need for doctors to refer people suffering from ADHD to specialist services.
The stigma attached to ADHD can make it difficult to open about treatment and many adults are reluctant to admit the fact that they have ADHD to their family, friends or employers. There is growing evidence that revealing the existence of the disorder can help to break down barriers for treatment.