Adult ADHD Medication in the UK
In the UK there are guidelines to diagnose ADHD among adults. Referrals to the adult ADHD specialist clinic quadrupled in the course of the pandemic.
Non-stimulants and stimulants are both used to treat ADHD. Methylphenidate is the most common medication used to treat symptoms of ADHD, along with two amphetamine-based drugs known as lisdexamfetamine and dexamfetamine.
Stimulants
The most popular type of medication used to treat adult ADHD is a stimulant. These drugs work by increasing the activity in brain areas that regulate behavior and attention. They are quick-acting and are frequently the first choice of GPs. Methylphenidate, more commonly known as Ritalin, is the most frequently prescribed stimulant for adults as well as children.
This drug boosts the levels of neurotransmitters in the brain. It improves attention span, and decreases the impulsivity and hyperactivity. It can also help reduce anxiety and depression, which may be a co-morbidity with ADHD.
In the past, stimulants were used to enhance cognition, motivation, and performance. They include nicotine, caffeine amphetamines, cocaine modafinil and methylphenidate. They also serve for appetite suppressants and energy boosters. They can have serious physical and mental side effects when taken in excessive amounts.
There are a variety of different drugs used to treat adults suffering from ADHD, and a psychiatrist will typically be careful to adjust the dosages for each patient they see. They will also take into consideration any other medical issues a patient might have, and the effects of the medication on sleep patterns. treating adhd without medication will also look at the impact of the medication on the diet of a patient and lifestyle.
A large network meta analysis carried out 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 any other stimulant at reducing the symptoms of ADHD. It is recommended by NICE, and it is available for prescription in the UK.
Despite evidence-based research that supports the use of medications for ADHD is still viewed as a stigma. Unhelpful framings compare it to child exploitation and controlled substances. This makes many not want to request an assessment or to think about taking medication 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 being treated for ADHD. Adult ADHD referrals now outnumber those for children. Boys remain more likely to be referred, but the number of women seeking treatment for ADHD has quadrupled in the last two years.
Unlicensed Medication
There are a number of medications that are prescribed to treat ADHD in both adults and children. These include stimulant medications like methylphenidate, and sometimes the more recent amphetamine-based medication called lisdexamfetamine. These are classified as controlled medications because they can be addictive and abused. Your doctor will prescribe them if they feel they are the best option for you as part of your treatment. You will be given an official prescription which you can pick up at your local pharmacy. Your pharmacist will explain to you that this is for a monthly supply of medication.
In some cases your doctor might decide that the medications available to them are not suitable for you, and may recommend an unlicensed medication. It's an individual decision, and your doctor should only prescribe unlicensed medications as an option last resort. Keep in mind that while medication is a crucial component of treating ADHD and related disorders, therapy plays a vital role. Therapy can change your coping mechanisms as well as behavior patterns. Medication can manage your symptoms.
The medication used to treat ADHD in adults has to be licensed in the UK with a license known as marketing authorisation (MA) that will define the specific health conditions it's approved for. This includes the ages of people who can be treated and how the medication is to be used. The MHRA will provide an official evaluation of any IMP before it is made available and the manufacturer can only promote it under its MA or if it has an exclusive license for paediatric medicine.
This is where a medicine has been approved for use by a child, but a psychiatrist feels it's appropriate to prescribe it for an adult. This is also known as off label prescribing. A'manipulated product' is possible in the event that a pharmacist mixes ingredients to make a formula for a patient who is unable to take tablets. There is some stigmas associated with using unlicensed medications to treat ADHD in adults, with some psychiatrists expressing concern about the over-prescribing of psychoactive drugs to treat mental health issues.
Licensing
In the UK, a number of medications are available to treat ADHD for adults. These include a number of stimulant medications, including methylphenidate (Ritalin) and the newest amphetamine-based medication lisdexamfetamine (Elvanse). They are usually prescribed to patients who have been diagnosed with the condition by psychiatrists. The treatment is typically prescribed in capsules and patients are closely monitored by their physician to ensure that the correct dose is found.
There are other options to treat and manage the illness, in addition to medication. For instance, behavioural therapy can assist patients in understanding the underlying causes of their symptoms and devise strategies to combat these. Environment-related changes can help people cope with the impact their symptoms affect their daily lives. This includes arranging seating arrangements at school or at work and arranging for frequent movement breaks and providing 'I need a break' cards, and cutting down on distractions and noise.
The medicines that have been approved by the UK to treat ADHD in adults aren't meant to be a cure but can improve the quality of life for many. They aren't a cure-all and should only be a part of a complete care package that includes psychoeducation, psychiatric treatment, and medications.
Patients with childbearing capacity should have an examination for pregnancy prior to taking any medication. They should also inform their GP in the event that they fall pregnant or want to become pregnant. Patients should also talk to their GP for any adverse effects or if they do not think they are gaining.
On the 27th of September, 2023, a national patient safety alert was issued about the shortage of extended-release Guanfacine tablets, tablets of lisdexamfetamine and methylphenidate tablets. On 8 May 2024, an Medicine Supply Notification was issued, which lifted the restrictions on prescribing Elvanse capsules.
It is a Schedule 2 drug, so it can only be prescribed by a registered physician and is subject to the Misuse of Drugs Regulations of 2001. The guidelines recommend that people suffering from ADHD should be reviewed every year by a health expert with experience and training in managing the disorder, either in primary or secondary treatment based on local arrangements. The review should include a monitoring of heart rate and blood-pressure, a discussion on the need to continue treatment, and ongoing evaluation and monitoring of symptom improvements.
Side Effects
ADHD medication is safe and generally well accepted by adults, however it is not a cure for the condition. It can help to reduce symptoms of behavioural disorders and improve quality of life. It can also assist with learning, work and relationships.
However, it's important for anyone starting treatment to be aware of potential adverse reactions and discuss them with their doctor before they begin taking the medication. The side effects can include changes in appetite, headaches or sleepiness. Certain medications can increase heart rate. It is usually mild and harmless but is worth noting to your doctor if you have a history of heart problems or cardiovascular disease.
The effects of stimulants increase the levels dopamine and norepinephrine in the brain. This alters the way that the brain receives and transmits messages, increasing attention and focus. They are considered to be the first-line treatment for adult ADHD. Atomoxetine and Buproprion, which are medications that do not stimulate have a more intricate action on the brain. They also take longer to start working. The latter works by blocking dopamine reuptake into nerve cells, and helps in enhancing concentration.
According to research, about half of children diagnosed with ADHD will overcome their symptoms by adulthood. This may be because they learn to manage their symptoms, or because they are less active. But many continue to struggle in an environment that isn't specifically designed specifically for them. This is why Nice recommends doctors prescribe ADHD drugs only when they are appropriate and to keep a close eye on patients.
There are other ways to treat ADHD symptoms. These include lifestyle changes and psychoeducational therapy. These therapies can be used together with medication to lessen the need to refer people who have ADHD to specialist services.
The stigma that surrounds ADHD can make it difficult to speak openly about the medication. Many adults are reluctant to disclose the fact that they have ADHD to their friends, family or employers. There is increasing evidence that talking about the disorder and promoting awareness of its symptoms can help to overcome barriers to treatment.