Adult ADHD Medication in the UK
In the UK, there are guidelines for diagnosing ADHD among adults. During the pandemic, the number of referrals to the adult ADHD clinic quadrupled.
Both stimulants and non-stimulants are 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 popular type of medication used to treat adult ADHD is a stimulant. These drugs work by increasing the activity in brain areas that control attention and behavior. They are quick-acting and are frequently the first choice that is considered by GPs. Methylphenidate (also called Ritalin) is the most frequently prescribed stimulant in both adults and children.
This drug increases neurotransmitter levels in the brain. It increases the quality of attention, and reduces hyperactivity and impulsivity. It can also reduce depression and anxiety that can be a result of ADHD.
Through time, stimulant drugs have been used both medicinally and for recreational purposes, to enhance cognitive function, motivation, performance, and mood. understanding include nicotine and caffeine, amphetamines modafinil, methylphenidate, and cocaine. They also serve as appetite suppressants and energy boosters, and can cause significant psychological and physical negative effects when taken in excessive amounts.
A psychiatrist will carefully adjust the dosages for each patient. They will take into account any other medical conditions patients 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 patients' lifestyle and diet.
A massive meta-analysis of the network carried out by the NIHR Oxford Health Biomedical Research Centre and Stichting Eunethydis, has found that the drug Lisdexamfetamine (commonly called Adderall) is more efficient than other stimulants in decreasing symptoms of ADHD. It is recommended by NICE and is available on prescription in the UK.
Despite positive evidence, the use of medication for ADHD is still stigmatized. Falsely framed arguments compare it to child exploitation and the use of controlled substances. This may cause people to be hesitant to take a test or even think about taking medication for their condition.
As the number of people referred to NHS psychiatry grew during the COVID-19 epidemic, so too did the number of adults receiving treatment for ADHD. In fact, adult ADHD referrals have now overtaken those for children. Boys are still 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 variety of medicines that can be prescribed to treat ADHD in adults and children. These include stimulant drugs like methylphenidate, and sometimes the more recent amphetamine-based medication lisdexamfetamine. These drugs are categorized as 'controlled medications' because they can be addictive and abused. Your psychiatrist will only prescribe these drugs if he or believes that they are the most effective option for your treatment. You will then receive the prescription to take to your local pharmacy and take home. Your pharmacist will explain to you that this prescription is for an ongoing supply of the drug.
In certain instances, your doctor may decide that the medications they offer aren't right for you and will suggest a non-licensed medication. It's a case-by-case decision and your doctor should only use unlicensed medication as the last option. It is crucial to remember that, while medication is a crucial component of treatment for ADHD and ADD, therapy with a therapist is also vital. Therapy can alter your coping mechanisms as well as behavior patterns. The use of medication can help manage your symptoms.
In the UK the medication used to treat ADHD among adults must have an authorization for marketing (MA) that outlines the specific conditions under which it is approved. This will include the age of the people who are treated and how the medication should be taken. The MHRA will evaluate any IMP before its release and the manufacturer is only permitted to promote it under their MA, except if they have a specific license to market paediatric medicines.
Off label prescribing occurs when a psychiatrist believes it is appropriate to prescribe a medication for an adult even though it was approved for a child. A'manipulated product' is possible when pharmacists mix ingredients to create a formulation for a patient that is unable to take tablets. There's a stigma around the use of unlicensed drugs to treat ADHD in adults, with some psychiatrists complaining about the excessive prescribing of psychoactive drugs for mental health issues.
Licensing
In the UK there is various medications that are authorised to treat ADHD in adults. There are several stimulant drugs, such as methylphenidate, (Ritalin) and the newer amphetamine based medication lisdexamfetamine (Elvanse). Typically, these are offered to patients suffering from the condition following consultation with a psychiatrist. The treatment is prescribed as capsules and the patient must be closely monitored by their physician to determine the proper dosage.
In addition to these medications however, there are a myriad of other ways that the disease can be managed and treated. For example, behavioural therapies can help people understand the causes of symptoms and develop strategies to overcome these. In addition, environmental modifications can be beneficial in helping people deal with the effects of their symptoms in daily activities. This includes making seating arrangements at work or school or even distributing cards that say "I Need a Break" and scheduling frequent breaks for movement as well as decreasing noise and distractions.
The drugs that have been licensed in the UK to treat ADHD among adults are not intended to cure but can improve the quality-of-life for many people. They aren't a cure-all and should only be a part of a complete care package that includes psychoeducation, psychiatric treatment, and medication.
It is crucial that any patient with childbearing potential takes a pregnancy test before starting medication, and should inform their GP immediately in the event that they are pregnant or plan to become pregnant. It is also recommended that patients should visit their GP if they experience any significant side effects or do not think they are benefiting from the medication.
On 27 September 2023, a national safety alert was issued regarding the shortage of extended-release Guanfacine tablets, tablets of lisdexamfetamine and methylphenidate tablets. This was replaced by a Medicine Supply Notification (MSN) on 08 May 2024 that lifted restrictions on prescribing Elvanse capsules and urged ADHD services to resume the initiation of treatment.
It is a Schedule 2 controlled drug so it must be prescribed by an accredited physician 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 performed in primary care or secondary care, depending on the local arrangements. This review should include monitoring of blood pressure and heart rate as well as a discussion about the need to continue treatment, and ongoing evaluation and monitoring of symptom improvements.
Side Effects
ADHD medication is generally well-tolerated and is safe for adults. However, it does not cure this condition. It can help reduce symptoms of behavioural and improve the quality of life for people. It can also improve the quality of work, relationships and learning.
Having said that, it's essential for anyone who is starting treatment to be aware of possible adverse reactions and discuss them with their doctor prior to when they begin taking the medication. The side effects can include an increase in appetite, headaches or sleepiness. Some medications can also increase the heart rate. This is generally harmless and not harmful however, it is worth telling your doctor if there's a history of heart disease or heart problems.
Stimulants increase the levels of dopamine and norepinephrine in the brain. This changes the way the brain receives and sends messages, increasing concentration and attention. They are regarded as the first line treatment for adults with ADHD. Non-stimulant drugs like 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 into nerve cells and assists with concentration.
Research suggests that about half of children diagnosed with ADHD are able to overcome their symptoms in adulthood. It could be due to the fact that they manage their symptoms or perhaps because they are less active. However, a large portion struggle to cope with the society that was not specifically designed for them. This is why Nice recommends that doctors prescribe ADHD drugs only where they are needed and continue to monitor patients regularly.
There are other methods to treat ADHD symptoms. These include psychoeducational therapy and lifestyle changes. These therapies can be utilized alongside medications to decrease the need to refer adults with ADHD to specialist services.
The stigma attached to ADHD can make it difficult to 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 speaking out about the condition can help break down barriers for treatment.