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 include stimulants as well as non-stimulants. Methylphenidate, dexamfetamine and Lisdexamfetamine are three amphetamine-based drugs that help manage ADHD symptoms.
Stimulants
Stimulants are the most common treatment for ADHD in adults. They increase activity in parts of the brain responsible for attention and behaviour. They are quick-acting and often the first option considered by GPs. Methylphenidate (also known as Ritalin) is the most commonly prescribed stimulant for adults and children.
The drug boosts neurotransmitter levels in the brain. It increases attention span, and decreases the impulsivity and hyperactivity. It also helps reduce depression and anxiety that may occur with ADHD.
In the past, stimulant drugs were used to enhance cognitive function, motivation, and performance. They include caffeine, nicotine amphetamines, cocaine modafinil, methylphenidate and others. These substances are used to reduce appetite and boost energy. However, they can also cause serious physical and psychological effects if taken in excess.
A psychiatrist will be careful to adjust the dosages for each patient. They will take into account any other medical conditions that patients may have, as well as the impact of the medication on their sleeping patterns. They will also look at the effects of the medication on the diet of a patient and lifestyle.
A large 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 any other stimulant in reducing symptoms of ADHD. It is recommended by NICE and is available on prescription in the UK.
Despite the positive evidence that supports it, there is a certain stigma attached to the use of medications to treat ADHD, with unhelpful framings that refer to it as child abuse and comparisons to controlled substances. This may make some people unwilling to seek an assessment, or to consider taking medication to treat their condition.
As the number of people referred to NHS mental health services increased during the COVID-19 pandemic as did the number of adults being treated for ADHD. Adult ADHD referrals are now more than those for children. Boys are still more likely to be referred for ADHD treatment, but the number women receiving it has quadrupled in just 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, sometimes, the newer amphetamine based medication lisdexamfetamine being prescribed. These drugs are classed as controlled medications since they are susceptible to abuse and can be addictive. Your doctor will prescribe them if they believe they are the best option for you as part of your treatment. You will then be given an order to visit your local pharmacy and take home. This will be for a month's supply the medication and your pharmacist should be able to explain the procedure to you.
In some instances, your doctor might decide that the medicines they have available are not suitable for you and recommend an unlicensed medication. This is a choice that will be made on an individual basis. Your doctor should only recommend non-licensed medications as a last resort. It is crucial to remember that even though medication is an integral part of treatment for ADHD however, talking therapy is equally important. Therapy can change your coping mechanisms and behaviour patterns. The use of medication can help manage your symptoms.
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 health conditions it is approved for. This will include the age 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 permitted to promote it under their MA, in the event that they do not have a special licence to market paediatric medicines.
Off uk adhd medication prescribing occurs when a psychiatrist believes that it is appropriate to prescribe a drug for an adult even though it was originally approved for use by a child. A "manipulated product" is a possibility when pharmacists mix ingredients to create a formulation for a patient who is unable to swallow tablets. There's a stigma around using non-licensed medications to treat ADHD in adults, with psychiatrists criticising the over-prescribing of psychoactive drugs for mental health problems.
Licensing
In the UK, a number of medications are available to treat ADHD in adults. There are a number 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 a psychiatrist. The treatment is prescribed in capsules, and patients should be closely monitored by their doctor to determine the proper dosage.
There are other options to treat and manage the condition, aside from medications. For example behavioural therapy can assist people to understand the root cause of their symptoms and to create strategies to combat these. Environment-related changes can aid people in coping with the impact that their symptoms can affect their daily lives. This includes setting up seating arrangements at work or at school or even distributing cards that say "I Need a Break" and arranging frequent movement breaks and reducing noise and distractions.
The medications that are approved to treat ADHD in adults in the UK are not designed to be a cure, but can greatly improve the quality of life for many people suffering from the condition. However, they aren't an instant cure, and should only be used as a part of an integrated care package that includes psychiatric and psychoeducational care.
It is crucial that any patient of childbearing potential takes a pregnancy test before starting medication, and that they inform their GP immediately if they become pregnant or want to become pregnant. It is also recommended that patients should see their GP when they experience significant side effects or do not believe they are getting the benefits from the medication.
On the 27th 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 with an Medicine Supply Notification (MSN) on May 8, 2024. The MSN lifted prescribing restrictions for Elvanse capsules and advised ADHD services to resume the initiation of treatment.
It is an Schedule 2 drug, so it is only prescribed by a licensed physician and is subject to the Misuse of Drugs Regulations of 2001. The guidelines suggest that a person with ADHD is reviewed every year by a healthcare professional who has training and experience in managing the disorder. This can be done in primary or secondary care depending on the local arrangement. This review should include a check for heart rate and blood pressure, a discussion about the ongoing need for treatment, as well as ongoing monitoring and evaluation of symptom improvement.
Side Effects
ADHD medication is safe and generally well accepted by adults, however it doesn't cure the condition. It can reduce behavioural symptoms and improve the quality of life for people. It can also enhance the quality of work, relationships and learning.
Having said that, it's essential for anyone who is starting treatment to be aware of possible side effects and discuss these with their doctor prior to when they start taking the medicine. Some of the side effects include changes in appetite, headaches or sleeplessness. Certain medications can raise your heart rate. This is generally harmless and not harmful but it's important to tell your doctor if there's a history of heart disease or heart problems.
Stimulants boost levels of dopamine and norepinephrine in the brain. This alters the way the brain transmits and receives messages, and increases focus and attention. These drugs are the first line treatment of adult ADHD. Non-stimulant drugs like buproprion and atomoxetine also available, but they perform more complex actions on the brain and take longer to begin working. The latter works by blocking the reuptake and release of dopamine into nerve cells, which aids in concentration.
According to research, about half of the children diagnosed with ADHD will overcome their symptoms by adulthood. It may be due to how they manage their symptoms or because they become less hyperactive. But many continue to struggle in a society which is not made specifically for them. This is why Nice suggests that doctors prescribe ADHD drugs only when they are necessary and continue to monitor patients regularly.
There are many other options to treat ADHD symptoms. These include psychoeducational therapy and lifestyle changes. These can be used alongside medications to decrease the need for doctors to refer adults with ADHD to specialist services.
The stigma associated with ADHD can make it difficult to be open about medication and many adults are reluctant to disclose that they are taking it to their family, friends or employers. There is increasing evidence that talking about the disorder and raising awareness of its symptoms can help to overcome barriers to treatment.