ADHD Medication For Adults in the UK
In the UK, a number of medicines are licensed to treat ADHD. This includes the stimulant methylphenidate and the amphetamine based medication lisdexamfetamine. The precise dose needs to be monitored closely during the early stages of treatment (titration) and then stable prescriptions will be administered by your GP as part of a shared care' arrangement.
What is a Licensed Medication?
A medicine that is licensed has undergone all the appropriate clinical studies and tests, and the MHRA (Medicines and Healthcare Products Regulatory Authority) has given it the go ahead for use in Great Britain. The medication will also be clearly identified as being suitable for specific conditions on its packaging or in the leaflet that is included with it. All licensed medicines are subject to rigorous regulation, even after they are on the market. This allows problems to be detected quickly and risks to be reduced.
Unlicensed medicines are often prescribed to patients with ADHD however, they are not often prescribed to adolescents or children. The unlicensed medication could be prescribed for other conditions which have been found to work well with it (known as off-label prescribing), or it might be a particular formulation that isn't yet on the market, such as an oral liquid in place of tablets or something free from certain additives. It could be an experimental medicine that is being evaluated in the UK.
Experimental drugs are known as Investigational Medicinal Products (IMPs) or Medicines with a Marketing Authorisation (MIA)(IMP). These medications are not yet approved and can only be purchased through a prescription from a doctor. The MHRA will have conducted a formal evaluation as part of the Early Access to Medicines Scheme.
There is one non stimulant medication that is commonly prescribed for ADHD in the UK and Europe and that is atomoxetine. This is a selective noradrenaline-reuptake inhibitor, and therefore is different from other ADHD medications. It increases the amount of noradrenaline in the brain which is a type of chemical that transmits messages between nerve cells, which improves concentration and helps control impulses. It is usually taken as a capsule once or twice per day.
Only a psychiatrist can diagnose ADHD and prescribe medication for adults. It is crucial to understand that ADHD isn't just a condition that can be treated by medication alone, and therapy is often incorporated into treatment plans for people suffering from the condition. This may include psychoeducation, which helps teens, children and adults understand their diagnosis, as well as behavioural therapy, which teaches strategies to manage symptoms.
What is an unlicensed drug?
The term 'unlicensed medicine' refers to any medicine that has not been granted a licence by MHRA. It could be that the medicine was not developed by a company based in the UK or it was prescribed outside of the licence conditions (off-label). The GMC's guidelines state that 'unlicensed drugs are generally used when a suitably licensed product isn't readily available or a clinically effective treatment can't be found using the drug with which the prescriber feels at ease'.
The label of a medicine will include the conditions it treats, and the ages it can be administered to. It will also indicate how it should be used and by whom. The MHRA will only grant a licence if the drug is considered to be safe and effective for the use, which is built on research in medical science and clinical trials. The drug's manufacturers are not permitted to promote or advertise any use that isn't covered by the licence.
In the UK, it is not illegal to let medical professionals to prescribe an unlicensed medication provided that the patient is aware of the potential risks and benefits. They must keep records of the use of medications that are not licensed and give the patient enough information to make an informed choice regarding whether or not they wish to take it.
Hospitals are more likely to offer unlicensed medicines due to their more experiences with them than GP surgeries. The hospital will have procedures in place to ensure the safety of the medication, including keeping detailed patient records and making sure that any adverse effects are recorded. They must also adhere to the MHRA's guidelines for the safe supply of non-licensed medicines.
Doctors who prescribe specials have to be transparent with patients and their parents or carers about the nature of the medication, why it is being used, and the possible negative side consequences. They should be able answer any questions and provide written information on any medication they prescribe, as well as the reasons for it.
What is a Shared-Care agreement?
As the number of adults who are suspected to have ADHD has increased in recent years so have requests to be referred for an NHS assessment and to receive medication for the condition. The waiting lists for NHS assessments can be long and a lot of patients choose to pay privately for ADHD assessments in specialist private clinics. It is hoped that once a diagnosis has been confirmed by this process, the GP will sign a shared care agreement (SCA).
A SCA is an agreement between your psychiatrist and your GP where the responsibility of prescribing, monitoring and the basic health checks for medicines is transferred to your GP. It is a well-known and accepted method of shifting the responsibility of managing ADHD patients from a specialist clinic or hospital to general practice.
These SCA guidelines should be agreed between the doctor and the GP before responsibility is passed over, and this should be clearly stated on any referral form. It should also be clarified that the GP remains responsible for continuous monitoring and titration of the medication.
Unfortunately, a lot of GPs are reluctant to accept SCAs. It is not because they lack desire however, it is because the work involved in SCAs isn't part of their regular funding.
The GP should be provided with adequate information regarding the motivation behind SCA and what the expectations of both parties are, including the roles of the patient and their carer. It should be made clear that the decision to go ahead with SCA must be made by the physician who initiated treatment. The GP should be informed if the patient is not willing to participate in SCA.
If a doctor doesn't wish to take on the responsibility of SCA they may choose not to do so, but this could result in patients being sent back to the private ADHD assessment clinic and psychiatrist who carried out their initial diagnosis. This can lead to medication prescriptions being issued privately, instead of through the NHS. This could be more costly.
What is a Titration Period?
The tration phase is an important step in finding the right medication to manage your ADHD. It is the process of gradually increasing your dose until you reach a dose that maximises the benefits of your medication while minimizing negative side effects. It takes time, but your healthcare professional should work closely with you to ensure that the titration process goes as smooth as is possible.
Some patients may experience an increase in their symptoms during the titration phase. People who are hyperactive, like can become agitated and angry. It is crucial to let loved ones know of any changes in behavior and offer support. To reduce the side effects from ADHD medications it is crucial to maintain a healthy lifestyle and a regular sleep schedule.
Medication is not the only treatment for ADHD however it is usually recommended as the first option for treatment for adults. Talk therapy can be beneficial in addressing anxiety and depression, which can be the cause of some symptoms of ADHD. It is crucial to remember that medication is only able to treat the symptoms, not change long-standing negative coping mechanisms. Some patients prefer not to take meds in the first place and instead focus on self-help treatments such as nutrition, exercise as well as stress reduction and sleep strategies.
It is important to understand the adverse effects and how they will affect your body. Certain medications can cause headaches or drowsiness and also reduce appetite. Always use your medication according to the instructions and consult your doctor for any adverse effects that occur.
Currently, many of the medications used for treating adult ADHD are in short supply. This has led to delays in the diagnosis process and a backlog in appointments with psychiatrists. NHS England has created a taskforce to study the issue and make recommendations on how to cut down the time it takes to get medication.
Despite over the counter adhd medication of certain popular medications, it is still possible to receive ADHD treatment through the NHS and it's worth speaking with your local GP about the options available to you. You might be able to get the same medication privately or they might suggest alternative medications that have similar results.