ADHD Medication For Adults in the UK
In the UK there are a variety of medications that are approved for treating ADHD. The stimulant methylphenidate and the amphetamine-based drug lisdexamfetamine, are two of the most commonly prescribed medications. The dosage will be carefully checked in the initial stages of treatment.
What is an Licensed Medication (L.M.)?
A licensed medicine has gone through all of the necessary tests and clinical trials, and the MHRA the Medicines and Healthcare Products Regulatory Authority (MHRA) has given the go ahead for its use in Great Britain. The packaging of the medicine or the leaflet that comes along with it will clearly indicate whether it is suitable for a specific condition. All licensed medicines are regulated even after they've been placed on the market, meaning that any problems can be spotted quickly and any risks reduced.
Some people with ADHD may be prescribed medications that are not licensed, but these are rarely used for teenagers and children. The medication that is not licensed may be used to treat other conditions which have been found to work well with it (known as off-label prescribing) or it could be a particular formulation that isn't available on the market, such as an oral liquid instead of a tablet or something free from certain additives. It could also be an experimental drug currently being evaluated in the UK.
Experimental drugs are referred to as Investigational Medicinal Products (IMPs) or Medicines with a Marketing Authorisation (MIA)(IMP). These medicines have not been granted a licence yet and can therefore only be sold on an order from a doctor. They will have undergone an official assessment by the MHRA as part of the Early Access to Medicines Scheme (EAMS) and so the quality of pharmaceuticals is guaranteed.
There is one non stimulant medication that is often prescribed for ADHD in the UK and Europe, and this is atomoxetine. This medication is a specific inhibitor of noradrenaline uptake and therefore works in a different way than other ADHD medications. It increases noradrenaline, which is a chemical that aids in transmitting messages between brain cells. This helps improve concentration and also helps control impulses. It is usually taken in capsules once or twice a day.
Only psychiatrists are able to diagnose ADHD and prescribe medication for adults. It is important to keep in mind that ADHD isn't just a disorder that can be treated through medication alone. Therapy is often included in treatment plans. Psychoeducation is a form of therapy which aids adolescents, children, and adults comprehend their diagnosis, as well as behavioural therapy, which teaches techniques to manage symptoms.
What is an Unlicensed Medication?
The term 'unlicensed medicines' refers to medications that have not been approved by the MHRA. It could be that the drug was not developed by a UK-based company or it was prescribed in violation of the terms of licence (off-label). The GMC's guidelines say that 'unlicensed medicine is usually used when a suitable licensed product is not available, or when a clinically-effective treatment cannot be found using the product the prescriber feels most comfortable using'.
A medical license will specify the conditions it treats and the ages of patients it can be administered to. The licence will also state the manner and method by which the medicine is to be administered. The MHRA only grants a license only if it is safe and effective for that specific use, based upon clinical trials and medical research. The drug's manufacturers are not allowed to promote or advertise any use that is not covered by the licence.
In the UK, it is not a crime to let medical professionals to prescribe an unlicensed drug provided that the patient is informed of the risks and benefits. They must keep records of the use of non-licensed medications and provide the patient sufficient information to help them make a decision.
The majority of unlicensed medications are administered in hospitals, as there is more experience of using these medications than in GP clinics. The hospital will have procedures in place to ensure the security of the medication, including keeping accurate patient records and ensuring that any adverse reactions are documented. They will also have to adhere to the MHRA's guidelines on the safe supply of unlicensed medicines.
Specials are prescribed by doctors who must communicate with their patients, parents or caregivers about the medicine, its purpose and any possible adverse effects. They must be able answer any questions that they are asked and must always provide written information about the medicine they prescribe as well as the reasons for it.
What is a Shared Care Agreement?
In recent years as the number of adults who are suspected of having ADHD increased, so did the requests for referrals to the NHS for an assessment and medication to treat the condition. Unfortunately, the waiting lists for NHS assessments are long and this means that a lot of patients are reverting to self-funding private ADHD assessments at private clinics. The hope is that after the diagnosis is confirmed by this process, the GP will sign an agreement for shared care (SCA).
A SCA is an agreement between your psychiatrist and your GP where the responsibility for monitoring, prescribing and basic health checks for medication is transferred to your GP. This is a recognised and accepted method for the transfer of the responsibility for managing a patient with ADHD from the hospital or specialist service to general practice, provided it is in line with NHS England guidelines.
Before responsibility is transferred, the specialist and GP should agree on these SCA guidelines. This should be clearly stated on any referral form. It should be made clear to the GP that they are accountable for the continuous titration of the medication as well as the monitoring requirements.
Unfortunately, a lot of GPs aren't keen on accepting SCAs. This isn't due to the lack of motivation, but because the work involved with SCAs is often out of their normal funding and it is typically an additional task in addition to their busy schedule.
The doctor should be given good quality information on the motivation behind SCA and what the expectations of both parties are, including the roles of the patient and their caregivers. It should also be made clear that a decision on SCA should be taken by the doctor who initiated treatment. The GP should be told whether they wish to participate in the SCA.
If a doctor does not want to assume the responsibility of SCA they can refuse to do so, but this can lead to patients being sent back to the private ADHD assessment clinic and psychiatrist who performed their initial diagnosis. This could lead to prescriptions for medications being given privately, rather than through NHS. This could be more expensive.
What is a titration period?
The tration phase is a crucial step to determine the best medication for ADHD. It involves increasing your dosage gradually until you reach the level that maximizes the benefits and minimises side effects. It takes time however, your healthcare professional should work closely with you to ensure the process of titrating is as smooth as possible.
Certain patients may experience worsening of their symptoms during the time of titration. People who are hyperactive, for instance, may become restless and irritable. It is important that loved ones be aware of any changes in behavior and provide support. It is also crucial to have a healthy diet and to create a regular sleep routine in order to reduce the adverse effects of ADHD medications.
similar resource site isn't the sole treatment for ADHD however it is generally suggested as the first option for treatment for adults. Talk therapy can be a helpful tool to address depression and anxiety, which can trigger certain symptoms of ADHD. It is crucial to remember that medication is only able to treat the symptoms, not alter the coping mechanisms that have been in place for a long time. Some patients choose not to take any medication and instead concentrate on self-help strategies such as exercise, nutrition and stress reduction.
It is important to understand the side effects and how they will affect your body. Certain medications can reduce appetite, cause headaches, or cause you to feel sleepy. Always use your medication according to the instructions and speak to your doctor for any adverse effects that occur.
Many of the medications used to treat adult ADHD are currently in short supply because of supply issues. This has led to delays in diagnosis and appointments with psychiatrists. NHS England has created a taskforce to study the issue and offer suggestions on how to reduce waiting times for medications.
Despite the lack of certain popular medications, it is still possible to get ADHD care in the NHS and it's worth asking your local GP about the options available to you. You may be able receive the same medication privately, or they may suggest alternatives that can provide similar results to what you're used to.