ADHD Medication For Adults in the UK
In the UK there are a range of drugs that are licensed to treat ADHD. These include the stimulant methylphenidate as well as the amphetamine based medication called lisdexamfetamine. The exact dose will need to be carefully monitored 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 an Licensed Medication (L.M.)?
A licensed medicine has gone through all the required tests and clinical trials and the MHRA, the Medicines and Healthcare Products Regulatory Authority (MHRA), has given the green light for its use in Great Britain. The packaging of the medicine or the leaflet that comes with it will clearly indicate whether it's suitable for a specific condition. All licensed medicines are controlled, even after they're on the market, so problems can be spotted quickly and any risks reduced.
Certain people with ADHD may be prescribed unlicensed medications however they aren't often used for teenagers and children. Unlicensed medications may be prescribed for other ailments that have been shown to be effective (known as "off-label prescribing"), or they could be a form of treatment that isn't yet in the market for example, liquid oral instead of tablets. It could be an experimental drug that is being evaluated in the UK.
The term "experimental drugs" is used to describe Medicines that have an Marketing Authorisation(MIA) (IMP) or Investigational Medicinal Products. These drugs aren't yet approved and can only be purchased with the prescription of a physician. They will have undergone an official assessment by the MHRA as part of the Early Access to Medicines Scheme (EAMS) and therefore the quality of pharmaceuticals is guaranteed.
There is a non-stimulant medication that is often prescribed for ADHD in the UK and Europe, and this is Atomoxetine. It is a selective inhibitor of noradrenaline's uptake, so it works differently than other ADHD medication. It increases noradrenaline, a chemical that helps transmit messages between brain cells. This aids concentration and helps to control impulses. It is taken as a capsule once or twice daily.
A psychiatrist is the sole mental health professional who can identify ADHD in adults and prescribe medications to treat it. It is crucial to understand that ADHD isn't an illness which can be treated with medications alone. Therapy is often incorporated into treatment plans for those suffering from the disorder. This may include psychoeducation, which aids children, teenagers and adults understand their diagnosis, as well as the behavioural therapy, which helps teach methods to manage symptoms.
What is an Unlicensed Medication?
The term "unlicensed medication" refers to any drug that has not been granted a licence by MHRA. It could be that the medication was not created by a UK company, or it was prescribed outside the terms of its licence (ie off-label). The GMC's guidance states that 'unlicensed medicines are usually employed when a licensed product is not available or a clinically effective treatment cannot be found using the drug with which the prescriber feels at ease'.
The medical license will specify the conditions it treats along with the age ranges it is able to treat. It will also specify how it should be taken and by whom. The MHRA only grants a licence if it is deemed safe and effective for that particular use, based on clinical trials and medical research. The manufacturers of the drugs are not allowed to promote or advertise any use that isn't covered by the licence.
In the UK, it is not a crime to let a healthcare professional prescribe an unlicensed medicine as long as the patient is aware of the potential risks and benefits. They must also keep records of the use of non-licensed medications and provide the patient with enough information to make an informed decision regarding whether or not they wish to accept it.
The majority of unlicensed medications are given in hospitals, where there is more experience of using them than in GP practices. The hospital will have procedures in place to ensure the safety of the medication including keeping detailed patient records and ensuring that any adverse reactions are recorded. They must also adhere to the MHRA's guidelines on the safe supply of medicines that are not licensed.
Doctors who prescribe specials need to be open with patients and parents or caregivers about the nature of the medication, why it is being used and the potential side consequences. They must be able to answer any questions that they are asked and always provide written information about any medicine that they prescribe, and the reason for it.
What is a Shared-Care Agreement?
The number of people who are suspected of having ADHD has been increasing in recent years, so are requests to be referred for an NHS assessment and also to receive medication for the condition. The waiting lists for NHS assessments can be very long and a lot of patients choose to pay for their ADHD assessments in specialist private clinics. Once a diagnosis is confirmed and the diagnosis is confirmed, the GP could sign a shared-care arrangement (SCA) with the patient.
A SCA is an agreement between your psychiatrist and GP and GP, in which the responsibility for medication prescribing, monitoring, and basic health checks is transferred to your GP. This is a recognised accepted method of transferring the responsibility for managing ADHD patients from a specialist service or hospital to general practice.
Before responsibility is transferred the specialist and GP should be in agreement on these SCA guidelines and this must be clearly stated on any referral form. It should be clear to the GP that he or she is responsible for the ongoing adjustment of the medication and for the monitoring requirements.
Unfortunately, a lot of GPs aren't keen on accepting SCAs. This isn't due to the lack of motivation however, the work involved in SCAs is often out of their normal budget and is usually an additional project on top of a busy schedule.
The GP must be informed about the reasoning of SCA, the expectations of all parties involved, and the role of patients and carers. It is also important to be clear that a decision on SCA should be taken by the prescriber who initiated treatment and the GP should be told whether they wish to participate in the SCA.
If a physician refuses to take responsibility for SCA, they can refuse. However, this can result in patients being referred back to the private ADHD clinic and psychiatrist who provided their initial diagnosis. This can lead to prescriptions for medication being issued privately, instead of through the NHS. This could be more expensive.
What is a Titration Period?
The tration time is a crucial step in finding the right medication to treat your ADHD. It involves gradually increasing your dosage until you reach a dose that maximises the benefits while minimizing negative side effects. adhd and medication is a process that takes time. Your healthcare professional must be in close contact with you to ensure the titration procedure is as effortless as it can be.
Some patients may experience worsening of their symptoms during the time of titration. Hyperactive people, for example, may become restless and angry. It is crucial to let loved ones know of any changes in behavior and provide support. It is also crucial to eat a balanced diet and to establish a regular sleep routine to lessen the side effects of ADHD medication.
Medication isn't the sole treatment for ADHD however it is usually recommended as the first option for management in adults. Talk therapy can be a helpful tool to address depression and anxiety that can cause certain symptoms of ADHD. It is important to remember that medication is only used to treat symptoms and doesn't alter the negative coping mechanisms. Some patients opt not to take meds at all and instead focus on self-help treatments such as nutrition, exercise and stress reduction strategies.
It is crucial to know the side effects and how they affect your body. Some medications can cause headaches or drowsiness and also reduce appetite. Be sure to use your medications as directed and speak to your doctor if you notice any adverse reactions.
Many of the medications used to treat adult ADHD are currently in short supply because of supply issues. This has caused delays in the diagnosis process and appointments with psychiatrists. NHS England has set up a taskforce to investigate the issue and recommend methods to speed up the process of waiting for medication.
Despite the shortage of some popular medications, it is still possible to get ADHD care in the NHS, and it's a good idea to ask your local GP about options for you. You might be able to get the same medications privately, or they could suggest alternatives that have similar results.