ADHD Medication For Adults in the UK
In the UK, a number of medicines are licensed to treat ADHD. The stimulant methylphenidate, and the amphetamine-based medication lisdexamfetamine are two of the most commonly prescribed medications. The exact dosage will need to be carefully monitored during the early stages of treatment (titration) and then stable prescriptions can be managed by your GP as part of a'shared care arrangement.
What is a 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 granted the green light for its use in Great Britain. The packaging of the medicine or the leaflet that comes with it will clearly state whether it is suitable for a specific condition. All licensed medicines undergo strict supervision, even after they are on the market. This allows for issues to be identified quickly and risks to be reduced.
Unlicensed medications are sometimes prescribed to people with ADHD however, they are not often prescribed to children or teenagers. The unlicensed medication may be used for other conditions which have been proven to work well with it (known as off-label prescribing) or it could be a specific formula that isn't yet available on the market, for instance an oral liquid in place of tablets or something without 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 medicines are not yet approved and can only be purchased with the prescription of a physician. They will have been subject to a formal assessment by the MHRA as part of the Early Access to Medicines Scheme (EAMS) and so the quality of pharmaceuticals is guaranteed.
There is a non-stimulant medication that is commonly prescribed for ADHD in the UK and Europe, and this is Atomoxetine. This drug is a selective inhibitor of noradrenaline uptake, so it works differently than other ADHD drugs. It boosts the levels of noradrenaline within the brain, which is a sort of chemical that passes messages between nerve cells which improves concentration and assists in controlling impulses. It is taken in capsule form every day, either once or twice.
A psychiatrist is the only mental health professional who can identify ADHD in adults, and prescribe medication to treat it. It's important to note that ADHD isn't just a disorder that can be treated by medication alone, and therapy is very often included in treatment plans for people suffering from the disorder. Psychoeducation is a form of therapy which assists adolescents, children, and adults understand their diagnosis, and the behavioural therapy, which helps teach methods to manage symptoms.
What is an Unlicensed Medication?
The term "unlicensed medicine" is a reference to any drug that has not been granted a licence by the MHRA. It could be because the drug was not developed by a UK-based business or it was prescribed in violation of the licence conditions (off-label). The GMC's guidance states that 'unlicensed medicines are usually employed when a licensed product is not available or when a clinically effective treatment can't be found with the product that the prescriber is comfortable'.
A medicine's licence will list which health conditions it treats and the age of the patients it can be prescribed to. The licence will also specify what and how the medicine is to be administered. The MHRA will only issue permission if the drug is considered to be safe and effective for that use, which is based on medical research and clinical studies. The manufacturers of the drugs are not permitted to promote or promote any use that is not covered by the licence.
It is not illegal in the UK for a healthcare professional to prescribe an unlicensed medication provided they explain the advantages and risks of doing so to the patient. They must keep an account of the use of unlicensed drugs and provide the patient with sufficient information to make the decision.
Hospitals tend to provide unlicensed medications because they have more experiences with them than GP surgeries. The hospital will have procedures in place to ensure the safety of the medication which includes keeping detailed patient records and ensuring that any adverse effects are recorded. They will also have to adhere to the MHRA's guidelines on the safe supply of medicines that are not licensed.
Doctors who prescribe specials need to be transparent with patients and their parents or caregivers about what the medicine is, why it is being used and the potential negative side consequences. They should be able to answer any questions asked, and should always provide written details of any medicine that they are prescribing, along with the reasons for it.
What is a Shared Care Agreement?
The number of adults who are suspected of having ADHD has increased in recent years so are demanded to be referred for an NHS assessment and also to receive treatment for the condition. The waiting lists for NHS assessments can be long, and many patients opt to pay privately for ADHD assessments in specialist private clinics. Once a diagnosis is confirmed, the GP might sign an agreement of shared-care (SCA) with the patient.
A SCA is an agreement between your psychiatrist and your GP where the responsibility of prescribing, monitoring and the basic health checks for medications is handed over to your GP. This is a recognised and agreed method for the transfer of responsibility for managing a patient with ADHD from a hospital or a specialist service setting to general practice, provided this is in line with NHS England guidelines.
These SCA guidelines should be discussed between the specialist and the GP before responsibility is passed to the GP and should be clearly stated on any referral form. It should be clear to the GP that he or she is responsible for the ongoing monitoring of the medication and the monitoring requirements.
Unfortunately, a lot of GPs are hesitant to accept SCAs. see this website isn't due to a lack of desire, but because the work involved in SCAs can be outside of their core funding, and usually an additional project on top of their busy schedule.
The GP should be informed of the reasons of SCA, the expectations of the parties involved, and the role of patients and their carers. It should also be made clear that a decision regarding SCA should be taken by the prescriber who initiated treatment. In addition, the doctor should be informed whether they wish to participate in the SCA.
If a GP refuses to take responsibility for SCA or SCA, they may refuse. However, this can result in patients being sent back to the private ADHD clinic and psychiatrist who provided their initial diagnosis. This could mean that prescriptions for medication are given privately instead of through the NHS which, naturally, can be more costly.
What is a titration time?
The tration phase is an important step to determine the best medication for ADHD. It is a process of increasing the dosage gradually until you reach the dosage that maximizes benefits and minimises side effects. It is an process that takes time. Your healthcare professional should work with you closely to ensure that the titration process is as effortless as it can be.
Certain patients may experience an increase in their symptoms during the titration time. People who are hyperactive, for instance, may become restless and angry. It is crucial to let loved ones know of any changes in behavior and provide support. It is also essential to have a healthy diet and to establish a regular sleep routine to minimize the side effects of ADHD medication.
Medication isn't the sole treatment for ADHD, but it is usually recommended as the first option for treatment for adults. Talk therapy is a useful tool to address underlying depression and anxiety that could cause some of the symptoms of ADHD. It is essential to keep in mind that medication is only used to treat symptoms and doesn't alter the negative coping mechanisms. Some patients opt to not take any medication, instead focusing on self-help techniques such as fitness, nutrition and stress reduction.
It is essential to be aware of the adverse effects and how they will affect your body. Certain medications can cause a decrease in appetite and cause headaches, as well as cause you to become drowsy. Make sure you take your meds as directed and consult your doctor if there are any adverse reactions.
Currently, many of the drugs used to treat adult ADHD are out of stock. This has caused delays in diagnosis and a backlog in appointments with psychiatrists. NHS England has set up a taskforce to investigate the issue and recommend ways to reduce the time spent waiting for medication.
Despite the shortage of some well-known medications, it's still possible to get ADHD care in the NHS, and it's a good idea to ask your local GP about the options available to you. You may be able to obtain the same medications privately, or they might suggest alternative medications that provide similar results.