ADHD Medication For Adults in the UK
In the UK, a number of medications are approved for treating ADHD. This includes the stimulant methylphenidate as well as the amphetamine-based drug called lisdexamfetamine. The exact dosage will need to be monitored closely during the initial stages of treatment (titration) and then, once stable, prescriptions can be managed by your GP as part of an agreed'shared care' arrangement.
What is what is Licensed Medication (L.M.)?
A licensed medicine will have gone through all necessary clinical studies and tests and the MHRA (Medicines and Healthcare Products Regulatory Authority) has given it the go ahead to use it in Great Britain. see this site will also be clearly identified as being suitable for a particular condition on its packaging or in the leaflet that comes with it. All licensed medicines are controlled and monitored, even after they've entered the market, meaning that any problems can be identified quickly and risks minimized.
Unlicensed medications are sometimes prescribed to people with ADHD however, they are seldom prescribed to adolescents or children. Unlicensed medications may be prescribed for other conditions that have been proved to be effective (known as "off-label prescribing"), or they could be a form of treatment not yet available on the marketplace like a liquid oral instead of tablets. It could also be an experimental drug currently being evaluated in the UK.
The term "experimental drugs" is used to refer to Medicines that have an IMP or Marketing Authorisation(MIA) (IMP) or Investigational Medicinal Products. These medicines are not yet licensed and can only be purchased through a prescription from a doctor. They will have been subject to an official assessment by the MHRA as part of the Early Access to Medicines Scheme (EAMS) and therefore the quality of the pharmaceutical is guaranteed.
Atomoxetine is an anti-stimulant medication that is often prescribed in the UK and Europe for ADHD. This drug is a selective inhibitor of noradrenaline's uptake and therefore works in a different way than other ADHD medication. It increases noradrenaline in the brain which is a type of chemical that transmits 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 sole mental health professional who can diagnose ADHD in adults, and prescribe medications to treat it. It is important to remember that ADHD isn't just a disorder that can be treated through medication alone. Therapy is often incorporated in treatment plans. This may include psychoeducation, which helps children, teenagers and adults understand their diagnosis, as well as behavioural therapy, which teaches methods to manage symptoms.
What is an unlicensed medicine?
The term 'unlicensed medicine' refers to any drug that has not been granted a license by the MHRA. It could be that the medicine was not developed by a UK-based company or it was prescribed in violation of the licence terms (off-label). The GMC's guidelines state that 'unlicensed medications are typically used when a suitable licensed product isn't readily available or a clinically effective treatment can't be found using the product that makes the prescriber feel at ease'.
The license of a medicine will list the conditions it treats, along with the ages it can be administered to. It will also indicate the dosage and by whom. The MHRA only grants a licence when it is considered safe and effective in that specific use, based upon clinical studies and medical research. The drug's manufacturers are not permitted to promote or advertise any use that isn't covered by the licence.
It is not illegal in the UK for a healthcare professional to prescribe a medication that is not licensed provided they are able to explain the risks and benefits of this to the patient. They must also keep a record of the use of non-licensed medications and provide the patient sufficient information to make an informed decision.
Hospitals tend to provide unlicensed medications due to their more experience with them than doctors' surgeries. The hospital will implement procedures to ensure the safety and effectiveness of the medication. This includes keeping detailed patient records, and noting any adverse effects. They will also have to follow the MHRA's guidance on the safe supply of unlicensed medicines.
Doctors who prescribe specials need to be transparent with patients and their parents or carers about the purpose of the medicine and the reason it is being utilized and the possible side effects. They should be able to answer any questions they receive, and should always write down the details of any medicine that they are prescribing, along with the reasons for prescribing it.
What is what is a Shared Care Agreement?
As the number of adults who are suspected to have ADHD has increased in recent years so have the demand to be referred to an NHS assessment and to receive medication for the condition. The waiting lists for NHS assessments are long, and this means that a lot of patients are turning to self-funding private ADHD assessments at specialist private clinics. The hope is that once the diagnosis is confirmed through 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 basic health checks for medicines is assigned to your GP. This is a recognised and agreed method for the transfer of the responsibility of managing a patient with ADHD from a hospital or a specialist service setting to general practice, provided that it is in line with NHS England guidelines.
These SCA guidelines should be agreed between the specialist and the GP before the responsibility is handed to the GP and should be clearly in any referral form. It should also be clarified that the GP is responsible for the continuous monitoring and titration of the medication.
Unfortunately, a large number of GPs do not accept SCAs. This isn't due to a lack of desire however, it is because the work involved in SCAs isn't part of their regular funding.
The doctor must be informed about the reasoning of SCA as well as the expectations of all parties involved, as well as the role of the patients and their carers. It should be clear that the decision to go ahead with SCA should be made by the doctor who is initiating treatment. The GP should be informed of the patient's refusal to be willing to participate in SCA.
If a doctor refuses to take responsibility for SCA and/or SCA, they are able to refuse. However, this can result in patients being sent back to the private ADHD clinic and the psychiatrist who provided their initial diagnosis. This could lead to medication prescriptions being issued privately, rather than via the NHS. This could be more costly.
What is a Titration Period?
The tration phase is an important step to find the appropriate medication for ADHD. It is a process of increasing your dosage gradually until you reach a dosage that maximizes benefits and minimizes adverse effects. It takes time but your healthcare specialist should work closely with you to ensure that the titration process is as smooth as possible.
Some patients may experience a worsening of their symptoms during the time of titration. For example, those who are hyperactive might become more restless and angry than they normally are. It is crucial that loved ones be aware of any changes in behavior and offer support. To reduce the side effects of ADHD medications, it is important to lead a healthy lifestyle and a regular sleeping schedule.
Medication isn't the sole treatment for ADHD, but it is generally recommended as the first option for management in adults. Talk therapy is an effective tool to deal with anxiety and depression, which can trigger some symptoms of ADHD. It is crucial to remember that medication is only used to treat symptoms and does not alter negative coping mechanisms. Some patients choose not to take any medication and instead focus on self-help strategies such as nutrition, exercise and stress reduction.
It is crucial to look about the possible adverse effects of any medication you are prescribed and know how the medication will affect your body. Certain medications can cause a decrease in appetite, cause headaches, or make you drowsy. Always take your medication as directed and speak to your doctor for any adverse effects that occur.
Many of the medications used to treat adult ADHD are currently out of stock due to supply issues. This has caused delays in the diagnosis process and appointments with psychiatrists. NHS England has created a taskforce that will investigate the issue and provide recommendations on how to cut down the time it takes to get medication.
Despite the lack of certain well-known medications, it's still possible to get ADHD treatment in the NHS and it's worth asking your local GP about your options. You may be able receive the same medication privately, or they may suggest alternative treatments that will produce similar results to what you're accustomed to.