ADHD Medication For Adults in the UK
In the UK there are a range of drugs that are licensed to treat ADHD. This includes the stimulant methylphenidate as well as the amphetamine-based medication called lisdexamfetamine. The dose will be closely monitored in the beginning stages of treatment.
What is a Licensed Medication?
A licensed medicine has gone through all the required tests and clinical trials and the MHRA 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 indicate whether it is suitable for a specific condition. All licensed medicines are carefully regulated, even after they're on the market, which means that any issues can be spotted quickly and any risk reduced.
Certain people with ADHD might be prescribed unlicensed medications however, they are not often used on children and teenagers. The medication that is not licensed may be prescribed for other conditions that have been found to work well with it (known as off-label prescribing), or it might be a particular formulation that isn't available on the market, for instance an oral liquid instead of tablets or something free from certain additives. It could also be an experimental medication currently being evaluated in the UK.
The term "experimental drugs" is used to refer to medicines with a Marketing Authorisation(MIA) (IMP) or Investigational Medicinal Products. These drugs aren't yet approved and can only be purchased through a prescription from a doctor. They will have undergone a formal assessment by the MHRA as part of the Early Access to Medicines Scheme (EAMS) and thus the quality of pharmaceuticals is guaranteed.
Atomoxetine is a medication that's not stimulant that's often prescribed in the UK and Europe for ADHD. This is a selective noradrenaline reuptake inhibitor, which differs from other ADHD medication. It boosts the levels of noradrenaline within the brain, which is a sort of chemical that transmits messages between nerve cells, which improves concentration and aids in controlling impulses. It is taken in capsules at least once or twice a day.
A psychiatrist is the sole mental health professional who can diagnose ADHD in adults, and prescribe medication to treat it. It is crucial to remember that ADHD isn't just a disorder which can be treated by medication by itself. Therapy is often incorporated in treatment plans. Psychoeducation is a way to assist children, teens, and adults comprehend their diagnosis and behavioral therapy that teaches strategies for managing symptoms.
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The term "unlicensed medication" refers to any drug that has not been granted a licence by the MHRA. It could be that the medication was not created by an UK company, or because it has been prescribed outside the conditions of its licence (ie off-label). The GMC's guidelines say that 'unlicensed drugs are generally utilized when a suitable licensed product is not available or a clinically effective treatment is not available with the medication that the doctor is most comfortable with'.
The licence for a medicine will state which health conditions it treats and the age of patients it may be prescribed to. It will also state how it should be used and by whom. The MHRA only issues a licence if it is deemed to be safe and effective in the specific use, based upon clinical trials and medical research. The manufacturers of drugs are not allowed promote or advertise any uses that are not covered under the licence.
In the UK It is not illegal to let a healthcare professional prescribe an unlicensed drug as long as the patient is aware of the risks and benefits. They must keep records of the use of medications that are not licensed and provide the patient with enough information to make an informed decision about whether they want to take it.
The majority of unlicensed medications are offered in hospitals, as there is more experience of using these medications than in GP clinics. The hospital will implement procedures to ensure the safety and effectiveness of the medication. This includes keeping thorough patient records, and also recording any adverse effects. They will also have to adhere to the MHRA's guidelines on the safe supply of unlicensed medicines.
Doctors who prescribe specials must to be open with patients and parents or caregivers about the purpose of the medicine and the reason it is being used, and the possible negative side effects. They must be able answer any questions that they are asked, and should always provide written details of any medication they prescribe and the reason for prescribing it.
What is an Shared Care Agreement?
The number of people who are suspected to have ADHD has been increasing in recent years, so are the demand to be referred to an NHS assessment and to receive medication for the condition. The waiting lists for NHS assessments can be long, and many patients opt to pay for their ADHD assessments in specialist private clinics. If a diagnosis is confirmed then the GP may enter into a shared-care arrangement (SCA) with the patient.
A SCA is an agreement between your psychiatrist and your GP where the responsibility for prescribing, monitoring and basic health checks for medicines is transferred to your GP. This is a recognised and agreed method of transferring the responsibility of managing a patient suffering from ADHD from the 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 doctor and the GP before responsibility is passed over, and this should be clearly written on any referral form. It is important to communicate to the GP that he or she is responsible for the continual titration of the medication and the monitoring requirements.
Unfortunately, a lot of GPs are reluctant to accept SCAs. This is not due to the lack of motivation but rather because the work involved in SCAs can be outside of their core budget and is typically an additional task on top of their busy schedule.
The doctor should be provided with good quality information on the rationale for SCA and what the expectations of both parties, including the role of the patient and their caregivers. It is important to be clear that the decision to go ahead with SCA must be made by the prescriber initiating treatment. The GP should also be informed that the patient isn't willing to participate in SCA.
If a GP does not wish to take on the responsibility of SCA they can choose not to do so, but this can lead to patients being reverted back to the private ADHD assessment clinic and psychiatrist who made their initial diagnosis. This could mean that prescriptions for medication are issued privately, rather than through the NHS which, naturally, is more expensive.
What is a titration period?
The tration phase is a crucial element in determining the best medication to help manage your ADHD. It is a process of increasing your dosage gradually until you get to the level that maximizes the benefits and minimizes adverse effects. It takes time but your healthcare professional should work closely with you to ensure the titration process goes as smooth as is possible.
Some patients might notice an increase in their symptoms during the titration phase. Hyperactive people, for example might become restless and angry. It is essential to let loved ones know of any changes in behavior and offer assistance. To lessen the negative side effects of ADHD medications it is essential to lead a healthy lifestyle and a consistent sleep schedule.
It is important to note that medication is not the only option for ADHD treatment. However it is suggested as a first-line treatment option for adults. Talk therapy is a useful method to deal with depression and anxiety that may cause some of the symptoms of ADHD. It is important to remember that medication is only able to treat the symptoms, not change the coping mechanisms that have been in place for a long time. Some patients choose not to take medication in the first place and instead focus on self-help therapies like exercise, nutrition and stress reduction strategies.
It is important to go over the adverse effects of any medication you are prescribed and know how the medication will affect your body. Some medications can decrease appetite and cause headaches, as well as cause you to feel sleepy. Always use your medication according to the instructions and consult your doctor if any adverse effects 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 set up a taskforce to investigate the issue and suggest methods to speed up the process of waiting for prescriptions.
Ask your local GP what options are available to you. You may be able to get the same medications privately, or they may suggest alternatives that can provide similar results to the ones you're accustomed to.