Medication

Despite much controversy surrounding the treatment of ADHD, research has shown that medication is generally safe, if used as prescribed (see Reference 1 below).  It can make a real difference to your daily life, work and relationship opportunities.  Medication is recommended in the NICE (The National Institute of Health and Clinical Excellence) guidance (see Reference 2 below).

There are two types of medication commonly used for ADHD:

  • Stimulants
  • Non stimulants

In the UK, these medications are licensed for use by children and adolescents. However, there are no medications currently licensed for treating newly diagnosed adults. If you are diagnosed with Adult ADHD, we can discuss which medications and therapies may be suitable for you and these can be recommended as ‘off licence’ prescribing. ‘Off licence’ does not mean that they do work, but that the research that was used to apply for the licence was for childhood use only, as at that time it was not recognised that this was a problem for adults.  This will change slowly as new research emerges. In the meantime, NICE and the British Association of Psychopharmacology recommend that we use these drugs ‘off licence’ as they are undoubtedly helpful to adults.

Stimulant medications

Methylphenidate or dexamphetamine are the two available in the UK at the time of writing. Others are available in the US and may become available here at some point.

Stimulants for ADHD are controlled drugs, which means their availability and use is more closely controlled than other prescription medicines. If prescribed, you will probably be given small dosages at first, which may then be gradually increased. The maximum amount recommended on one prescription is a one month supply. Stimulants are usually first line treatment and are effective in around 80% of individuals. They produce a short-lived improvement after each dose, but they are not a permanent cure. They create a short period when someone who has ADHD can concentrate better, be less impulsive, feel calmer, and learn and practice new skills.

  • Methylphenidate comes in various different brands:
    • Ritalin (now available as generic methylphenidate hydrochloride)
    • Concerta XL
    • Equasym XL
    • Medikinet and Medikinet XL
  • Dexamphetamine (also known as dexamfetamine sulphate or Dexedrine)

You will need to return to your GP for regular check ups to monitor your blood pressure, pulse and weight if you take stimulants regularly, in order to ensure that your treatment is causing no ill effects. Occasionally it is recommended to take a break from treatment to help assess how you can manage without the medicine, as symptoms often reduce with age and life long treatment is often not needed. You do not always need to take stimulants daily. They may be used as required for days when you feel it is important to reduce your symptoms.

Treatment goals
The goal is to reduce the symptoms of inattentiveness, motor hyperactivity and impulsiveness that disrupt social, school and occupational functioning. The aim is to slowly increase treatment dose until symptoms are under control or until the improvement is stable and then to continue treatment as long as improvement occurs. The need for treatment should be reassessed annually to ensure that there is a continued benefit.

When to take stimulants
Take when needed and not necessarily daily. You may only need to take medication during the working week or for part of the day when symptoms are problematic. You may want a rest from taking medicine over holiday times to assess the benefits.

Non-Stimulant medications 
Atomoxetine comes in a brand called Strattera, and it works differently to methylphenidate and dexamphetamine. It is known as a selective noradrenaline reuptake inhibitor (NARI), which means that it increases the amount of a chemical in the brain called noradrenaline. Like methylphenidate and dexamphetamine, the use of atomoxetine must be closely monitored and only initiated under a specialist experienced in ADHD. Atomoxetine comes in tablet form that you take once or twice a day.

How long until it works?
Some effect may be seen from the first dose but therapeutic actions may improve over 4-8 weeks after starting therefore daily dosing is important. If it is not working after 6-8 weeks then it may not work at all.

References

Reference 1
Safety of therapeutic methylphenidate in adults: a systematic review of the evidence. Godfrey J. Journal of Psychopharmacology  Mar;23(2):194-205. 2009 http://www.ncbi.nlm.nih.gov/pubmed/18515459

Reference 2
http://www.nice.org.uk/Guidance/CG72

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