Medication Treatments for Adult ADHD / ADD

Adult ADHD Medication
Medication is considered to be the first line treatment for ADHD / ADD – once the right dose is found the improvements can be remarkable.

Introduction to ADHD medication

Research having been done into drug treatments for adults with ADHD as currently there are very few medications licensed specifically for it.

Only someone who is experienced and qualified can prescribe ADHD medications so you may have to return to your psychiatrist to receive repeat prescriptions and will need check-ups every 6 months or so.

There are two types of medications used to treat adult ADHD - stimulant and non-stimulant medications. Whilst NICE guidelines are clear that treatment must start with a stimulant medication – Methylphenidate, lack of response to it should be considered in light of the diagnostic subtypes: Hyperactivity/Impulsivity might respond better to a non-stimulant and Attention deficit to a stimulant medication.

However, this is not a rule and treatment should be decided on an individual basis – tailored to the patient’s presentation and needs.

ADHD medication – stimulants

How do stimulants work?

Stimulants help the symptoms of ADHD in several ways. They increase dopamine levels in the brain. Dopamine is a neurotransmitter associated with pleasure, attention span and motivation. Stimulants help people with ADHD concentrate and focus more and can also decrease irritability and hyperactivity.

Examples of stimulant medications

• Methylphenidate – Ritalin, Concerta, Equasym
• Dexamphetamine – Dexedrine
• Adderall – mixture of dextroamphetamine and levoamphetamine salts

People will react differently to the different types of stimulants and it is important to be closely monitored by your consultant psychiatrist to make sure you are taking the right drug for your condition.

Stimulants are legally ‘controlled’ drugs because they can be open to abuse and can be addictive.

Side effects of stimulant ADHD medication

• Decreased appetite and weight loss
• Sleep disturbances
• Increased blood pressure
• Stomach problems such as nausea and diarrhoea
• Headaches
• Mood swings
• Increased aggression and anxiety

Download our ADHD Assessment Guide

ADHD medication – non-stimulant

Atomoxetine (also known as Strattera) is a "selective noradrenaline re-uptake inhibitor" which increases the amount of noreadrenaline in the brain.

This helps increase the amount of messages passed in the brain which in turn increases concentration and helps control impulses.

Non-stimulant ADHD medications are longer lasting, which means they only need to be taken once a day and can be useful for people who also suffer with depression as they have anti-depressive qualities.

Strattera is generally used when stimulants have been ruled out or are not effective.

Side effects of non-stimulant ADHD medication

• Dry mouth
• Decreased appetite and weight loss
• Sleep disturbances
• Increased blood pressure
• Stomach problems such as nausea and diarrhoea
• Headaches
• Mood swings
• Increased aggression and anxiety

With any medication it is important any adverse side effects to your medication are reported to your Psychiatrist or doctor as soon as possible.

Accessing medication for ADHD

Once you have a diagnosis of ADHD there are several options as to how you can receive treatment. This will depend on the services offered by your local NHS team. We always advise that you speak to your GP when deciding whether this assessment is right for you, to ensure you understand where you might be able to access ongoing treatment.

ADHD medication treatment options

1. Continue privately
   You may wish to continue with private treatment. This will involve several follow up appointments with a consultant psychiatrist to start you on medication and monitor your progress and dosage levels. Normally 4 or 5 appointments are needed to get the ADHD medication levels stable and to check for side effects. The psychiatrist will need to see you fortnightly, moving to monthly, to ensure the medication is having the desired effect.
2. NHS care
   Alternatively you may choose to return to NHS care, in which case your report will be shared with your GP. If your GP is happy and qualified to follow the consultant psychiatrist recommendations, they will be able to prescribe the ADHD medication you have been prescribed and carry out the monitoring process. Not all GPs are able to do this, so we always recommend you talk to them before hand to clarify what is available in your area.

Prescriptions
You may wish, or need, to pay privately for your medication prescriptions – again this is based on your personal preferences and what services are available to you via the NHS. Your GP should be able to advise.

(We cannot guarantee that your GP will be happy to prescribe our recommendations, but we are happy to discuss this option with you.)

Over 50% of the patients respond well to the first medication they are offered. It is important to bear in mind that the response is dose dependent; this means that each individual will respond differently to the dose taken. Whilst in children the dose is mostly decided on the weight of the child, in adults it is not. The golden rule is to always start low and increase according to the individual response. Some patients will respond to a low dose whilst others will need a higher one. It can take a few months to get the dosage levels right.

Dr Pablo Jeczmien

MD MRCPsych

Consultant Psychiatrist

Brighton

Dr Pablo Jeczmien is a Consultant Psychiatrist in General Adult Psychiatry for the Sussex Partnership NHS Foundation Trust. Dr Jeczmien has a medical degree and is a Member of the Royal College of Psychiatrists.