ADHD Medication Disclaimer:
This summary of medication is based on experience and is not a substitute for medical advice. You should discuss any decisions you make about medication directly with your doctor.
Some general points to consider:
- Following diagnosis you will usually be offered a trial of medication. (NB If you decide not to try medication, bear in mind it may be more difficult to access your psychiatrist for a trial at a later date).
- A trial of medication will allow you to assess how it affects your ADHD symptoms and if you’d like to continue using it in the longer term.
- Medication is not a ‘miracle cure’ (‘pills don’t teach skills’). However it may help you to use strategies more successfully to manage your ADHD.
- Individuals will all vary in how they process medication, and which side effects they experience.
Titration:
‘Titration’ is the process by which you find the dosage level of medication which which improves your ADHD symptoms – with the fewest side effects.
- The psychiatrist/ nurse specialist initially supervises this process. Once they have helped you find your best dose, then your care will be usually handed over to your GP. Your GP then organises any repeat prescriptions and you’ll usually have an annual review with your Psychiatrist. This process is called shared care.
- During titration, you or the person titrating, will monitor your blood pressure, pulse and weight. If you have a pre-existing heart condition you may also need an ECG.
- During titration, you’ll be assessing the effect of medication on your ADHD symptoms, as well as any side-effects you notice. You may want to keep a record of these, or your prescriber may give you a form to complete.
- You will start on a low dose and gradually increase this over several weeks/ months. If you have unwanted side effects, then your prescriber will usually reduce your dose.
- Dosage isn’t related to severity of ADHD. Some people require a very low dose – others require a high dosage.
- The appropriate dosage for you depends not on body weight but how quickly or slowly your brain processes medication.
Medication options for ADHD:
There are three main groups of medicine licensed to treat ADHD in the UK. NICE guidelines recommend your doctor offers these options in the following order:
1. Stimulants
(These are ‘controlled drugs’ so your psychiatrist/ nurse-prescriber will carefully monitor their use.)
Doctors have now used stimulants to treat ADHD successfully for over 50 years. Around 80% of people with ADHD find stimulants help improve their focus and regulation.
There are two different types of stimulant medications used in the UK – it may be worth trying both to compare which works better for you. Effects of stimulants may last between 2-12 hours depending on whether they are instant-release or slow-release. Different brands also vary in how they are released in the gut, and how long they remain in your body.
a) Methylphenidate-based:
Brand names:
Long-acting (10-12 hrs): Concerta XL, Equasym XL, Medikinet, Medikinet XL.
Short-acting (2-4 hrs): Ritalin/ Methylphenidate
b) Dexamfetamine-based:
Brand name:
Long-acting (10-12 hrs): Elvanse (long-acting version).
Short-acting (2-4 hrs) Dexamfetamine.
Practical tips when taking stimulants:
- Taking medication on an empty stomach may affect the way medication impacts you – sometimes resulting in a feeling of ‘being wired’ or heightened anxiety. To prevent this, many people with ADHD find that eating a high-protein breakfast alongside medication optimises the effect of the medication.
- High doses of Vitamin C reduces the effectiveness of stimulants (most research specifies dexamfetamine-based stimulants). It’s best to avoid taking Vitamin C an hour before or after stimulant meds.
Side effects of stimulants*:
- Loss of appetite.
- Stomach-ache/ headache – this often resolves quickly.
- Difficulty falling asleep (but medication also helps some people sleep better).
- Emotional problems: some people feel ‘zoned out’, tearful or irritable; some people feel calmer).
- ADHD symptoms may rebound as medication wears off in the evening.
- Some experience an increase in anxiety/ depression (but this may also improve on meds).
- Rapid pulse (may require ECG test) or feeling ‘jittery’: avoid caffeine
- Tics: avoid caffeine.
*If these are intolerable see Combination Therapy below
2. Non-stimulants
Atomoxetine (brand name: Strattera)
This increases the levels of noradrenaline, and helps improve focus and impulse control.
Guanfacine (brand name: Clonidine)
In the UK this is mainly used with children & teenagers but can be used with adults with generalised anxiety disorder or high blood pressure.
(Both these will take several weeks to have full effect, and have an ongoing effect rather than wearing off in the evening).
3. Antidepressants:
Venlaxafine
Buproprion
Modafinil
Tricyclic antidepressants
These will all be less effective with ADHD than stimulants, however, they help some people focus better. (They will take several weeks to have full effect, and have an ongoing effect rather than wearing off in the evening).
*Combination Therapy
This is just beginning to be trialled in the UK – if a high dose of stimulants is needed to control ADHD symptoms then side-effects often feel intolerable. Adding in non-stimulants (such as Atamoxetine) can mean the stimulant dose can be reduced. Read more here.
