Medication
Baseline assessment is essential for prescribing of medication. Although we do not currently offer a medication service, this review incorporates all aspects of the baseline assessment to enable prescribing. This means that pending a physical review from your chosen physician, our report is substantial enough to present to a prescription service and will be of a high enough rigor to stand up to review and scrutiny.
Long-acting options are usually preferred over immediate release medications due to various factors (improved adherence, less risk of diversion or misuse, reduced stigma, convenience & improved control of symptoms).
Whichever provider you choose - Most GP’s cannot commence ADHD medication unless they are a ‘GP with Special Interests or GPwSI’ and have completed specialist training - if you are specifically seeking medication for ADHD, we would strongly recommend that you speak to your GP about whether they will recognize a private diagnosis or enter into shared care agreements before financially investing in an assessment.
So what do we consider?
- Cardiac history or history of congenital heart disease
- Family history of cardiac illness
- Current symptoms indicative of a cardiac concern
- Current and previous medication history
- Physical health & medical health history (including hypotension or endocrine disorders)
- Previous difficulties around weigh management
- Lifestyle factors / family planning
- Developmental history
- History of addictions/substances
- Mental Health history
How do they work?
Medications for ADHD work by targeting and inhibiting the norepinephrine and dopamine reuptake transporters, blocking this (these are the neurotransmitters associated with challenges in ADHD), results in increased synaptic concentrations of both dopamine and norepinephrine; which in turn enhances the neurotransmission in those brain regions, improving attention and focus whilst reducing impulsivity and hyperactivity. Methylphenidate improves the activity of catecholamine activity in the prefrontal cortex and improves cognitive control and working memory.
Pharmacological / Medication Treatment Options:
1) Lisdexamfetamine or Methylphenidate – these are considered the first line pharmacological treatment for adults with ADHD.
2) If there is no improvement after a 6 week trial period it may be that you need to switch to another stimulant medication
3) Lisdexamfetamine (this is a long-acting medication with more prolonged side-effects) for adults who have shown some response to lisdexamfetamine but cannot tolerate a longer effect profile or side effects
4) Atomoxetine – (none stimulant) where adults cannot tolerate stimulants or may be at risk of physical health implications or there may be a risk of diversion (misuse or illegal re-selling of medication)
5) Finally - prescribers are able to consider off-label treatments as a last resort, though this should always be with consultant support, this may include medications such as guanfacine.
Costs of Medication?
In the UK costs for a private prescription can vary between £25 - £85 per prescription
Supermarket pharmacies can be cheaper
ADHD medication is available under the NHS if you have had an assessment through the NHS or if your medication has been started by a private provider your GP can then accept a shared care agreement to take over prescribing.
Commonly prescribed medications include:
Affenid XL
Concerta XL
Delmosart
Mefylnate XL
Matoride XL
Medikinet XL
Xaggitin XL
Xenidate XL
Potential Side effects (Methylphenidate)
Very common – Nervousness, Insomnia
Common – Abdominal pain, nausea, vomiting, headache, drowsiness, dizziness, dyskinesia, rash, dry mouth, decreased appetite, moderately reduced weight gain, slight growth retardation.
Less common – Blurred vision, apathy, confusion, tics, Worsening or pre-existing tics, psychotic disorders, mood changes
Rare – Angina pectoris, difficulties in visual accommodation
Very Rare – Leukopenia, Thrombocytopenia, Anemia, Abnormal liver function
Helpful videos explaining how ADHD medication works: