If you are diagnosed with ADHD during your assessment, your clinician may recommend medication as part of your treatment plan. This plan will be personalised to you, taking into account factors such as your day-to-day routine, lifestyle, medical history and any other relevant individual needs.
If you decide that medication may be right for you, you will be referred to our Titration Service.
What is titration?
Titration is the process of starting medication safely and gradually, while monitoring how your body responds. During this time, you will have regular contact with a member of our specialist ADHD prescribing team, who will monitor your progress and adjust your treatment where needed. The aim is to help you reach a stable, or ‘optimised’, dose that offers the greatest benefit with the fewest side effects.
How does it work?
Getting Started
You will first have an Initial Assessment with one of our doctors. If you are diagnosed with ADHD and they believe medication may be beneficial for you, they will refer you to our Titration Service.
What happens next will depend on your treatment pathway.
For NHS and Right to Choose patients, you will usually join our titration waiting list before being allocated a prescriber. You can check for waiting time updates here.
For private patients, there is no titration waiting list. Once your referral has been processed and we have received the information we need to begin treatment, we will contact you with the next steps.
When you are ready to begin titration, one of our prescribers will contact you through the patient portal to introduce themselves, explain the process and provide some background information.
Your feedback and observations are an essential part of the process
Before you begin medication, we will ask you to provide some baseline observations. These usually include your blood pressure, pulse, weight and height.
In some cases, you may also be asked to provide the results of an ECG and/or blood tests, if these were recommended by your assessing doctor. Your doctor will have written to your GP to request these, but it can often help if you also contact your GP directly to help move things forward.
During titration, you will be asked to monitor and record your blood pressure, pulse and weight at regular intervals, and report these back to your prescriber using monitoring forms.
To do this, you will need to buy a blood pressure (BP) monitor. These are usually available from local pharmacies and online retailers, often costing around £20+, although prices can vary.
You can find more information about choosing a BP monitor and taking accurate blood pressure readings in our website guide.
Once your baseline information has been received, your titration prescriber will review it. If your observations are within a normal range, you will be ready to begin treatment.
Starting medication
Once you are ready to begin, your prescriber will arrange your first prescription and explain how and when to take your medication.
This guidance will also explain how to monitor your blood pressure and what to do if a reading falls outside the expected range. If you are ever unsure, or feel you need more support during the process, please contact your prescriber through the patient portal.
In Week 3, we will ask you to complete an Adult ADHD Self-Report Scale (ASRS). If there is anything concerning in your updates, we will contact you.
In Week 4, we will review your progress. If everything is going smoothly, we will arrange your second prescription. This may be a continuation of your current treatment plan, or we may recommend some changes, depending on how you are responding to the medication.
End of Titration Review
For NHS and Right to Choose patients, titration typically takes 12 to 16 weeks and (usually around 14 weeks). For private patients, titration usually takes 12 weeks.
This allows time for your body to adjust to the medication and for us to identify the dose that provides the best balance of symptom improvement and side effects.
Towards the end of titration, you will be invited to attend an End of Titration Review.
If your prescriber is satisfied that your treatment has stabilised, they will write to your GP to recommend ongoing prescribing under a Shared Care Agreement. This means your GP may take over issuing your repeat prescriptions. Your medication will need to be reviewed after six months by your GP, and you will need to attend an annual medication review with Psychiatry UK – or, in some cases, by another service such as your local NHS team.
Frequently Asked Questions
Why can’t my GP start titration?
Right to Choose patients
If you live in England and have been referred to Psychiatry UK through the NHS Right to Choose (RTC) scheme, we are required to follow guidance from the National Institute for Health and Care Excellence (NICE). This means that ADHD medication must be started and monitored by a specialist ADHD titration service, rather than by your GP.
Your prescription will be issued by Psychiatry UK and will either be delivered to your home or made available for collection from your local pharmacy, depending on whether electronic prescribing is available in your area through your local Integrated Care Board (ICB).
You can find further information in our website guide.
Private patients
If you are a private patient, you can choose which pharmacy to use.
Why do I need to wait for titration?
In recent years, the UK has seen a significant rise in the number of people seeking ADHD and autism assessments through the NHS Right to Choose scheme. This has led to increased demand and longer waiting lists.
We know patients are waiting longer than we would like for both assessment and titration. We are actively recruiting new doctors, prescribers and non-clinical staff, and we are continuing to introduce new technology to help improve our services and reduce waiting times.
In the meantime, we ask for your patience and understanding. We are working as quickly as we can to improve access to care and support as many patients as possible.
Why can starting titration take time?
Start times vary depending on your treatment pathway and on whether we have received all the information needed to begin treatment.
We operate a waiting list for NHS and Right to Choose patients. You can find our current estimated waiting times for titration on our website Waiting Times Update page.
For private patients, treatment can begin once your referral has been processed and all required information has been received.
Why do waiting times vary?
It is difficult for us to give an exact start date for titration because each patient’s treatment journey is different. The length of titration varies from person to person, depending on how quickly they reach a stable dose and whether any adjustments are needed along the way.
This means movement on the waiting list can be difficult to predict. Please be assured that we are doing everything we can to reduce waiting times.
Hello,
I was wondering do you accept diagnosis from other private clinics as I’ve been diagnosed with adhd however they do not supply medication and I’m trying to find someone who will help,
Hi Mia – Thank you for getting in touch. Normally we would accept a diagnosis from another clinic and would be able to help with supplying medication.
However, we are currently closed to private referrals, and only able to accept referrals via the Right to Choose scheme.
This situation is set to change in the near future, although we are unable to give a date at present. Please keep an eye on our website if you do not find another provider who can help you sooner.
Hello Rachel. I am also interested in understanding if you are open to taking patients who have been diagnosed elsewhere.
Many thanks
Rowena
Oh I just commented something similar as I’m now in the same boat! Did you get it sorted?
Hello, is this limited to referrals from GPs in England or is it possible to be referred from my Welsh GP? If not, is there an equivalent in Wales?
Hi Andrea – Unfortunately the Right to Choose scheme is only available to those registered with a GP surgery in England. There is no equivalent in Wales unless you are eligible to apply for an IFR (Individual Funding Request). There is more information about this on the NHS Wales website.
Is there any possibility of doing a consultation via zoom or face time as I am am living in South Africa and is a private patient with a referral letter from my local GP.
I have heard about so many positive results, here in SA and am devastated that doctor now has left the country ….
As per my referral letter I am an 59 year old female with depression (currently using Prozac short term just to help me through a tough time. I have experienced too many traumatic life struggles which added sever anxiety disorders as well as the worst case scenario of insomnia, and because of the high recommendation would appreciate treatment for all by yourself.
Current medication for the past 3 months includes :
Prozac, 20mg mane po
Pexola p.5mg mane ; 1mg no te po
Stilnox MR 12.5mg 2-3 tabs nocte po
Seraquel 300mg nocte po
Rivotril 0.5mg nocte po
together with experiencing chronic sinusitis due to upper teeth roots growing and irritating the membrane of the sinus canal on the right side of my face, causing me to have to take anti-biotic basically every one-two months just to clear up all the green & yellow coloured mucus and extreme amount of flem running down onto my lungs.making it impossible to try and live a normal healthy live.
Hi Amanda – To qualify for an assessment under the NHS Right to Choose scheme, you have to be registered with a GP in England. We unfortunately cannot provide private ADHD assessments at this time, but we do offer appointments for other mental health conditions (please check under the ‘Treatment and Conditions’ menu on our website).
Our assessments take place via the Teams platform. If you would like to book an appointment, you can do this directly from our website here: https://psychiatry-uk.com/how-it-works.
If you would like to speak to a member of our customer service team, please use our website chat service (you will find this at the bottom right of our Contact Us page. Alternatively, you can call our support line on: 0330 124 1980 (Our opening hours are Mon-Fri: 8am-8pm; Sat-Sun: 9am-5pm (UK time)).
We do hope you manage to get things sorted out.
Hi my son has been diagnosed with Adhd via cahms but the waiting list to be seen for medication is 15 months. We can’t wait that long and he also has autism. Could we been seen by yourselves for medication consultation and then the NHS continue? If so how much would that be?
I just want to say a massive thankyou to P UK!
I will be coming to the end of my titration soon and hope the shared care with gp goes as well as p UK .
You have given me my life back. my independence and better health.
Thank you
Hi Emma – Thank you for taking the time to share this feedback. It is always really good to hear that our service has made such a difference to the lives of our patients, and I will make sure your comments are shared with our staff.
My son has already been assessed and diagnosed with autism and adhd and I’m looking at going private to get him on meds. Is it possible to go back to NHS once we have the meds? How much would it cost?
Hi Helen – Thank you for getting in touch. I need to check with our CAMHS team to make sure I am giving you the right information. Please bear with me.
Would it be possible to get a call back at all?
Hi Helen – I have spoken to our Child & Adolescent Lead. Could you please send the diagnostic report, with your query, directly to [email protected]. They will check to see whether it meets P-UK’s criteria and advise on costs if appropriate.
Sent
Hi, I am an existing patient which was diagnosed with ADHD and titrated in 2020 with P-UK. But I can’t find any information on the waiting times for re-starting titration following my annual review. I discussed how my current medication is now ineffective with my psychiatrist and he was very helpful and referred me back to titration to trial another type. I was added to the waitlist however I am now really scared I will need to wait 6 months and have to continue to take my current medication with significant side effects for half a year. Could you please give me any information you may have on this?
Many thanks!
Hi Lia – I will get in touch with our titration team and find out what you need to do.
Hi Lia – Please see our advice below:
1- The best way to get information re. re-starting titration is to log onto the portal and send a message to our Admin Team.
2- Titration Admin will also be able to advise your current position on our waiting list.
3- If you are experiencing significant side effects from your current medication, please contact your Consultant via the portal for advice on how to reduce the dose and stop taking the medication whilst on the waiting list.
I was discharged back to GP from your service after my diagnosis I’m now awaiting a medication review and my GP will not prescribe until I’ve been seen but I’ve been told 6-9 months. i was discharged due to not attending an appointment but i emailed to say i could not access my account 3 times before i was on the highest dose of my medication and now am having none. I’ve already been waiting since January is there anyway i can pay to start titration as I’m struggling severely without being on my medication. im not sure how i can speak to someone in regards to this.
Hi Laura – Just seeking advice on this. I will get back to you asap.
Hi can a diagnosis be made on a 3 year old? And at what age can you prescribe medication?
Hi Kim – Thank you for getting in touch. Unfortunately our service is only available to children over the age of seven.
Extremely concerned regarding this service, I have a full comprehensive diagnosis and my Gp after raising a serious complaint with my practice manager, then referred me to yourselves for a medication review. I was referred in the January of 2023 and even though I raised more then several times that I had a comprehensive diagnosis and all blood tests and ECG ready to go. I was called and offered an assessment appointment of which I was outstanding at the clear lack of communication between your teams.
I spoke to one of your colleagues who had informed me that due to my diagnosis being comprehensive, he had referred my case to a senior psychiatrist and that either the psychiatrist doing the review would either prescribe the medication and that I need to have my passport etc to hand or I would just require a health check and start titration ASAP, not months ASAP.
I have a comprehensive diagnosis of combined ADHD by a psychologist from the Priory which I received in September 2022 and I’ve been on the wrong waiting list for 6 months which is abysmal.
Tomorrow I have my ADHD review appointment and in fairness I would rather stay under the same professional however I am extremely anxious as I just want to finally be in a position where I can manage my ADHD with the correct medication which will be amended and reviewed by a psychiatrist.
I have coped all of my life with ADHD and since the diagnosis all I would like is to manage my condition better. I have a therapist in place, i have Access to work in place plus each of those recommendations. I have also been lucky enough for my employer to pay separately for Egress. However having all of these elements in place with a confirmed diagnosis is basically ineffective.
I have communicated all of these elements at every turn and highlighted the pertinent importance of reading the diagnosis and interpreting the blood and ECG results.
From spending more than 6 months on a waiting list that wasn’t required, I personally feel like I have just been left and forgotten about not only that but that my needs and requirements mean nothing at all to any staff who I had communicated with very clearly.
The management of cases like mine are not fit for purpose in the current climate that is facing the United Kingdom.
On my ADHD medication review tomorrow consultant’s have the right to prescribe medication ( if it is in the best interests of the patient ). By being completely transparent the benefits of prescribing that medication outweighs the re-occurring risks of leaving a patient unmedicated.
This system has to get better and staff need to listen more carefully. If you have titration nurses what is the relevance of a psychiatrist when a psychologist could diagnose just as effectively.
Food for thought. This can not continue to happen it is unfair.
Hi Ellena – Thank you for posting a comment to let us know that you are unhappy with our service. This blog is managed by Psychiatry-UK’s internal Communications Team. We are unable to get involved in individual patient cases, to ensure that your data is kept secure. From reading your note, it sounds as though you will have been able to discuss these issues with your consultant today, and hopefully you will be starting titration. However, if you would like to speak to someone about the issues you have experienced to date, please contact our Patient Experience Team at: [email protected]. They will be very happy to help.
Hi there,
I have private health insurance, that have agreed to cover the cost of an ADHD assessment, but not titration for medication. Once I have the diagnosis / assessment, could I be put on the waiting list for titration with right to choose if my NHS GP refers me?
Thank you!
Gemma
Hi Gemma – Thank you for getting in touch. You can indeed ask your GP to be referred to P-UK for titration via the RTC scheme. However, we do have certain conditions: (1) we would need to see a copy of your original assessment report; (2) we would need to arrange a review appointment with you (this could be a full appointment if the report is below standard) before being added to the titration wait list.
Hi, I have been referred to another company via my GP and Right to Choose but they are only a diagnostic service and do not provide a titration Service. If I have a confirmed diagnosis that requires medication can my GP refer to you for the titration Service on its own?
Dear Psychiatry UK,
My son (under 18) has been tested by the SENCO at his school who confirm they have been trained in conducting the diagnostic interview and a British
Psychological Society registered Test User and hold a valid Certificate in Psychometric Testing, Assessment and Access Arrangements and he has been diagnosed with ADD – is it possible to send this report to you to be able enter your private service for titration / medication?#
Thank you
Hi Maria – Thank you for getting in touch. Our blog platform is managed by our Communications Team, and we are not permitted to share data or to handle general enquiries here. Please could you direct your enquiry to our CAMHS team at: [email protected]. They will be happy to assist you.
I have an overseas assessment and full report for ADHD. How do I access titration through yourselves? What is the process abd cost?
Hi, my 11y old child has been diagnosed with ADHD and ASD privately in Aug 2023. The consultant recommended we schedule a medication consultation appointment to discuss medication advice and possible referral with Dr Katleen Brooks, who they’ve worked with before.
However I am unclear which type of appointment we need to arrange as our consultant said we don’t need to pay for an assessment again. Can you please advise?
Hi Emmanuel – Thank you for getting in touch. This area is managed by the Marketing Team for blog comments only, so I do apologise that you have waited for a response.
I’m afraid we are unable to look into patient cases from this platform, so you will need to speak to our CAMHS Team directly. Please email them at: [email protected].
Hi there,
I have a private combined type ADHD diagnosis from Seik Psychiatry (Oct ’22) and I am also on the wait list now for a medication review with the NHS which I’ve been told is a 2 year wait. What is the process of being moved over to you guys instead (if I already have a diagnosis)? I’m keen on trying medication so would like to start titration asap.
Thank you in advance,
Sapphire
Hi Sapphire – Thank you for getting in touch. Unfortunately, our website blog is managed by our Communications Team and we are unable to respond to patient enquiries. The quickest way to speak to a member of our customer support team is via our website chat. You will find this in the bottom right-hand corner of our Contact Us page (https://psychiatry-uk.com/contact-us/). They will be able to help you with your query.
Hi
I’ve already been diagnosed with adhd twice once by yourselves and once by the adhd centre. I was at the end of my titration but got discharged because I missed a few appointments by accident (I was on paramedic placement at university alternating between day shifts and nightshifts and got my days mixed up and missed my end of titration review) my doctor said she’ll refer me again but I haven’t heard back since. It’s been a few months off of medication and I tried treating my adhd naturally but I’m really struggling. I tried really hard but I’m struggling to manage my responsibilities both at home and at university. Is there a way I could continue treatment with yourselves? Thank you
Hi Sadhia – Thank you for getting in touch. Unfortunately, our website blog is managed by our Communications Team and we are unable to respond to patient enquiries. The quickest way to speak to a member of our customer support team is via our website chat. You will find this in the bottom right-hand corner of our Contact Us page (https://psychiatry-uk.com/contact-us/). Our web chat team will be able to help you with your query.
hi, i was diagnosed with adhd through this service back in 2021 and through that i was about to go through with the titration process. However, when it came to it i realised i couldn’t afford the prescription at the time due to being a student. right now im working and im wanting to go through that titration process as i can afford it. i tried to sign in to my account but i saw that it was deactivated. is there any way i can get in contact with someone to help me with this ? i talked with my gp and there is no local adhd service here. please any advice would be appreciated thank you!.
Hi Mohammed – Thank you for getting in touch. Unfortunately, our website blog is managed by our Communications Team and we are unable to respond to patient enquiries. The quickest way to speak to a member of our customer support team is via our website chat. You will find this in the bottom right-hand corner of our Contact Us page (https://psychiatry-uk.com/contact-us/). They will be able to help you with your query.