Treatment for ADHD
Managing your ADHD symptoms
If you receive an ADHD diagnosis, your doctor may prescribe medication to help you manage your ADHD symptoms.
Non-pharmacological treatments, such as coaching or therapy, are also effective in tackling some of the symptoms of ADHD. Your doctor may recommend a combination of both types of treatment.
Please note: Psychiatry UK does not currently offer non-pharmacological treatments. You will need to make an appointment with your GP to discuss options available in your local area.
Treatment options
What are the choices?
There are 2 broad types of medication used to treat ADHD symptoms: stimulant and non-stimulant medications.
Stimulants are the first-line treatment. The response rate is around 70-80% for the management of ADHD. However, it is important to bear in mind that every person responds to medication differently; while some people will feel benefits, not everyone will respond in the same way.
What are the differences between stimulant and non-stimulant medications?
Stimulants
Stimulants work for the time that they are in your body. Their effect will wear off during the day, and the dosage is therefore usually designed to fit with your work or school hours.
Examples of stimulant medications:
- Lisdexamfetamine (e.g. Elvanse)
- Methylphenidate (e.g. Xaggitin XL, Delmosart MR, Concerta XL, Equasym XL, Meflynate XL, Medikinet XL)
Although Lisdexamfetamine and Methylphenidate both work to increase the same chemicals in the brain, they work in a slightly different way. In practice, this means that some adults may respond to either medication well, but may find one or other slightly more effective or easier to tolerate.
Both stimulants come in two versions:
- Prolonged release (release over an 8-12 hour period)
- Immediate release (release over a 4-6 hour period
NICE guidelines always recommend to trial prolonged release medications first, as the dosage is one per day and has a smoother release.
Non-stimulants
Non-stimulant medications tend to be effective all-day-long, but it might take longer to feel their full effect.
They need to be taken every day, whereas stimulants can be taken just on week/work/school days.
Examples of non-stimulant medications:
- Atomoxetine
- Guanfacine
Visit the Choice and Medication website for more information.
Your prescriber will also be able to give you more information when you are undergoing titration.
How will medication be prescribed?
If medication is recommended, you will be referred to our Titration Service to initiate your treatment.
If your first medication does not agree with you, or is ineffective, you may decide to try others. It can take up to 3 months to find a medication dose that balances maximum effectiveness in treating ADHD, while causing the fewest possible side effects.
Please note: Since becoming a Right to Choose provider, we have seen a sharp rise in the number of referrals received. We are doing everything we can to recruit more nurse prescribers and ask you to please bear with us while we onboard new staff as quickly as possible to minimise delays.
Please refer to our current ADHD titration wait times.
The importance of non-pharmacological interventions
- Non-pharmacological treatment can be used alongside or instead of medication.
- Specialist coaching and therapies such as Cognitive Behaviour Therapy (CBT) can help you recognise and build on your strengths and develop helpful ways to manage the symptoms that cause you problems.
- Therapy can also help you manage associated conditions such as depression and anxiety.
What is titration?
Titration is the process of slowly increasing the dose of a medication by very small amounts over days, weeks or months, to find the perfect dose for you. We will be looking for the dose which provides the most effective treatment at the lowest dose possible, without causing excessive side effects.
The titration process
- Titration requires careful monitoring to introduce your body safely to your new medication. You will be required to submit your weight, blood pressure (BP) and pulse readings, both at the start and regularly during the titration process. Download our guide to taking your blood pressure.
- If the readings fluctuate, or are cause for concern, we may ask for further investigations, such as an ECG or input from a cardiologist, before we can continue prescribing. We understand that it can be frustrating if your medication is delayed or stopped, but please understand that this is for your personal safety.
When to order
- Please submit your prescription request 7-10 days before you are due to run out.
- You are responsible for ordering your prescriptions. We understand that it can be difficult for people with ADHD to remember to place repeat orders, but we are unable to send out reminders due to the number of people under our care.
- We recommend adding a recurrent reminder to your calendar – perhaps on your phone – to remind you when it is time to place a new prescription request.
How does it work?
- Submit a note to your prescriber via your MedQare portal requesting a new prescription. You will be required to fill out a form to ensure that your address and GP details are up to date.
- A prescription will be sent via Royal Mail to our partner pharmacy, The Private Pharmacy (TPP), unless you request otherwise.
- The medication will be delivered to your home address by our courier service.
Treatment under Right to Choose (RTC)
Treatment under Right to Choose is funded by your local Integrated Care Board (ICB) and allows patients to have medication treatment only.
If you or your doctor decide that a non-pharmacological pathway is more suitable to manage your ADHD, you will need to arrange an appointment with your GP to discuss the options available in your local area.
Titration: How it works
Titration with Psychiatry UK typically takes 8-12 weeks.
During this period, you will be asked to:
- Submit forms that record your blood pressure, pulse and weight every week throughout the titration process
- Submit an Adult ADHD Self-Report Scale (ASRS) every 3 weeks
- Respond promptly to any queries from your prescriber
Our titration model follows a strict schedule to ensure that patients who are on our waiting lists can be seen as quickly as possible.
If you are unable to complete a form due to unforeseen circumstances (e.g. you are going on holiday, or having a planned surgical procedure), you must let your prescriber know about this in advance, so that it can be planned into the process for you.
Early Discharge
If you miss a weekly monitoring form update on three occasions, your prescriber will undertake a clinical review of your case, after which you may be discharged.
If the decision is made to discharge you from our titration service, you will be fully informed about how to discontinue medication safely and seek a re-referral, if this is something you would like to pursue.
Useful Tips
- Download the Psychiatry UK Companion App (available from the App Store (Apple) or Google Play (Android)) to receive notifications when new forms are added to your portal
- Add a weekly calendar reminder or alarm on your phone to remind you to check your portal for the latest forms
Support Resources
If you are discharged from our service early, you may find the resources below helpful. They provide details of charities and organisations that provide support, forums and advice for people who have received an ADHD or ASD diagnosis.
ADHD Discharge Support Resources
Frequently Asked Questions
NICE guidelines recommend that treatment for ADHD is commenced by a specialist ADHD clinician. Not all GPs have the knowledge to prescribe and titrate ADHD medications, and some prefer not to carry out this process.
The titration process typically takes 8-12 weeks to allow your body to adjust to the new medication and find the optimal dose for you to feel maximum treatment effects with minimal side effects.
At this stage, you will receive an end-of-titration review, and a letter will be sent to your GP recommending that your prescription be continued under a Shared Care Agreement (SCA). This means that ongoing prescriptions will be issued by your GP surgery, and there will be an expectation that your medication will be reviewed on a 6-monthly basis by your GP.
You will also be offered an annual review by Psychiatry UK – or another service, such as your local NHS team.
The Titration Service does not work within an appointment booking format. When you reach the top of our waiting list a titrating prescriber will contact you via the MedQare portal, so please ensure you check your portal regularly for notifications.
When your treatment begins, you will be asked to complete a weekly feedback form to let your prescriber know how you are responding to the medication and monitor any problems along the way.
Your prescriber will communicate with you through notes left on the portal. This allows you to exchange information flexibly through the course of your treatment without having to take time away from your working day or usual routines.
Before starting your medication, we will ask you to provide a health update and to send in your baseline weight, height, blood pressure and pulse readings. If advised by your doctor, you may also be asked to provide the results of an ECG and/or blood tests.
If you are an NHS or RTC patient, you can request for a blood pressure monitor to be sent to you at home to be able to record your observations.
During the titration process, you will be required to complete a weekly medication monitoring form, recording your latest weight, blood pressure and pulse readings. You will also be asked to provide information about the way you are responding to the medication and let us know if you are experiencing any problems.
Treatment under the Right to Choose (RTC) scheme will be provided by the NHS, with no charge to you.
If you order your prescription through our partner pharmacy, PPG, it may take around 7 days for your medication to be issued.
Your prescription will be sent via Royal Mail to the pharmacy for processing, and they will arrange for your medication to be delivered to your home via our approved courier service.
This process can sometimes take longer if there is any disruption to Royal Mail’s delivery service, and we therefore advise you to request your prescription 7-10 days before you are due to run out of medication.
Your first prescription will be sent out with a treatment plan, which will give guidance on how and when to take the medication.
Your treatment may be stopped if there is a change in your physical or mental health which indicates that it may not be safe for you to continue with your medication. Your safety is a priority and the reasons for stopping your medication will be explained by your titrating prescriber or doctor.
For your own safety you should never take medication that has not been prescribed for you.
When a controlled drug is prescribed, it is prescribed to a specific person. It is not safe to take anyone else’s medication.
The doctor or prescriber will have checked for any potential contraindications (situations in which the drug will not be safe) and cleared you to take the medication. Anyone else who takes the medication will not be able to rely on the medication being safe for them.
Your doctor or prescriber will also tailor the dose to the needs of the person being treated. For these reasons, it is very important to adhere to the guidelines issued with the medication.
No. We are a remote service provider, so when you reach the top of our titration waiting list a titrating prescriber will send a welcome letter via the MedQare portal.
You will be notified via SMS and email that you have a message waiting on your portal. Please ensure that you respond promptly.
Unfortunately, we are not able to expedite the prescription and delivery process if you run out of your medication before your new prescription is delivered.
We recommend you request your prescription 7-10 days before you are due to run out of medication.
To speak to our pharmacy, TPP, please call: 0330 124 4305.
We are only insured to carry out titration for patients who are residing in the UK. If you are living abroad, we will not be able to titrate for you. Our partner pharmacy is also unable to send medication outside the UK.
Psychiatry UK is a remote titration service provider, meaning that all messaging is carried out online via the MedQare portal.
If it is difficult for you to communicate online, Psychiatry UK may not be the most appropriate service provider for you. Speak to your GP about your concerns.
We aim to respond to portal messages within 5 working days. Any updates to our response times will be communicated on the MedQare patient portal.
We appreciate your understanding that due to the high number of patients under our care, we may not always respond to patient requests immediately. Occasionally, your note may need to be forwarded to your doctor, which could result in a slightly longer response time.
For urgent matters, please consider contacting us via our Virtual Assistant service (Mon-Fri: 8am-6pm).
Please note: While we endeavour to provide timely assistance, we are not an emergency service and cannot offer emergency medical services for urgent or crisis situations, or for patients who are acutely ill.
Some of our patients are experiencing additional delays in the prescribing of medication for ADHD due to global drug shortages. Please download the latest Update Regarding National ADHD Medication Shortage for further information. This information is updated regularly.
ADHD is a condition that can persist into adulthood, contrary to the outdated belief that it only affects children. Despite this, many medications for ADHD are still only licensed for use in children, and the patient information leaflets have not been updated to reflect current knowledge.
NICE Guidelines and Unlicensed Use
In the UK, the NICE guidelines recommend several pharmacological treatments for adults with ADHD. These include:
- Methylphenidate: This is the first-line treatment and includes various formulations such as Xaggitin XL, Concerta XL, Medikinet XL, Equasym XL, and short-release methylphenidate.
- Lisdexamfetamine: Recommended if methylphenidate is not effective or tolerated.
- Dexamfetamine: Considered if lisdexamfetamine is not tolerated due to prolonged effect.
- Atomoxetine: An alternative for those who are not clinically suitable for or cannot tolerate stimulants or if there is a risk of misuse.
- Guanfacine: Third line option, particularly if other treatments are not suitable.
Unlicensed Use of Medications
While these medications are primarily licensed for children, they are commonly prescribed off-label for adults based on clinical guidelines and evidence of their effectiveness. This practice is known as unlicensed or off-label use. It is important to understand that:
- Unlicensed use means the medication is not officially approved for a specific age group or condition, but it is prescribed based on clinical judgement and guidelines.
- Safety and efficacy: The safety and efficacy of these medications for adults with ADHD have been supported by clinical studies and real-world use.
Further Information
For more information, please visit the NICE website or the Choice and Medication website and search for their Handy Fact Sheet: Unlicensed Uses of Licensed Medicines