During your assessment with the Consultant, you may discuss whether medication would be appropriate to help you manage your ADHD symptoms. If you decide that you might find this beneficial, you will be referred to our Titration Team.
Titration is the process that introduces your body to medication safely. During this period you will have regular contact with your prescriber, who will adjust and monitor the treatment until you reach a stable or ‘optimised’ dose to help you achieve the maximum benefit with minimum side effects.
What does the process involve?
You will have an Initial Assessment with one of our Consultants. If they believe that you would benefit from receiving ADHD medication then your name will be put on our Titration waiting list (See here for waiting times).
When you reach the top of that list one of our prescribers will get in contact with you via the patient portal to introduce you to the process and give you some background information.
Your feedback and observations are an essential part of the process
Before starting your medication, we will ask you to send in some baseline observations including your blood pressure, pulse and weight. You may also be asked to send in the results of an ECG and/or blood tests if these have been advised by your assessing consultant. Your Consultant will have written to your GP to request these, but it often helps if you can contact them directly to make the arrangements go more smoothly.
During the titration process, you will be asked to monitor and record your blood pressure, pulse and weight on a weekly basis, reporting it back to your prescriber towards the end of each four-week prescription period, so you may find it helpful to purchase a blood pressure monitor to keep at home.
Once your baseline information has been received, it will be reviewed by your titration prescriber and if your observations are within a normal range you will be ready to start the treatment process.
Receiving your medication
At this stage we will send out your first prescription, together with a treatment plan, which will give guidance on how and when to take the medication. You will also receive a Response to Treatment Form, where you will be required to record your blood pressure, pulse and weight on a weekly basis, returning it to us towards the end of each four-weekly prescribing period.
The guidance we send will contain details of how to check your blood pressure, and what to do if it is outside the normal range. If you are ever unsure or feel that you need more support during this process, you can contact the team at any time via your portal.
In Week 3, we will ask you to complete an Adult ADHD Self-Report Scale (ASRS), which is included in your Response to Treatment Form. If there is anything of concern in your updates, we will get in touch.
In Week 4 we will review your progress and, if everything is going smoothly, we will send out your second month’s prescription. This may be a continuation of your current treatment titration, or we may need to make some adjustments to your treatment plan.
End of Titration Review
Once you have begun titration, the process typically takes 8-12 weeks. This allows your body to adjust to the new medication and find your optimal dose. This means that you will feel maximum treatment effects from your medication with minimum side effects.
At this stage, you will be referred back to your assessing Consultant for an End of Titration Review.
If your Consultant is happy that your treatment is now stabilised, they will write to your GP to recommend that your prescription be continued under a Shared Care Agreement. 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 six-monthly basis by your GP. You will also be offered an annual review by Psychiatry-UK (PUK) – or perhaps by another service, such as your local NHS team.
At the end of the first year, you may be invited back for review by your PUK Consultant to check that everything remains stable and that you are still receiving the maximum benefit from your medication, with continuation of as few side-effects as possible.
Can I receive titration through my GP?
Right to Choose Patients
If you live in England and have been referred to PUK via the NHS Right to Choose (RTC) scheme, we are bound by the guidelines of the National Institute for Health and Care Excellence (NICE) to ensure that any medicine you receive is issued by a specialist ADHD titration service.
Your prescription will be delivered by our private online pharmacy, PPG, and you will only be required to pay the standard NHS prescription fee.
Private Patients or ICB Referrals
If you have been referred by your GP and your assessment is being funded by your local Integrated Care Board (ICB), or if you are a private patient, you can choose which pharmacy to use.
Why are waiting times longer than usual at PUK?
In December 2020, PUK became a designated RTC provider for mental health assessment. This resulted in an unanticipated influx of new patients accessing its ADHD services.
We are in the midst of a recruitment drive to engage new Titration Team prescribers to bring down waiting times, as well as recruiting Agency staff to reduce the waiting list as quickly as we can. In fact, our team will increase from four just 18 months ago to 40 members in the coming weeks and months. We ask if you would please bear with us while new team members complete the required onboarding and training processes. Our aim is to increase our capacity to be able to reduce waiting times to a minimum over the course of the next six months.
Why do waiting times vary?
When your referral is picked up by our Titration Team, you will be given a latest date for the start of your titration. At this stage, it is difficult for us to give you an exact start date as the titration period varies from patient to patient, making it difficult to assess how quickly you will move up the list. However, as we increase the capacity of our unit over the next few months, waiting times will reduce and we are doing everything in our power to get this process moving as quickly as possible.
Kate Bevan, Titration Team Lead