ADHD medication: a complete UK guide

Deciding about ADHD medication can bring up real questions. You might wonder what taking a daily medicine feels like, what people will think, or whether it’ll change who you are. Wanting a clear map before you see a prescriber makes sense. Taking medication is your choice, never a requirement.

What is ADHD medication?

ADHD medication means prescription medicines that help you manage ADHD symptoms [2]. They can help with symptoms such as trouble concentrating or sitting still [2]. They don’t take ADHD away, though, and they’re one of several ADHD treatment options rather than the whole picture.

NICE guidance sets care standards for the NHS in England. For adults, it offers medication when ADHD still causes a significant problem in at least one area of life [1]. That offer comes after changes to your surroundings, at home or at work, have been made and reviewed [1].

Medication is an option to talk through with a prescriber, not a step you have to take. Not everyone with ADHD needs or wants to take medicine [2]. Some people try more than one medicine before they find one that works for them [2].

Which medicines are used for ADHD in the UK?

NICE guidance names five medicines for ADHD [1]. They fall into two groups, and the table shows where NICE guidance places each one.

Any of these medicines can cause side effects [1]. We do not recommend specific medication until after a full clinical assessment. Brand names, and how long each medicine lasts, are set out in ADHD medicines compared.

Stimulant ADHD medication

Stimulant medicines come in slow-release forms, taken once a day, and in standard forms [1]. Guidance favours once-daily forms because they’re convenient, avoid a dose at school or work and are harder to misuse [1]. Your prescriber talks through which form fits your day. Standard forms may suit when the dose needs more flexibility, or while it’s still being found [1]. How well a stimulant works, how long it lasts and its ADHD medication side effects vary from person to person [1]. What suits a friend is no guide to what will suit you.

Your heart rate and blood pressure are checked before and after each dose change, and every 6 months [1]. When you collect methylphenidate, you may need to prove who you are, and you must collect it within 28 days [3]. Our guides cover the best time of day to take ADHD medication and taking ADHD medication daily or only when needed.

Non-stimulant ADHD medication

Non-stimulant ADHD medication is an option when stimulants don’t suit you [1]. Adults are offered atomoxetine if they can’t tolerate lisdexamfetamine or methylphenidate, or neither helped after separate 6-week trials [1]. Children aged 5 and over and young people can be offered atomoxetine or guanfacine on the same basis [1]. Guanfacine is licensed for ages 6 to 17, and adults get it only on advice from a highly specialised service [5] [1].

In trials, suicidal thoughts and behaviour with atomoxetine were uncommon, but more frequent in under-18s than with a dummy pill [6]. So your mood is watched closely while you take it [6]. Tell your prescriber straight away about any low mood or dark thoughts. If stimulants and a non-stimulant haven’t helped, guidance suggests a second opinion or a more specialised service [1]. Our guide explains when to switch ADHD medication.

How is ADHD medication prescribed in the UK?

The route to ADHD medication runs through an ADHD specialist [2]. Before you start, a full review confirms the diagnosis and checks your heart rate, blood pressure, height and weight [1]. The aim is a safe start. Your prescriber then raises the dose in small steps, called titration, until benefits and side effects are best balanced [1]. NICE says to consider slower titration, with more checks, if you also have autism, anxiety or another mental health condition [1]. Our guides cover starting ADHD medication and the signs your dose may need changing.

Before AuDHD Psychiatry prescribes, we ask for your GP summary and blood pressure readings. Your first medication appointment lasts 45 to 60 minutes, and if medication is right for you, your first prescription is issued then. Most people then have 3 to 4 follow-ups, spaced 3 to 4 weeks apart. Our prescribing team includes a consultant psychiatrist, nurse prescribers and a senior clinical pharmacist.

Our medication pathway may suit you if:

• you’ve been diagnosed with ADHD, by us or elsewhere, and want to talk about medication.
• you can complete the safety checks before prescribing.
• you want dose changes made step by step, with regular reviews.

It might not be right today if:

• you need urgent help now. Call NHS 111 and choose the mental health option, or in Northern Ireland call Lifeline free on 0808 808 8000, any time. In an emergency, call 999 or go to A&E [7].
• you mainly want a quick prescription without monitoring.
• you already have a prescriber managing your ADHD medication.

Without a diagnosis, you’d start with an adult ADHD assessment. With one from elsewhere, you can transfer your care to us, and our adult medication pathway shows each step.

What is a shared care agreement?

A shared care agreement lets your GP take over prescribing from the specialist [2]. Under the agreement, the specialist and your GP share responsibility and agree who does what. Once your dose is stable, guidance says prescribing and monitoring should move to shared care with your GP practice [1].

Shared care is always your GP’s decision, so it can’t be guaranteed. If your GP doesn’t accept shared care, we carry on prescribing for you privately. If your GP does take over, the NHS prescription rules where you live apply.

Either way, your treatment keeps being checked. ADHD medication should be reviewed at least once a year, including whether to carry on [1]. We review adults’ medication every 6 months. Our guide explains how to pause or stop ADHD medication safely, with your prescriber.

ADHD medication when you’re also autistic

Autistic people with ADHD get the same medication choices as anyone with ADHD [1]. Your prescriber may move through dose changes more slowly, with more frequent checks [1]. So the titration stage can take longer, with more conversations along the way.

It helps to tell your prescriber about sensory sensitivities, routines you rely on and any change in appetite or sleep. Details like these help your prescriber judge how each dose is going. No medicine treats autism itself, so we’ve a separate guide to autism treatment and support. If you haven’t been diagnosed with either condition, you can be assessed for ADHD and autism together at AuDHD Psychiatry.

Can you take ADHD medication with sertraline or other medicines?

Your prescriber checks first whether ADHD medication can be taken with sertraline or another antidepressant [8]. Sertraline is an antidepressant, an SSRI (selective serotonin reuptake inhibitor), used for depression, OCD, panic disorder, PTSD and social anxiety [9]. It isn’t one of the five ADHD medicines above [1]. Anxiety doesn’t narrow your ADHD options, as guidance offers the same choices to people with an anxiety disorder [1].

A few combinations need care. With methylphenidate, tell your prescriber about any medicine for depression or another mental health condition [8]. It must not be taken with MAOI antidepressants, or within 14 days of stopping them, because blood pressure can suddenly rise [8]. Other pairings need care too. Serotonin syndrome, a rare but serious reaction, has been reported when amfetamine medicines such as lisdexamfetamine are taken with SSRIs [10]. Some SSRIs, such as fluoxetine and paroxetine, raise atomoxetine levels, so a lower dose may be needed [6].

Before your medication appointment, list every medicine, supplement and remedy you take. Never stop an antidepressant on your own to start ADHD medication.

What’s different for children?

For children aged 5 and over, methylphenidate is the usual starting point in NICE guidance [1]. During treatment, a child’s height is measured every 6 months and plotted on a growth chart, along with their weight [1]. Our child pathway is for children aged 6 to 17 with an ADHD diagnosis from us or a partner clinic. Children and teenagers may need to try more than one medicine before one suits them [11]. So an early change of medicine is part of the process, not a sign that something has gone wrong. Our page on ADHD medication for children covers the child pathway, its reviews and its fees in full.

What appointments does ADHD medication involve?

ADHD medication involves a first appointment, follow-ups, repeat prescriptions and regular reviews. In order, you can expect:

• an initial medication appointment with a prescriber, after your assessment or a review of your existing diagnosis.
• follow-up appointments during titration, to check how you’re responding, look at side effects and adjust the dose.
• repeat prescriptions once your dose is stable and unchanged.
• medication reviews, every 6 months for adults.

The medicine itself is paid for at the pharmacy, and the amount depends on the brand, dose and pharmacy. If your GP takes over under shared care, you pay us only for your reviews. Each appointment has its own fee, set out on our page about what medication costs. If your pharmacy can’t supply your medicine, our guide explains what to do in an ADHD medication shortage.

Questions people ask

In short

ADHD medicines come in two groups, stimulants and non-stimulants, and an ADHD specialist starts them. Your dose then rises step by step, with health checks at each stage. Once things are steady, your GP may take over under shared care. Other conditions and other medicines are always part of the picture. If you’d like to ask AuDHD Psychiatry a question first, a free 15-minute call is an information call, not an assessment.