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The Effra Clinic - Resources

Resources

What to Expect:
Starting Treatment for Adult ADHD at the Effra Clinic

See the FAQ section of the Effra Clinic website for more information.

Welcome to the Effra Clinic. We understand that beginning treatment for Adult Attention Deficit Hyperactivity Disorder (ADHD) can feel like a big step. This guide is designed to provide you with essential information to help you navigate this process.

Overview of Treatment:

Stimulant medications are commonly prescribed to manage symptoms of ADHD. These medications work by increasing the levels of certain neurotransmitters in the brain, helping to improve focus, attention, and impulse control.

 

Short video on the mechanism of action of methylphenidate in the brain

 

It is recommended that medication for ADHD is part of a comprehensive treatment package which could include psychotherapy, education about ADHD and lifestyle changes (https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/)

 

Stimulants include:

 

  • Methylphenidate (which comes as Ritalin, Medikinet, Tranquilyn, Equasym, Affenid XL, Concerta XL, Delmosart, Matoride XL, Xaggitin XL, and Xenidate XL) 
    For more information: https://www.nhs.uk/medicines/methylphenidate-adults/

  • Dexamfetamine (which comes as Amfexa)

  • Lisdexamfetamine (Elvanse, Elvanse Adult)
     

Methylphenidate and lisdexamfetamine are first line treatment for adults diagnosed with ADHD and recommended by the National Institute for Health and Care Excellence (NICE). 

Licensed and off license use of medication to treat ADHD:

  • Lisdexamfetamine is licensed for use in adults with ADHD.

  • Concerta XL is licensed for use in adults with ADHD if methylphenidate was started in childhood with good effect.


​The other formulations of methylphenidate and dexamfetamine are prescribed off license for adults with ADHD. 

 

Off license or off-label use means that the medicine isn't licensed for treatment of your condition. But the medicine will have a licence to treat another condition and will have undergone clinical trials for this. Your psychiatrist may recommend an unlicensed medication if they think it will treat your condition effectively and the benefits are greater than any risks. In this case methylphenidate and dexamfetamine are licensed for use in children with ADHD but not in adults.

 

Other medication for ADHD:

 

As well as stimulant treatment, your psychiatrist has the option of prescribing non-stimulant treatment which may include atomoxetine and guanfacine MR. Of those only atomoxetine is licensed for use in adult ADHD. 

 

Sometimes there may be other medications used for ADHD and if your psychiatrist recommends these, they will discuss this with you in detail.

Costs Involved:

We are aware that undertaking a course of treatment privately can be daunting with respect to costs involved and while each course of treatment will be different there is some broad guidance we can offer.

 

During the titration phase of treatment (when medication is initiated and dose adjusted), we recommend at least monthly  follow up appointments with your psychiatrist (which can in person or online), (information about fees).

 

Your prescription will be provided at no additional cost during the appointment, but you will need to pay for medication prescribed. The amount will vary for pharmacy to pharmacy as they will charge a dispensing fee. For information, the British National Formulary (BNF) gives information about the drug tariff price which gives a broad indication of the cost of medication  (for example for lisdexamfetamine). 

 

If prescriptions need to be issued between appointments, there will be an administrative fee incurred (information about fees) and you will need to allow at least 5 working days before you run out. You can request a prescription by completing the form on our website.

 

Once you have been stabilised on treatment, you may want to continue to receive medication and follow up from the Effra Clinic and  in this case we usually recommend that you have follow up appointments on a 3 monthly basis. 

 

Alternatively once you are stable on treatment, we can liaise with your GP regarding shared care arrangements which would mean that you receive your prescription via the GP and at a minimum you would need to have an annual review in the Effra Clinic. 

 

Please note that we cannot guarantee that your GP will accept a shared care agreement and if this is important for your treatment, we recommend that you discuss ongoing prescribing with your GP before you start treatment.

Use of Alcohol, Caffeine, and Recreational Drugs:

It is essential to discuss the use of alcohol, caffeine, and recreational drugs with your prescribing psychiatrist. While moderate alcohol and caffeine consumption may be permissible for some patients, it's crucial to understand how these substances may interact with your medication. 

 

The use of alcohol while being prescribed stimulants may mean that the effect of alcohol is masked or more unpredictable.  

 

The use of caffeine while being prescribed stimulants can lead to increased level of side effects due to the combination of the stimulant effect of caffeine with the effect of the stimulant.

 

Recreational drug use can have serious consequences when combined with stimulant medications and should be avoided.

Side Effects of stimulants:

As with any medication, stimulants can cause side effects. Common side effects may include:

 

Decreased appetite

Difficulty sleeping

Increased heart rate and raised blood pressure

Headaches

Irritability or mood swings

Dry mouth

‘Crash’ or rebound tiredness, lethargy and irritability as the medication leaves your body

 

Most side effects are mild and tend to diminish over time as your body adjusts to the medication. However, if you experience severe or persistent side effects, it's essential to contact your prescribing psychiatrist promptly via email at maria@effraclinic.co.uk.

 

Your psychiatrist with review with you whether you have been experiencing side effects when you are seen for follow up.

 

Further details about risk and side effects of the medications we use to treat ADHD can be found at https://www.medicines.org.uk/emc#gref

Home blood pressure monitoring during initiation and titration of ADHD medication.

 

Stimulants (including methylphenidate, dexamfetamine and lisdexamfetamine) and atomoxetine have the potential side effect of raising blood pressure and pulse during treatment and for this reason they should be monitored during treatment. This can often be done at home and this document provides some information about how to do this safety (see below) 

 

Before starting treatment

 

At assessment a detailed history will have been taken to determine if there are any physical health,  reasons not to use stimulants. If there were concerns about the use of stimulants, your psychiatrist will have discussed these with you. 

 

If you or your family have a significant history of heart problems and you have not mentioned this to your psychiatrist,  it is recommended that you do so before starting treatment (in particular if you have ever been told by a doctor that you have heart disease, high blood pressure or a heart murmur;  if a member of your family  had heart disease below the age of 60 or there is a history of sudden death below age 40 in your family).

 

In some instances, further investigations including blood tests and ECG are recommended however this does not need to be done routinely.

 

Before starting treatment, you will need to have baseline physical observations done and shared with your psychiatrist. These can be done at your GP surgery, at a pharmacy or at home (see below for guidance to do home monitoring)

 

When to check blood pressure and pulse. 

 

Please have readings to hand for all appointments with your psychiatrist:

At baseline:                                                       3 readings taken at the same time of day on 3 different days

During the titration phase of treatment:        On day 2 of treatment

                                                                           Then every 2 weeks

                                                                           Day before any clinic appointment

Once treatment is stabilised:                          Every 3 months

Throughout treatment, you should contact your psychiatrist if you experience any emerging cardiovascular symptoms (eg, chest pain, prolonged palpitations, and breathing difficulties), or any other concerning symptoms.

 

Guidance on checking blood pressure at home

  • Use a validated home blood pressure monitor and the right sized cuff 

  • Take the BP at least 2 hours after taking a dose

  • Sit down for 10-15 minutes before taking the reading

  • Take the reading on the left arm

  • Take 3 recordings and record the lowest reading

  • Try to record blood pressure at approximately the same time 

 

Interpreting your results

 

It is not unusual to get variation in your results, your blood pressure will go up and down over the course of the day. If you have an unexpectedly high reading, don’t worry, recheck after a few minutes and if it remains high for a few measurements, you may want to inform your psychiatrist.

 

Results will be reviewed in your clinic appointment with your psychiatrist so you need to have the readings to hand. If you want to send them through by email before your appointment, you are welcome to (to maria@effraclinic.co.uk)

 

Please contact your psychiatrist, if you are concerned about any readings and if either your systolic (the top number) is above 140 and/or your diastolic (the bottom) is above 90.

 

Which blood pressure monitor to buy

  • make sure it is approved for use in the UK. 

  • choose one that has been listed as validated for accuracy by the British and Irish Hypertension Society (BIHS). 

  • Use a digital monitor

  • Use a monitor with an upper arm cuff (rather than a wrist cuff)

  • Check you have a cuff of the right size (standard or large adult)

 

A good monitor we recommend 

 

Practical advice from British Heart Foundation about checking your blood pressure at home.

Adult ADHD
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