Finding the right ADHD medication
Once diagnosed you may be offered medication. The more experienced psychiatrists would agree that finding the right medication and the right dose can take from a few weeks to many months. If your specialist considers all medications to be the same it’s not a good sign! The three main drugs offered for adults are:
These medications vary a lot and even medications from the same family like methylphenidate: Concerta, Medikinet, Ritalin, Equasym – may affect you differently, the compositions are not identical and the fillers and dispersal methods vary.
UK NHS specialists tend to prefer to prescribe Methylphenidate first, Atomoxetine (Straterra) second and Dexamfetamine last. Which is odd since Dexamfetamine has the edge in clinical effectiveness with Methylphenidate second and Atomoxetine last. Unfortunately, many UK ADHD specialists don’t plan for lengthy titration periods, so if your initial medication does not work – be prepared to push to try out another
New med on the block: lisdexamfetamine
If methylphenidate based medications like Ritalin or Concerta don’t work well for you, then you could ask to try out a new dexamfetamine variant called lisdexamfetamine. Doctors often irrationally fear dexamfetamine, which I have never really understood from the clinical evidence. GPs seem unconcerned when regular painkillers like aspirin kill thousands every year but are horrified by dex! In large part they are heavily influenced by the UK prescribing regulations, that deem dexamfetamine more dangerous and open to abuse. Consequently, doctors have to sign especially restrictive prescription forms for dexamfetamine based drugs.
Lisdexamfetamine is considerably safer than regular dexamfetamine. The manufacturers, Shire, link a lysine molecule to the dexamfetamine molecule rendering it inactive until digested. No option to sniff or inject it and a far smoother and longer action. Brand name in USA is Vyvanse and in Europe, it’s Elvance, a slow release dexamfetamine medication in a non-abusable form and licenced for children only (as usual) in Europe.
Off-label prescription
To date, most ADHD medications, are prescribed to adults “off-label”, not using the drug as designed/ licensed. Since almost all ADHD meds are only licensed for children, it means the GP has to bear some additional unwanted responsibility. A “shared care” agreement allows your specialist ADHD psychiatrist to shoulder responsibility, usually GPs demand one. See as example North Bristol Adult ADHD Shared Care Guidelines.
ADHD medication journal
It’s hard to judge how the medications are affecting you, as obviously you are actively changed by their effect. We vary so much day to day, ADHD medication may make you feel like you are having an effective day but not outside your normal bounds. Daily changes in sleep, diet and mood can hide immediate benefits, so persist and assess over weeks not days. Don’t rush to find the ideal dose, take your time to see the subtle effects.
Try keeping an “ADHD medication journal”, give yourself marks out of five on sleep, mood, focus, procrastination, but make some specific to your personal needs from the medication, e.g. hours spent on report or no. times distracted. That way you can track progress more accurately and less forgetfully! Ask for meds feedback from friends and relatives, their responses may surprise you, they may see more improvements than you do – after all, perfectionism is a key part of ADHD!
When you have your next psychiatric consultation about your dose, you will be clearer and more convincing. If you can show your psychiatrist your daily medication trends, it will lead to you more efficiently and effectively finding the best drug and dosage.
