ADHD Medication - UK Alternatives to Adderall

ADHD Medications in the UK – What Are Your Options?

If you’re an adult with ADHD and wondering about your options for medication in the UK, you’re not alone. The availability of ADHD treatments varies from country to country, and the UK offers a selection that falls between Europe’s limited options and the broader range available in the USA.

ADHD Medications in the UK

Since ADHD (previously called ADD) became a recognized diagnosis in the 1980s, medication options have significantly expanded. If you’re considering medication, you’ll need to consult a psychiatrist, as they are the only mental health professionals who can provide an official diagnosis and prescribe treatment.

Licensed vs. Unlicensed ADHD Medications

A licensed medication is one that has undergone research trials approved by a UK regulatory body. An unlicensed medication might not have been fully tested within the UK, but more often, it refers to medications that are either imported or prescribed for conditions beyond their original purpose.

In the case of ADHD, unlicensed medications are often those approved in other countries but not formally licensed in the UK. These tend to be more expensive and are more commonly available through private psychiatrists rather than the NHS.

[Learn more in the NHS “Guide to Unlicensed and Off-Label Medications.”]

Stimulant Medications in the UK

ADHD medications fall into two categories: stimulants and non-stimulants.

Stimulants have been used the longest for ADHD treatment and are typically the first-line option unless a person’s health history suggests otherwise. They work by increasing activity in brain areas responsible for focus and action.

One of the benefits of stimulants is that they take effect immediately. They are available in short-acting (immediate release) and long-acting (modified release) forms. If you’re new to ADHD medication and feeling uncertain, a short-acting option can help you get an idea of how it affects you.

There are two main types of stimulant medications used for ADHD:

1. Methylphenidate-based medications (e.g., Ritalin)
2. Amphetamine-based medications (e.g., Adderall)

Methylphenidate-Based Medications

Methylphenidates are the most commonly prescribed ADHD medications in the UK and across Europe. Their full scientific name is methylphenidate hydrochloride. Short-acting versions last around two to three hours.

Ritalin is one of the most well-known methylphenidate medications. However, in the UK, it is only licensed for children over six, not for adults.

Licensed methylphenidate options in the UK include:

• Generic methylphenidate
• Concerta XL
• Delmosart prolonged release
• Eqasym XL
• Medikinet XL
• Xaggitin XL

It’s important to note that doses exceeding 60 mg daily (or 54 mg for Concerta XL) are not licensed.

Side effects of methylphenidate medications:
Common side effects include increased heart rate, elevated blood pressure, trouble sleeping, stomach issues, headaches, appetite loss, and jaw clenching or teeth grinding. In some cases, people experience mood shifts, agitation, or a return of past physical tics. Very rarely, these medications can cause psychosis.

Amphetamine-Based Medications

Amphetamine salts contain either dexamfetamine or lisdexamfetamine.

Lisdexamfetamine is licensed in the UK and is often the next option if methylphenidates are ineffective. If someone does not tolerate lisdexamfetamine well, they may be offered generic dexamfetamine instead.

Off-license amphetamine options include:

• Adderall (only available as extended-release; the instant-release version used in the US is not available).

Lisdexamfetamine is not typically prescribed to individuals with a dual diagnosis of bipolar disorder or substance abuse issues. Additionally, amphetamine-based ADHD medications are illegal in many European countries, so if you travel, be sure to carry a doctor’s note.

Side effects of amphetamine medications:
Unlike methylphenidates, which often cause an energetic buzz, amphetamines can sometimes lead to drowsiness and dizziness. Other common side effects include nausea and diarrhea.

Non-Stimulant ADHD Medication in the UK

There is one commonly prescribed non-stimulant ADHD medication in the UK: Atomoxetine.

Atomoxetine

Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that works by increasing noradrenaline levels in the brain. This helps improve concentration by reducing impulsivity.

Unlike stimulant medications, which take effect quickly, atomoxetine requires several weeks before noticeable improvements occur, much like antidepressants.

Side effects of atomoxetine:
Common side effects include stomach cramps and diarrhea. More serious risks include suicidal thoughts or self-harm tendencies, as well as potential liver damage. Because of these risks, atomoxetine is usually only prescribed when stimulants have proven ineffective.

Other Unlicensed ADHD Medication Options

Some UK psychiatrists may prescribe other medications off-license for adult ADHD, including:

• Modafinil
• The antidepressant Venlafaxine
• Bupropion hydrochloride
• Tricyclic antidepressants

These options are not officially recommended by the NHS or the UK’s National Institute for Health and Care Excellence (NICE).

ADHD Medications Available on the NHS

If you seek ADHD treatment through the NHS, the following medications are available:

• Methylphenidate
• Dexamfetamine
• Lisdexamfetamine
• Atomoxetine

NHS practitioners follow NICE guidelines when prescribing these medications.

NICE Guidelines for ADHD Medication

In the UK, ADHD diagnosis and treatment recommendations are based on guidelines from the National Institute for Health and Care Excellence (NICE). These guidelines incorporate research from both the Diagnostic and Statistical Manual of Mental Disorders (DSM), used in the USA, and the International Classification of Diseases (ICD), published by the World Health Organization (WHO).

NICE currently recommends the following treatment plan for adults with ADHD:

1. Lisdexamfetamine or methylphenidate should be the first treatment offered.
2. If methylphenidate does not show benefits after six weeks, switch to lisdexamfetamine (or vice versa).
3. If lisdexamfetamine is effective but its long duration is problematic, dexamfetamine may be considered.
4. Atomoxetine should only be prescribed if stimulants are ineffective or poorly tolerated.

Factors to Consider When Choosing ADHD Medication

• Do I focus better when stimulated (e.g., after coffee), or when relaxed (e.g., after meditation)?
• Do I want to take medication daily or only on workdays? (Some require tapering and cannot be stopped suddenly).
• Do I prefer medication that lasts all day or just part of the day?
• Do I have any pre-existing health conditions that could affect my choice?
• Will my chosen medication be available through the NHS, or will I need a private prescription?

The Most Important Thing to Remember

Taking medication for ADHD is a personal choice. No psychiatrist should pressure you into taking medication if you are not comfortable with it.

While medication is the primary treatment option for adults in the UK, it is not the only option. Talk therapy is also highly recommended, as ADHD medications manage symptoms but do not address long-term coping mechanisms. Some individuals choose therapy first and decide on medication later, while others opt for therapy alone.

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