View Full Version : UK Adhd medication - What's on offer?


Destracted_UK
04-30-08, 06:18 PM
Hiya

I have just unsuccessfully tried Strattera. Worked wonders for Adhd but the side effects were too much, a common thing with this drug.

So now I am trying to find out what other medications are available in the UK - and what are not. I need this information for the next time I see my doctor as we can then discuss options. It will all be done through the NHS, not private.

If you could add what is and isn't available to this thread, that would be great.

Many thanks : )

xstarchildx
04-30-08, 06:24 PM
Hiya i'm a bit the same, I'm on strattera 40 mg, the first time i was on them the side effects where awful, i have now been on them again for, this is my 3rd week and luckily i am not having the side effects as bad.

But it's not working as well as i liked, i have therfore tried to add a 20mg ritalin just as an experiment and wow i feel so different.

I'm seeing my psych this friday and i am going to ask him if it is possible to be prescribed both. Like you i don't know what i can or can't have prescribed in the u.k.

columbo
05-01-08, 10:22 AM
Hi

Firstly, in the UK, no medication is licensed for adult use. Seems crazy, but that's the current situation. Thankfully, this does not mean that the doctor can't prescribe the medication, but when he/she does, it will be 'off-label', which means the doctor bears more responsibility. This is often why many doctors seem reticent to prescribe medication to adults. However, recent guidelines (http://www.bap.org.uk/consensus/ADHD_Guidelines.pdf) from the British Association for Psychopharmacology are designed to let the doctors off the hook, so the situation is better than it was.

Basically, first line medication for ADHD can be split into 3 types.


Methylphenidate based stimulants: these include short acting meds such as Ritalin and Equasym, and the long-acting medication, Concerta. Methylphenidate works primarily on Dopamine.
Amphethamine based stimulants: in the UK this is basically Dexedrine. (Adderall and Vyvanse come under this heading, but I don't think they readily available in the UK yet). Dexedrine works on both Dopamine and Noradrenaline, but in a different way to Methylphenidate.
Non-Stimulant: this is basically Strattera which is an NRI, working primarily on Noradrenaline.

The 'normal' procedure should be to try Methylphenidate first. If that doesn't work, then try Dexedrine, then Strattera.

Then there are 'second-line' treatments that a doctor may consider, the main ones I can think of are as follows:


Bupropion: commonly known as Zyban or Wellbutrin. An anti-depressant with stimulant-like qualities. Often used to help smokers quit smoking. (Interestingly, nicotine is said to have similar effects on the brain as methylphenidate, which could explain why certain people with ADHD get hooked easily).
Reboxetine: an antidepressant which is also an NRI similar to Strattera, but some adults report that it works slightly better. This is not available in the US.
Venlafaxine: sometimes considered when there is also depression.
Tricyclic antidepressants: These have a known effect on some behavioural aspects of ADHD, such as impulsivity and hyperactivity, but not so much on attention.
Some psychiatrists may consider another type of stimulant, Modafinil, to be safe, but there were one or two reports of Steven-Johnson syndrome, a potentially fatal skin condition. There is a possibility that the risk might be overstated, but most doctors urge caution at the present.

Re: Strattera
40mg is still a low dose, and it can take a while for Strattera to start working, even as long as six months in some cases. You may want to consider giving it a bit longer.

Re: Combination treatments
Some doctors in the US have begun to combine stimulants with Straterra. There have been no controlled studies done on combined treatments, so your doctor may be unlikely to allow this. However, there are 'case-studies' done which, so far, have not presented any major risks.

Dr Kenny Handelman, a well-respected US psychiatrist and educator on ADHD, runs a teleseminar course on for parents and ADHD sufferers on medications. In it, he explains that it is now becoming common practice in the US to combine a stimulant with strattera in some cases, particularly if the stimulant is doing some good, but is causing anxiety as a side-effect. Often, the Strattera can offset the anxiety side-effect of the stimulant, and the stimulant can offset the tiredness side-effect of Strattera.

Don't be surprised though if your doctor isn't too keen, as he/she may be under the impression there could be a conflict between medications.

If he/she is unwilling to combine treatments, ask if Bupropion is worth a try, because it is an NRI (as is Strattera) but works on dopamine too (as does Ritalin). I'm oversimplifying it, but that's basically it.

Thomas E Brown has a useful article (http://www.drthomasebrown.com/research/index.html) on this too. It's about halfway down the page. Take it with you and show your doctor.

This isn't an exhaustive list, but hopefully it's a start.

Another helpful document is the draft NICE guidelines which are available here (http://www.nice.org.uk/guidance/index.jsp?action=folder&o=39061), which for the first time, mentions adults with ADHD.

Hope this helps.

Destracted_UK
05-01-08, 03:28 PM
Columbo, this is excellent!

Just the sort of thing I wanted to read. I am really glad that there are so many different types. I just hope one of them works for me!

Thanks to for the NICE link. I will read them when I am more focused.

:)

xstarchildx
05-02-08, 09:59 AM
Excellent post columbo thanks for the info, i have just seen my psych and i'm over the moon his is going to prescribe me equsym and strattera, like columbo said it isn't licensed but that doesn't stop them prescribing it. :)

Destracted_UK
05-02-08, 11:07 AM
Good to hear, let's hope it's a good mix and works for you.

Strattera was the first med I ever took. As I said, I had to stop. Since then, about 3 weeks, my Adhd has been even worse, totally full on. I can't wait to get treatment again as I know what I can be like now. And I loved it : )

xstarchildx
05-02-08, 01:03 PM
yes i hear what your saying, hope you get the help soon :)

columbo
05-19-08, 05:34 PM
This is a brief summary of my personal experience. I have now had the chance to try all three main treatment types for ADHD so I thought I'd share my comparisons. Everybody responds differently, so this may not be the way your own body responds.

I started on Concerta, was on that for 2 years, then changed to Strattera for 6 months. Now I'm on Dexedrine.


Concerta made me alert, but too anxious.
Strattera made me fairly alert eventually, and more calm, but too tired. My GP took me off it because he didn't like the look of one of my liver test results.
Dexedrine has been just right so far. I've only just started it and it's a low dose to start with. It makes me fairly alert, motivated and sociable. Friends and family like the change (they didn't like the change so much with Concerta). However, it keeps me awake at night which can make it difficult to get up in the morning. Apparently there can be a risk of addiction with Dexedrine, but I will have to wait and see.

I found it slightly easier to wake up when I was on Strattera, but I found it hard to get to sleep if I took it too late.

xstarchildx
05-19-08, 06:49 PM
Good luck with the Dexedrine, what dose are you on and what time are you taking it ?

flashboy
05-30-08, 03:48 PM
I wouldn't recommend anyone to use Venlafaxine, since it is very hard to stop taking them, if you must shift medication for some reason, my life was like hell for over two weeks after I stopped using them. I'm on Zyban now, and thinks that they are working pretty okay. I find them better than Concerta, Amphethamine or Dexamphethamine. But it is very individual what's working or not for you.
In Sweden Zyban is used as a pill for them who wants to quit smoking, so I was a bit surprised when my doctor told me she wanted me to try them instead.

columbo
06-03-08, 10:53 AM
I wouldn't recommend anyone to use Venlafaxine, since it is very hard to stop taking them, if you must shift medication for some reason, my life was like hell for over two weeks after I stopped using them. I'm on Zyban now, and thinks that they are working pretty okay. I find them better than Concerta, Amphethamine or Dexamphethamine. But it is very individual what's working or not for you.
In Sweden Zyban is used as a pill for them who wants to quit smoking, so I was a bit surprised when my doctor told me she wanted me to try them instead.

You are absolutely right. It's very individual. Venlafaxine is really a drug for depression. It wouldn't be what I personally would recommend, but then I'm not a doctor. I just know that sometimes, when ADHD comes with comorbid depression or anxiety, it is sometimes prescribed. It works on Serotonin and Noradrenaline.

Because many British psychiatrists are still not used to prescribing ADHD medications to adults, they will often offer antidepressants simply because they are more familiar with them. This is the problem many adults with ADHD face here in the UK. The treatment simply isn't appropriate a lot of the time.

I have heard good things about Zyban. It doesn't work for everybody, but I have heard others describe it as a miracle for them. It is also used to help people quit smoking herein the UK, as well as for depression.

Though it may seem surprising, there is a logical connection here between smoking and ADHD. Nicotine has been recently found to have just as much effect on ADHD symptoms as Ritalin, because it affects dopamine in a very similar way. This may partly explain why so many people with Adult ADHD get hooked on cigarettes. Nicotine is still harmful, even on its own, but I think there are some trying to explore whether it might be possible to create a nicotine based medication that can help ADHD.

Good luck with the Dexedrine, what dose are you on and what time are you taking it ?

I started on 5mg three times a day, which is a small dose. I have now been told to gradually increase the amount, so I will eventually be taking 10mg three times a day.

I have been advised to take it at 8am, 12pm, and 4pm. However, I was told these are guide times only, especially since I am rarely up by 8am.

With me, it feels like each dose lasts only two hours. Is this normal? I asked my psychiatrist this question and she said she couldn't tell me because they don't normally prescribe it to adults (this is the sort of rubbish I have to put up with due to not having access to a proper Adult ADHD specialist). Is there anyone here who with experience of dex who can tell me if two hours is normal?

planetdave
07-29-08, 01:04 PM
Anyone have any clue about 'Daytrana' - the methylphenidate patch?

I've done some web searching but it always zooms off to the FDA approval and brings up nothing for the UK.

Anyone got access to the online 'MIMS' catalogue?

Colin
07-29-08, 01:41 PM
Apparently there can be a risk of addiction with Dexedrine, but I will have to wait and see.
I found it slightly easier to wake up when I was on Strattera, but I found it hard to get to sleep if I took it too late.

I got addicted to feeling ^normal^ when I was on dexedrine, when they took it away from me for no good reason I was most upset. but i didnt notice any particular withdrawl symptoms other than even when it was stopped abruptly, I was just as bad as I was before i started taking it.

PS. this period was actualy quite worrying becuase they had been so reluctant to prescribe it, one of the reasons being how adictive it is and how awefull the withdrwal symptoms are. it scared me ****les tbh. that was actually far worse than the any non existant chemical withdrawl as such.

tree oh tree
07-29-08, 02:08 PM
It's realy pants what they have on offer in the UK. Just before I was 17 I was put on Concerta xl, builiding up to 72mg in the morning with 20mg of Equasym in the evening. Eventually I went abit shi tty and started drinkng again so it was just stopped working so well. After withdrawal for about a week I started getting a little violent and lashed out,.
There wasn't any support from early april to mid october availible, buy then I had started abusing stimulants, the gp would only prescribe 18mg, that was stupid and he made me angry he wouldn't listen to anything I said.
Then I didn't receive much help until I think it was March this year, and this dctor started prescribing me Zyprexa, what a f ucking U-turn in treatment.
That didn't help.
Eventually I rang my former shrink he suggested Reboxetine.
This was OK, but not really as effective as Concerta XL.
Then I got in trouble with the police and started drinking more then rtold my GP how I'd only ever found Concerta effective so the past two weeks I took 72mg in the morning, and by the end of the two weeks it was just didn't seem to be working so well on my attention span. Maybe i'll take it tommorrow again, but only at 36mg then see how that goes, any way I'll tell the psychatrist that Methylhenidate works OK, but seems to loose it's really prominent effect with me after alittle while and I just revert back to being inattentive, though since not taking since saturday I have started drinkinmg again and acting like an *** hat to people.

vixthenomad
08-06-08, 05:29 PM
I was prescribed Duloxetine (brand name Cymbalta/Xeristar), which is an antidepressant that works on dopamine and noradrenaline. It's the only medication I've tried so I don't have much basis for comparison, but I'm much better with it than without it! :)

It's an 'off-label' prescription and I haven't seen it mentioned anywhere else on the forum. It would be interesting to know if anyone else has tried it and how they found it.

Destracted_UK
09-11-08, 05:41 AM
Hehe, I took this list to my GP, guess which one I got?

Venlafaxine! Meh, turned me into a zombie and then realised first hand how difficult it is to come off it. It did zero for my Adhd too, I think for it to have an effect you have to take alot each day. I am slowly weaning myself off it though and starting to feel more human again. I will be so happy to see the back of this one.

Other news is that FINALLY I have been offered Ritalin, that should start in a month.

So yeh, avoid Venlafaxine / Effexor if you can help it. Not good fun.