This is intended as a starter guide to the ADHD treatment journey. There is no “cure” as such, so what follows are the official recommendations from the NICE guidelines and a holistic approach to support you to manage your condition.
A holistic treatment programme that involves a combination of interventions that suit the individual, can be very effective and reduce the symptoms. There are various types of treatment for Adult ADHD, including medication, self-awareness, talking therapy, support, lifestyle changes and coping strategies. The journey towards finding what works for you can be long, however, it can also offer the reward of a happier life.
Medications for Adult ADHD
Recommendations suggested in this website come from ‘NICE Guidelines’. The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health in the United Kingdom. It serves both the English NHS and the Welsh NHS and provides clinical guidance on treatments and their effectiveness.
You may have heard of NICE before; we will occasionally refer to it throughout this website and you may hear of it through your treatment. It is well worth reading these guidelines:
NICE guidance 87: https://www.nice.org.uk/guidance/ng87/chapter/recommendations
The first step is to go to your GP, describe your symptoms and ask for a referral to the ADHD specialist clinic. It may help to read about adult ADHD online or in printed information so that you can prepare some notes or key points that you want to bring up with your GP in the consultation, helping to clarify what you are experiencing and why you are seeking evaluation for ADHD and/or any other neurodiverse conditions. Both East Sussex and West Sussex have a specialist clinic to diagnose adults for ADHD, Autism, Tourettes and other neuro-diversity. If you are referred by your GP, you will see a specialist and begin to look at the options for treatment. This specialist will consider your symptoms and medical history to see what medication, if any, is appropriate. If you have a history of other diagnosis (co-morbidity), mental disorders, self-harm, alcohol or substance misuse issues, then this will be taken into account.
Your specialist will use the NICE Guidelines and move through the recognised stages. These are the named medications with a brief outline of their type and effect.
Please note: for detail about any part of this process and about each medication please consult the NICE guidance.
NICE guidelines: “Drug treatment for adults with ADHD should always form part of a comprehensive treatment programme that addresses psychological, behavioural and educational or occupational needs. Following a decision to start drug treatment in adults with ADHD, methylphenidate should normally be tried first.”
NICE GUIDELINES 87 QUOTES
Right to Medications for Adult ADHD
Offer medication to adults with ADHD if their ADHD symptoms are still causing a significant impairment in at least one domain after environmental modifications have been implemented and reviewed. See the recommendations on medication choice. 
Choices of Medications for Adult ADHD
Offer lisdexamfetamine or methylphenidate as first-line pharmacological treatment for adults with ADHD. 
Consider switching to lisdexamfetamine for adults who have had a 6‑week trial of methylphenidate at an adequate dose but have not derived enough benefit in terms of reduced ADHD symptoms and associated impairment. 
Consider switching to methylphenidate for adults who have had a 6‑week trial of lisdexamfetamine at an adequate dose but have not derived enough benefit in terms of reduced ADHD symptoms and associated impairment. 
Consider dexamfetamine for adults whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate the longer effect profile. 
1.7.15 Offer atomoxetine to adults if:
- they cannot tolerate lisdexamfetamine or methylphenidate or
- their symptoms have not responded to separate 6‑week trials of lisdexamfetamine and methylphenidate, having considered alternative preparations and adequate doses. 
Obtain a second opinion or refer to a tertiary service if ADHD symptoms in a child aged 5 years or over, a young person or adult are unresponsive to one or more stimulants and one non-stimulant. 
Right to Review Treatment for ADHD
1.10.1 A healthcare professional with training and expertise in managing ADHD should review ADHD medication at least once a year and discuss with the person with ADHD (and their families and carers as appropriate) whether medication should be continued. The review should include a comprehensive assessment of the:
- preference of the child, young person or adult with ADHD (and their family or carers as appropriate)
- benefits, including how well the current treatment is working throughout the day
- adverse effects
- clinical need and whether medication has been optimised
- impact on education and employment
- effects of missed doses, planned dose reductions and periods of no treatment
- effect of medication on existing or new mental health, physical health or neurodevelopmental conditions
- need for support and type of support (for example, psychological, educational, social) if medication has been optimised but ADHD symptoms continue to cause a significant impairment. 
Short Release: Ritalin
Effect: Lasts about 2 to 3 hours, 30 mins after being taken
Long Release: Concerta, Matoride
Effect: Lasts several hours, taken once daily
Type: Non stimulant
Constant Release: Strattera
Effect: This is similar to an antidepressant and will likely be given if there is a history of substance abuse or problematic behaviours. Takes time to build into the system
Name: Dexamphetamine or Dexamphetamine
Short Release: Dexamphetamine
Effect: Similar to Methylphenidate. It can be addictive and so not given to those with substance abuse issues or potential characteristics
Constant Release: Elvanse
Effect: Non-active chemical breaks down into liver and becomes dexamfetamine which has the brand name ‘elvanse’. Is not addictive.
It is important to remember that medication does not work alone and as with all treatments, an individual has to take ultimate responsibility for the downsides, as well as the benefits.
Facts about medication that are useful to consider
- ADHD medication is effective – it has an 80% success rate
- Medication does not have to be taken forever. It can be used to gauge how much it changes your daily life and how you wish to incorporate it
- An individual can decide to take the medication as and when they need it
- It is not a ‘miracle cure’
Psychotic mental health conditions
If an individual is going through a serious mental health crisis or an ongoing condition then they will not be prescribed ADHD medication in conjunction with antipsychotics. This is underlined in the NICE Guidelines.
HIV and HIV prevention medication
There are no known side effects that impact on the workings of HIV medication. This includes PrEP and PEP.
There can be a stigma around using medication as a treatment for ADHD. Often the language evoked in discussion becomes highly inflammatory, with references to ‘ADHD drugs’ being sold illegally, framings that describe medication of children with ADHD as child abuse and unhelpful comparisons between medications for adult ADHD and controlled substances.
Whilst discriminatory ideas come from a lack of understanding in mainstream society, even communities of neurodiverse people and advocates can perpetuate unhelpful moralistic interpretations of medications for adult ADHD, often splitting people with ADHD into ‘good’ people who reject medication and can manage their symptoms regardless and ‘bad’ people who depend on medication to manage their symptoms.
It is our view that medication is every person’s choice to explore on their own terms. We believe it is not inherently right or wrong to choose medication as a treatment for ADHD. There is a diversity of experience, with many people succeeding both with and without medication. Indeed, as with many things ADHD, the most common experience is a non-linear path where people change their relationship to medication throughout their life.
We hope that by reducing stigma it becomes easier to have a transparent discussion about ADHD medication. Simultaneously, it can be helpful to remember that you do not have to disclose that you are taking medication to anyone other than when it is required for legal health and safety purposes. Likewise, it is possible to request a modified-release once-daily preparation of ADHD medication so that it is easier to take without others’ awareness.
Co-morbidity and neurodiversity
An individual may have a dual diagnosis or co-morbidity alongside their ADHD diagnosis; such as Aspergers or Autism (ASD or ASC), Post Traumatic Stress Disorder (PTSD), Personality Disorder, Sensory Processing Disorder, Obsessive Compulsive Disorder (OCD), depression, or anxiety.
Note, one distinction that may be helpful to point out to your primary care physician is that ADHD often includes depression or anxiety are often secondary to ADHD as the primary condition, so this should be considered in terms of recommending appropriate care, as you may be more prone to depression or anxiety more often than the general population, especially when under stress, specifically as a symptom of your ADHD. This may mean that you require more counselling (and ideally, specialist counselling with someone experienced in ADHD and/or other neurodiverse conditions) for these associated symptoms.
Your GP may conduct an assessment with you using standardised tools such as the Generalised Anxiety Disorder assessment or the Patient Health Questionnaire, which is a common tool used in primary care to assess depression. They may also assess you using both of these questionnaires together and evaluate you based on your combined score. You may want to ensure that your GP considers, however, that anxiety and depression may not be conditions to be assessed or treated in isolation, and that they may instead be symptoms of your diagnosed or undiagnosed ADHD. This is important for many reasons, not least because some recommended treatments for anxiety and depression, such as Cognitive Behavioural Therapy (CBT), have effectiveness only for some neurodiverse adults and/or may need to be tailored to the individual moreso than in the general population. Alternative therapies or other treatments may need to be considered.
When you have a diagnosis, typically your specialist consultant and GP will consult with you about the right medications and therapies that help to treat these conditions, but you should ensure they are in communication – this might occur through a Shared Care Agreement, particularly if you were diagnosed privately and then your day-to-day monitoring treatment was reverted to the NHS.
Increasingly, physical health conditions are also being recognised as co-morbid with neurodiverse mental conditions. Ehlers-Danlos Syndrome (EDS) is a condition most often associated with hypermobility but which can manifest in other forms, including potentially life-threatening varieties such as vascular EDS. Increasingly, and particularly through the work of Dr Jessica Eccles at the University of Sussex and the Sussex Partnership NHS Trust, EDS is being linked to neurodiverse conditions in research, as well as in treatment. Postural Tachycardia Syndrome (PoTS) and other abnormal responses of the autonomic nervous system have been linked with neurodiversity and there is also substantial research connecting ADHD and other neurodiverse conditions to Coeliac Disease. Finally, increasing evidence points to links between ADHD and other neurodiverse conditions being more common in individuals predisposed to many other varieties of autoimmune conditions.
It is important to note that physical health conditions may be part of the “total health picture” of someone with ADHD because this may mean there are links between what that person is experiencing both physically and mentally. Increasingly, research is pointing to the need for cross-disciplinary care for individuals with neurodiversity and other conditions, requiring communication and collaboration between health professionals from several different disciplines. The NHS is currently working towards better understanding and addressing the complex needs of patients on its Neurodevelopmental Care Pathway.