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Primary Care GuidelinesAuthor: Juan Fernando Florido Santana
A podcast intended for healthcare professionals wanting to keep up to date relevant information about clinical practice guidelines Language: en-us Genres: Education, Health & Fitness, Medicine Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Podcast - ADHD Treatment in Focus: More Than Just a Pill
Tuesday, 23 December, 2025
The video version of this podcast can be found here: · https://youtu.be/w4d4qc7aHn4This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.This video also refers to a number of medical articles on ADHD published by a number of organisations (details below). Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by any of them. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I cover ADHD treatment options, especially in adults, always focusing on what is relevant in Primary Care only. The information is based on a number of published medical articles. The links to them are below.I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The resources consulted can be found here: 1. NICE. Attention deficit hyperactivity disorder: diagnosis and management (NG87): https://www.nice.org.uk/guidance/ng87?utm2. Ostinelli EG et al. “Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis.” The Lancet Psychiatry, 2025. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(24)00360-2/fulltext?utm3. Gosling CJ et al. “Benefits and harms of ADHD interventions: umbrella review of systematic reviews and meta-analyses.” BMJ, 2025. https://www.bmj.com/content/391/bmj-2025-085875?utm4. Cortese S et al. “Attention-deficit/hyperactivity disorder (ADHD) in adults.” World Psychiatry, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12434367/?utm5. Wakelin C et al. “A review of recent treatments for adults living with attention-deficit/hyperactivity disorder.” 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10730462/?utm6. Kooij JJS et al. “Updated European Consensus Statement on diagnosis and treatment of adult ADHD.” European Psychiatry, 2019. https://pubmed.ncbi.nlm.nih.gov/30453134/?utmhttps://www.cambridge.org/core/journals/european-psychiatry/article/updated-european-consensus-statement-on-diagnosis-and-treatment-of-adult-adhd/707E2A36539213CF85EACCA576F47427?utm7. Nimmo-Smith V et al. “Non-pharmacological interventions for adult ADHD: a systematic review.” Psychological Medicine, 2020. https://pubmed.ncbi.nlm.nih.gov/32036811/?utmhttps://www.cambridge.org/core/journals/psychological-medicine/article/nonpharmacological-interventions-for-adult-adhd-a-systematic-review/538F70FB89C5B687F4A75E7431E63B38?utm8. Mechler K et al. “Evidence-based pharmacological treatment options for ADHD in children, adolescents and adults.” Neuroscience & Biobehavioral Reviews, 2022. https://www.sciencedirect.com/science/article/pii/S016372582100142X?utm9. AWMF S3 Guideline. “Attention-Deficit/Hyperactivity Disorder (ADHD) in Children, Young People and Adults.” 2020. https://register.awmf.org/assets/guidelines/028_D_G_f_Kinder-_und_Jugendpsychiatrie_und_-psychotherapie/028-045eng_S3_ADHS_2020-12-abgelaufen.pdf?utm10. Wolraich ML et al. “Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents.” Pediatrics, 2019. https://publications.aap.org/pediatrics/article/144/4/e20192528/81590/Clinical-Practice-Guideline-for-the-Diagnosis?utm11. Faraone SV et al. “The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder.” Neuroscience & Biobehavioral Reviews, 2021. https://pubmed.ncbi.nlm.nih.gov/33549739/?utmhttps://www.sciencedirect.com/science/article/pii/S014976342100049X?utmhttps://www.adhd-federation.org/publications/international-consensus-statement.html?utm12. CADDRA. Canadian ADHD Practice Guidelines, Version 4.1. 2020. https://www.caddra.ca/canadian-adhd-practice-guidelines/?utm13. Therapeutics Initiative. “ADHD in adults.” Therapeutics Letter 144, 2023. https://www.ti.ubc.ca/2023/09/29/144-adhd-adults/?utm14. May T et al. “The Australian evidence-based clinical practice guideline for ADHD.” Australian Journal of General Practice / AADPA, 2023. https://adhdguideline.aadpa.com.au/?utmhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10363932/?utm15. Coghill D & colleagues / Australian Prescriber. “Pharmacological management of attention deficit hyperactivity disorder in children and adolescents.” Australian Prescriber, 2025. https://australianprescriber.tg.org.au/articles/pharmacological-management-of-attention-deficit-hyperactivity-disorder-in-children-and-adolescents.html?utm16. Thapar A et al. “Attention-deficit/hyperactivity disorder.” Nature Reviews Disease Primers, 2024. https://www.nature.com/articles/s41572-024-00495-0?utmTranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to talk about ADHD treatment options, especially in adults, always focusing on what is relevant in Primary Care only. I have based this episode on a number of published medical articles. The links to them are in the episode description. Right, let’s jump into it.Modern guidelines emphasise that ADHD management is multimodal — including psychoeducation, environmental adaptations, psychological interventions, and, where indicated, medication.For children and adolescents, NICE and other guidelines recommend starting with psychoeducation and behavioural or parent training, then adding medication when impairment remains significant.However, for adults, guidelines are very clear: medication is usually first-line when symptoms cause persistent, moderate to severe impairment, supported by psychoeducation and practical help.So, when is medication indicated?For children and adolescents, medication — usually methylphenidate — is recommended only when ADHD is clearly diagnosed, the impairment is significant, and non-drug approaches aren’t enough. In other words, it’s generally reserved for moderate to severe ADHD, rather than mild cases.However, for adults, medication is indicated when there is a clear diagnosis of ADHD with symptoms present since childhood, even if they were never recognised at the time. The symptoms must be causing clinically significant impairment, and other conditions — like depression, bipolar disorder, or substance misuse — shouldn’t fully explain what’s going on. And finally, the person needs to want to try medication after discussing the risks and benefits.Guidelines such as NICE and the European consensus explicitly state that, in adults, medication is the main evidence-based treatment for core ADHD symptoms, offered alongside education and support.Which medications should we use, and how effective are they?There are two main classes.First, stimulants, such as methylphenidate in various modified-release forms, and amphetamine formulations like lisdexamfetamine.Second, non-stimulants, including atomoxetine, guanfacine—which has more evidence in children and adolescents—and others like bupropion, clonidine, and viloxazine, though adult data for these are more limited.A landmark meta-analysis of randomised trials found that, in adults, amphetamines produced the largest improvements in clinician-rated symptoms. They were at least as well tolerated as methylphenidate, and more effective than atomoxetine and modafinil.A recent BMJ umbrella review, which examined multiple meta-analyses, concluded that in the short term—up to about twelve weeks—both stimulants and some non-stimulants produce medium to large reductions in symptoms. Evidence beyond one year is more limited, but it does not suggest a loss of effect.The World Federation of ADHD consensus summarises this by stating that ADHD medication is clearly effective for reducing symptoms, and that stimulants are more effective than non-stimulants.Are there any long-term benefits of regular medication use?Well, in terms of symptom control, longitudinal studies and reviews show that continued medication is associated with sustained improvements in symptoms and functioning in both children and adults, as well as improvements in overall life satisfaction.Furthermore, there is also evidence for broader life outcomes. The World Federation of ADHD consensus concluded that drug treatment is linked to substantial reductions in a range of adverse outcomes, including transport accidents, substance misuse and cigarette smoking, educational underachievement, depression and suicide attempts, and even criminal behaviour and teenage pregnancy.Taken together, this suggests that for many patients, long-term use of ADHD medication does more than just reduce symptoms. It appears to lower the risk of serious negative life events and improve quality of life.And now, let’s touch briefly on non-drug treatments.For children and adolescents, guidelines emphasise psychoeducation and parent-training programmes, school-based interventions, and behavioural approaches such as reward systems and structured routines.For adults, the main non-drug options include psychoeducation about ADHD, CBT tailored to ADHD, that is, focusing on time management, planning, and emotional regulation, and finally, coaching and skills training, along with workplace or academic adaptations.So how effective are these approaches? A systematic review of non-pharmacological interventions in adults found that particularly CBT and skills training produce small to moderate improvements in symptoms and functioning.However, the World Federation consensus is quite blunt: non-medication treatments are generally less effective than medication for core ADHD symptoms, although they remain very useful for addressing residual difficulties once medication has been optimised.Now that we know the benefits of treatment, what are the possible side effects, and how do we monitor treatment?Common side effects of both stimulants and atomoxetine include reduced appetite and weight loss, sleep disturbances, mild increases in heart rate and blood pressure, headache, dry mouth, gastrointestinal symptoms, and occasionally irritability or mood lability.There are also possible psychiatric adverse effects. Rarely, stimulants and atomoxetine can precipitate anxiety, irritability, mood elevation, or even psychotic symptoms, particularly in vulnerable people or at higher doses. To reduce this risk, guidelines recommend careful monitoring, dose adjustments, and stopping the medication if significant symptoms appear.Overall, the World Federation consensus concludes that “the adverse effects of medications for ADHD are generally mild and can be addressed by changing the dose or the medication,” while the consequences of untreated ADHD are often serious and long-lasting.In terms of cardiovascular safety, for most people without pre-existing heart disease, stimulants and atomoxetine cause only small increases in blood pressure and heart rate, and serious cardiovascular events are rare.So what does this mean in practice? Guidelines recommend taking a brief cardiac and family history, checking blood pressure and pulse, and making sure there are no red flags before starting medication. If someone has a known heart condition, or if the assessment raises any concerns, then we should ger cardiology input before prescribing.Regarding misuse, diversion, and dependency we need to be aware that stimulants have abuse potential, particularly in fast-acting formulations, which is why long-acting preparations and careful monitoring are recommended. However, the consensus statement notes that while stimulants can be diverted or misused, therapeutic doses in people with ADHD are actually associated with lower rates of later substance-use disorders, not higher.In summary, for adults with significant ADHD, medication is the most effective treatment for core symptoms. When used long-term with proper monitoring, it’s associated not only with better concentration, but with lower rates of other serious negative outcomes. At the same time, side effects are common but usually mild and manageable.So that is it, a review of ADHD treatment options.We have come to the end of this episode. Remember that this is not medical advice but only my summary and my interpretation of the guidelines. You must always use your clinical judgement.Thank you for listening and goodbye.
