What are the NICE guidelines?
The National Institute for Health and Care Excellence (NICE) is an independent organization responsible for providing national guidance and advice on the promotion of good health and the prevention and treatment of ill health. The NICE guidelines are a set of evidence-based recommendations and advice on various aspects of healthcare, including diagnosis, treatment, and management of a range of conditions and diseases. These guidelines are intended to assist healthcare professionals in making informed decisions about the care of their patients, considering the most up-to-date evidence and best practice. NICE guidelines cover a wide range of topics, including mental health, cardiovascular disease, cancer, and many others, and are regularly reviewed and updated to ensure they remain relevant and reflect the latest advances in healthcare.
What do the NICE guidelines say about ADHD in adults?
The National Institute for Health and Care Excellence (NICE) provides guidelines for the assessment, diagnosis, and management of attention deficit hyperactivity disorder (ADHD) in adults. These guidelines emphasize the importance of a comprehensive assessment, including a thorough medical and psychiatric history, a physical examination, and the use of standardized rating scales to confirm the diagnosis. The guidelines recommend a multimodal approach to treatment, including psychological interventions, such as cognitive behavioural therapy, and medication management.
The NICE guidelines support methylphenidate, lisdexamfetamine, and atomoxetine as the first-line medications for treating ADHD in adults. If these are not effective or not tolerated, then alternative medications such as dexamfetamine, bupropion, and modafinil may be considered. The guidelines also advise that any medication decision should consider the individual’s specific needs and preferences, as well as potential risks and benefits.
NICE guidelines are updated periodically to reflect new evidence and best practice, so it is always a good idea to check the most up-to-date version for the latest recommendations.
What are the most up to date NICE guidelines for ADHD?
The most up-to-date NICE guidelines for the assessment, diagnosis, and management of attention deficit hyperactivity disorder (ADHD) in adults were published in September 2018. You can find the most up-to-date NICE guidelines for ADHD in adults at the following link.
Do clinicians have to follow the NICE guidelines?
Clinicians in the UK are expected to take the National Institute for Health and Care Excellence (NICE) guidelines into account when making decisions about patient care. NICE guidelines provide evidence-based recommendations and advice on various aspects of healthcare, including the assessment, diagnosis, and management of attention deficit hyperactivity disease (ADHD) in adults, and are intended to assist healthcare professionals in making informed decisions. However, because NICE guidelines are not mandatory, clinicians may deviate from NICE guidelines if they have a good reason to do so, e.g., the specific needs, preferences, or medical history of the individual. Ultimately, healthcare professionals are responsible for ensuring that their patients receive the best possible care.
Do the NICE guidelines include the monitoring requirements for ADHD medications?
Yes, the National Institute for Health and Care Excellence (NICE) guidelines for the assessment, diagnosis, and management of attention deficit hyperactivity (ADHD) in adults include recommendations for the monitoring of medication for ADHD. The guidelines advise that individuals taking ADHD medication should have regular follow-up appointments with their healthcare professional to monitor the effectiveness and safety of their treatment.
The frequency and nature of these follow-up appointments may vary depending on the specific medication and individual circumstances, but may include monitoring for potential side effects, monitoring of blood pressure and heart rate, and assessment of the individual’s response to treatment. The NICE guidelines also advise that individuals taking ADHD medication should have regular blood tests to monitor for any potential adverse effects, especially if they are taking stimulant medications such as methylphenidate or dexamphetamine. The monitoring requirements for ADHD medication vary depending on the specific medication and individual circumstances. Therefore, clinicians must use their clinical judgment and expertise to determine the best approach for each patient.
For most people, the following measurements are required
- Weight every six months
- Heart rate and blood pressure a before and after each dose change and every 6 months
Although the following measurements may be needed, they are not routinely required
- Blood tests (including liver function tests)
- Electrocardiograms (ECGs)
What else does NICE recommend?
The NICE guidelines several other recommendations including:
- The value of a balanced diet, good nutrition, and regular exercise for adults with ADHD
- The use of non-pharmacological treatment for adults with ADHD who have made an informed choice not to have medication, who have difficulty adhering to medication, or who have found medication to be ineffective or hard to tolerate