ADHD Medication Titration

What is titration?

Medication titration is the process of starting and fine-tuning the dose of medication to find the most effective dose that provides maximum benefits with the least possible side effects for individuals.

The National Institute for Health and Care Excellence (NICE) state that medication should only be initiated and regularly reviewed by a healthcare professional that is experienced in diagnosing and managing ADHD. If you already have a diagnosis of ADHD from The Edinburgh Practice or from elsewhere, and you are considering starting medication, you can complete a self-referral form to request medication titration.

Throughout titration you will have regular appointments with one of our Consultant Psychiatrists/Specialty Doctors, who will adjust and monitor your medication until you reach a stable and optimal dose. Consultations can be offered remotely and/or in person.

The Titration Process at The Edinburgh Practice

 If you have been diagnosed outwith The Edinburgh Practice, prior to accepting your referral, we will request that you send us your ADHD Assessment report alongside any other relevant documents to review. Our Clinical Lead will review your assessment report to ensure that it meets best practice guidelines and that all the necessary information is provided.

Initial Consultation

Once your referral has been accepted you will be offered an initial 1-hour consultation with one of our Consultant Psychiatrists/Specialty Doctors.  At this initial appointment, our Consultant Psychiatrist will review your diagnosis of ADHD, your mental and physical health and will advise as to whether it is appropriate for you to start medication. If appropriate, you will discuss medication options available to you with the doctor including potential benefits and side effects.

Before starting medication, we will obtain baseline physical observations such as blood pressure, pulse and weight. You may be asked to send in results of an ECG and/or blood tests if these have been advised by your doctor. Once your baseline observations have been received, these will be reviewed by the doctor and if your observations are within a normal range, you will be ready to start the treatment process and you can then receive your first prescription.

Titration review appointments

During the titration process, you will meet with the doctor for 30-minute titration review appointments every 3-4 weeks to monitor your progress and to adjust your medication where necessary. Your physical observations will be reviewed prior to each new prescription and prior to/at each review appointment.

Post-titration medication reviews

The length of the titration process differs from person to person, however the process usually takes a minimum of 8-12 weeks. You will be fully titrated when your body has adjusted to the new medication, and you have found your optimal dose.

Once you have completed titration and are on a stable dose, you no longer require medication reviews every 3-4 weeks. Our doctors will let you know how often you require medication reviews post-titration, for example this may be every 3 or 6 months initially.

Prescriptions

During titration you do not need to request prescriptions as you will get these at your review appointments. After titration is complete you will need to request prescriptions via the client portal.

If you do not wish to run out of medication, please ensure you request your prescription 14 days before your medication is due to run out. It can be helpful to set a reminder to prompt you to make your prescription request on time.

Shared Care

Shared care is when your NHS GP agrees to enter into a collaborative care agreement with a doctor at The Edinburgh Practice following completion of titration. The GP takes over the responsibility of providing prescriptions, whilst you receive monitoring from The Edinburgh Practice at agreed intervals (e.g. 3 months, 6 months).

We are aware that as of June 2024 many GP practices across Scotland are no longer accepting shared care requests from private healthcare providers. Many GP practices in Scotland are no longer providing shared care to clients with a private ADHD diagnosis due to lack of funding and expertise in the field of ADHD care. If you would like to have the option of shared care, we advise that you liaise with your GP prior to commencing medication with The Edinburgh Practice to find out whether your GP practice will be able to provide shared care for you. The decision of whether GP practices accept clients for shared care is at the discretion of the GP practice.

GP communication

We must write to your GP when we are prescribing medication for you regardless of whether your GP agrees to shared care, this is for safety reasons, so that all involved in your care are aware of the diagnoses you have and the medication you are prescribed.