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GPs stop ADHD drugs 'too early'

By Lilian Anekwe

GPs are being forced to take young patients with attention deficit hyperactivity disorder (ADHD) off their medication too early because of a lack of specialist psychiatric support, researchers have warned.

An NHS-funded study has shown GP prescribing for ADHD falls off sharply between the ages of 15 and 21, even though many patients in this age group continued to suffer symptoms.

The sharp fall in prescribing through adolescence and early adulthood far outstripped the rate of decrease in symptoms seen in patients - suggesting GPs were prematurely discontinuing treatment in some young adults even though their symptoms persisted.

The prevalence of prescribing across all age groups increased eightfold in seven years, from 0.26 to 2.07 per 1,000 patients, between 1999 and 2006, according to the NHS Health Technology Assessment.

But the increase in older patients was far less evident, with prescribing in 15 year-olds increasing from 1.32 to 8.31 per 1,000 patients, but only from 0 to 0.43 per 1,000 patients in 21-year-olds.

And an analysis of modelling data showed that although about a third of patients still showed symptoms of ADHD at age 21, nearly all had already had their treatment withdrawn.

The analysis also showed the drop in prescribing was most noticeable in patients aged 16 and 17, once children had sat their GCSE exams and left school. Approximately 18% of patients restarted treatment if it had been stopped after the age of 15.

The HTA studied the prescription of ADHD drugs methylphenidate, dexamfetamine or atomoxetine between 1999 and 2006, using the General Practice Research Database.

Lead researcher Professor Ian Wong, professor of paediatric medicines research at the school, said the current NICE guidance for ADHD ‘is not really working – leaving GPs short of options for managing adolescents and young adults with ADHD.

He added: ‘We don't have a good system to cater for adolescents with ADHD. The only ADHD drug licensed for use in over 18s in atomoxetine but it's not licensed for first line treatment. The other drugs are not licensed for use in adults and GPs may feel that they are not comfortable continuing to prescribe drugs if they have not initiated them.'

‘Ideally there should be an assessment by an adult psychiatrist – that's what NICE recommends – but there are not many adult psychiatrists who are trained or even believe that adult ADHD exists. Currently what's recommended by NICE is not really working.'

Professor Amanda Kirby, a former GP and chair in developmental disorders at the University of Wales in Newport, said: 'There is a huge gap in service provision. Children are often appropriately medicated up to age 16 but in many areas there is nothing available. GP often feel nervous because there's a lack of training and services. It's quite a depressing situation.'

'There's a need for training and a need for adult psychiatric services. GPs are not going to be confident unless they are well equipperd and that stems from more services being available.'

Lack of support services have been blamed for GPs taking patients off medication too early Lack of support services have been blamed for GPs taking patients off medication too early

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