ADHD medication – practical tips for GPs on how to recognise common side effects and what to do

Today, we’re speaking to Dr Sara Noden, a GP with an extended role in ADHD, and Dr Nishi Yarger, Consultant Psychiatrist in adult ADHD services.

Title of paper: A guide for primary care clinicians managing ADHD medication side effects

Available at: https://doi.org/10.3399/bjgp25X742653

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.320 - 00:00:55.720

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors at the bjgp. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr.

Sara Noden, a GP with an extended role in ADHD, and Dr. Nishi Yarger, consultant psychiatrist in Adult ADHD Services.

We're talking about the recent Clinical Practice article here in the BJGP titled A Guide for Primary Care Clinicians Managing ADHD Medication Side Effects. So, thanks. It's great to meet you both Sara and Nishi.

This is a really topical area to highlight in the journal, and not least because it seems that every week there seems to be a new article in the media about the increasing diagnosis of adhd. So it's a really topical area to look at, but I guess, Sar, I just really wanted to start with what prompted you to write this article and why now?

Speaker B

00:00:56.620 - 00:01:39.320

Yeah, so I think coming from a GP perspective, before I specialized in adhd, I think these medications did create a bit of anxiety, especially as they're controlled drugs, their stimulants, their specialist medications, and there was a lot that I didn't know about them as I since developed a special interest and it sort of demystified some of these medications. And I just.

I think we wanted to pass on to primary care clinicians some of that knowledge that we've learned, some really basic things that they can look out for that may or may not be related to medications and some common things that they can advise and to know when to escalate secondary care and how to manage these patients, essentially.

Speaker A

00:01:39.560 - 00:01:54.040

Yeah. And Saura, I wonder if you could just tell us a bit more about your role as a GP with an extended role in adhd.

So you must be very much in demand at the moment, but talk us through what led you to sort of take that role and what your typical week is like.

Speaker B

00:01:54.320 - 00:02:58.810

Yeah, So I think my interest in ADHD stemmed during my training years and I currently am working as a salary GP, but also working at CNWL under Dr. Jaga. I'm doing diagnosis and medication titrations. And I think my interest stemmed because of how prevalent ADHD is becoming.

I was seeing such an increase in patients presenting to gp, suspecting they have ADHD and requesting referral, and reading about this treatment and what we can offer, I was really taken aback by not only how ADHD can impact a patient in terms of their symptoms and concentration of focus, but also the lifelong issues that can arise sometimes with adhd, like all the Research showing that it increases rates of depression, underachievement at school, even early death and accidental injuries. So I feel it's a really important, important condition for us to be able to pick up, to be able to refer promptly and start treatment.

And that's where the interest started.

Speaker A

00:02:59.050 - 00:03:14.570

And, Nishi, from your perspective, what's it like having a GP working with your team?

And from a secondary care perspective, I wonder if you could just tell us a bit more about your impression on how secondary care and general practice communicate around ADHD and people living with it.

Speaker C

00:03:14.650 - 00:04:27.649

It's been great having Sara in the team for many reasons. So I guess primarily we're very aware that we need to work more closely with primary care.

There's so much back and forth with emails and us trying to be helpful to primary care primary care, having concerns and needing our input, that the idea of actually training primary care keeps coming up for us as a service, like, how much can we involve them, how much can we train them? It's such a huge area of work. We know more and more patients are coming forward and we know very much that it can't just stay a specialist service.

So as a service, we're very keen to have involvement from primary care. So we have Sara and we also have a GP trainee, which is great from more selfish point of view.

It's been great to have a GP in the team because ADHD patients often have a lot of medical comorbidity and it's been great for us to be able to discuss that with a GP instead of needing to contact a cardiologist or go to another specialist. We know that probably this is, you know, within the remit of a gp, so it works well both ways.

Speaker A

00:04:27.969 - 00:05:05.980

Great.

And I think, as you mentioned, you know, I don't think any specialty or general practice practitioner would feel that less collaboration is a good thing. So I think the more the better. And I guess I'd recommend people listening to go and read the full article here and take a close look at it.

But I wanted to specifically focus on Table 1, which lists some common ADHD medication and then some key practical advice around prescribing it.

But I wonder if you could just summarize some of the common areas we should be consideri