Getting an ADHD diagnosis is not the same as getting the right medication. Between the two there is a stage called titration, and it is the part most people know least about before they start.
Here is what titration is, what happens at each stage, how long it usually takes and what it costs with us.
Titration is not trial and error. It is a planned, measured way of finding the dose that works for you with the fewest side effects.
What is ADHD titration?
Titration means starting ADHD medication at a low dose and adjusting it step by step until your symptoms are well controlled and any side effects are tolerable. The aim is the right dose for you, not the highest dose you can take.
The national guideline, NICE NG87, describes the goal as reduced symptoms and real improvements in work, education and relationships, with side effects you can live with.
Before you start: the baseline check
Before any medication is prescribed, your clinician records a baseline so that later changes can be measured against it. That normally includes:
- Your height and weight
- Your pulse and blood pressure
- A cardiovascular history, including any heart problems in you or your family
- Your current medicines and other health conditions
NICE does not recommend a routine ECG before starting ADHD medication. One is only needed if something in your history or examination suggests it.
What happens during titration
- You start on a low dose of the medication you and your prescriber have chosen
- You record how your symptoms, daily life and side effects change
- You have a review with your clinician, and the dose is adjusted up, down or kept the same
- Your pulse and blood pressure are checked before and after each dose change
- This repeats until the dose is right
If you are not sure which medicines are involved, our guide to the medications used for ADHD explains the stimulant and non-stimulant options.
What you will be asked to track
Titration works best when you notice the right things. Between reviews, keep a short note of:
- Focus, organisation and how well you finish tasks
- When the medication seems to start and wear off
- Appetite, sleep, mood and any headaches
- Anything a partner, colleague or family member has noticed
Common side effects, and why the dose goes slowly
Reduced appetite, trouble sleeping, headaches and a raised heart rate or blood pressure are the side effects people mention most. They are the main reason doses are increased gradually rather than all at once.
Many settle as your body adjusts, and many can be reduced by changing the dose or the timing. Tell your clinician rather than stopping on your own.
NICE recommends going more slowly, with closer monitoring, if you also have conditions such as autism, anxiety, epilepsy or heart disease.
How long does titration take?
With us, titration typically runs for three to six months, depending on how quickly you respond and whether a change of medication is needed. Some people find their dose quickly; others need longer, and that is not a sign anything has gone wrong.
Stimulant medicines are controlled drugs, so prescriptions are usually issued a month at a time throughout.
What titration costs
Titration reviews with us are £245 per month. Once your dose has held steady for three months, the monthly fee drops to £95 for ongoing prescribing and monitoring.
Our breakdown of what a first year of private ADHD treatment costs puts the assessment, titration and ongoing care side by side.
After titration: shared care with your GP
Once your dose is stable, NICE recommends that prescribing and monitoring move to your GP under a shared care arrangement. Your GP then prescribes on the NHS, while the specialist service stays involved for reviews.
GPs are not obliged to agree, so it is worth knowing how the process works. Our guide to shared care agreements covers your options, and a shared care agreement prepared by us costs £150.
Monitoring does not stop when titration does
Even on a stable dose, NICE recommends that your heart rate and blood pressure are checked every six months, and your weight every six months as an adult. Your medication should also be reviewed at least once a year.
Practical things to sort early
- If you drive, read our guide to ADHD, medication and the DVLA rules
- Keep medication in its original packaging, with your prescription details, if you travel
- Put review dates in your diary as soon as they are booked
Still deciding about medication?
Titration is only worth starting if medication is the right choice for you. If you are weighing it up, our article on whether to take ADHD medication sets out the questions to ask.
Our ADHD medication page explains how prescribing and follow-up work with us, and the patient journey shows where titration sits between assessment and long-term care.
Book a titration appointment
If you already have an ADHD diagnosis and want to start medication, you can book a medication titration appointment online. Appointments are by video, with a clinician who reviews your progress at each step.
Conclusion
ADHD titration is the careful middle stage between diagnosis and a stable treatment plan: a low starting dose, regular reviews and small adjustments until the balance is right. It usually takes a few months, and it is worth doing properly.
If you have questions about whether you are ready to start, or how titration would work for you, contact our team before you book.
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