Adult ADHD Medication: Best Practice in 2025

Medication is often the first thing people think of when treating ADHD, and with good reason. Evidence shows it’s highly effective for reducing symptoms and improving daily functioning. But for adults, prescribing isn’t just about choosing a pill—it’s about applying guidelines, weighing risks, and working with patients to find a fit that actually improves their lives.

The Framework: DSM-5 and NICE

DSM-5 defines ADHD as a neurodevelopmental disorder requiring impairment across settings, with onset before age 12. It doesn’t recommend specific drugs but sets the diagnostic foundation.

NICE NG87 (UK) is clearer: for adults, start with a stimulant—methylphenidate or lisdexamfetamine—as first-line. If one fails after ~6 weeks at the right dose, switch to the other. Dexamfetamine can be considered if lisdexamfetamine works but duration is problematic.

Non-stimulants (atomoxetine, bupropion, guanfacine) are for those who can’t tolerate stimulants, have contraindications (e.g. cardiac risk, substance misuse), or prefer them.

NICE also requires annual review to assess benefit, side-effects, and whether continuation is still justified.

What the Evidence Says in 2025

Stimulants work best: Meta-analyses confirm they produce the largest symptom reductions. Amphetamines often outperform methylphenidate in effect size.

Non-stimulants help too: Atomoxetine shows moderate but reliable benefits, especially with anxiety or substance misuse.

Real-world outcomes: Registry studies now show ADHD medication is linked to lower risks of suicide attempts, substance misuse, transport accidents, and even criminality. This reframes medication as not just symptom relief, but potentially protective.

Durability: Long-term benefits on work, relationships, and quality of life are promising but still less well-documented than short-term symptom gains.

Managing Risks

Cardiovascular: stimulants raise heart rate and blood pressure; monitor regularly.

Sleep: insomnia or delayed sleep onset is common; adjust dose timing and formulation.

Appetite/weight: reduced appetite is frequent. Atomoxetine can cause sexual side effects.

Monitoring: baseline CV checks, weight, sleep history; review at each follow-up.

Clinical Best Practice

Assess thoroughly: confirm ADHD per DSM-5, screen for comorbidities, check baseline vitals.

Trial stimulants first: usually methylphenidate; switch to lisdexamfetamine if needed.

Use non-stimulants when appropriate: intolerance, contraindications, or preference.

Monitor closely: physical health, sleep, side-effects, adherence.

Combine with psychosocial interventions: CBT, coaching, DBT skills improve outcomes beyond medication alone.

Practice shared decision-making: involve patients in formulation choice, dose timing, and weighing trade-offs.

The Takeaway

For adults, ADHD medication is effective, evidence-based, and safe when prescribed with care. Stimulants remain first-line, non-stimulants are valuable alternatives, and long-term monitoring is essential. The clinician’s role is not just to reduce symptoms, but to help adults with ADHD use medication as one piece of a bigger plan for a more stable, functional, and fulfilling life.