ADHD Titration Explained: Timeline, Appointments and Cost
- Suits You Media Developer
- October 20, 2026
- Edited 44 seconds ago
ADHD titration is the supervised period after diagnosis when a specialist starts medication at a low dose and adjusts it, checking symptoms, side effects, blood pressure, pulse and weight at each change, until a stable effective dose is found. It usually takes several weeks to a few months. At Harley Street Mental Health (HSMH), each review costs £150 virtual or £250 in person.
What is ADHD titration?
Titration is the process of finding the right dose of ADHD medication for you. Your specialist starts low and adjusts step by step, weighing symptom improvement against side effects.
NICE describes the goal as “dose optimisation”. In plain terms, that means fewer symptoms, positive changes in behaviour, better functioning at work and in relationships, and side effects you can live with (NICE NG87 1.7.27). It is not about reaching the highest dose. Some people settle on a low dose; others need several increases.
There is a reason your GP usually can’t start this. NICE says ADHD medication should only be initiated by a healthcare professional with training and expertise in diagnosing and managing ADHD (1.7.2), and the NHS puts it simply: “ADHD medicines must be started and monitored by an ADHD specialist.”
Titration sits in the middle of the treatment pathway. You are assessed, then titrated, then reach a stable dose, then move to shared care with your GP or continue private prescribing, with a specialist review at least once a year. Our guide to what happens after a private ADHD diagnosis covers the steps either side.
Before your first dose: the baseline checks
Before any medication is prescribed, NICE recommends a full baseline assessment (1.7.4). This gives your clinician a reference point, so later changes in blood pressure, pulse, weight or mood can be judged against where you started. It covers:
- Your diagnosis. A check that you still meet the criteria for ADHD and that treatment is needed.
- Mental health and circumstances. Any coexisting conditions (such as anxiety, depression or autism), your work or study situation, and a risk assessment for substance misuse and medicine diversion.
- Physical health. Your medical history (including conditions that may rule out particular medicines), current medication, height and weight, a baseline pulse and blood pressure taken with a correctly sized cuff, and a cardiovascular assessment.
Do you need an ECG? Not routinely. NICE says an ECG is not needed before starting the main ADHD medicines unless you have one of the cardiac warning features listed below, or you take another medicine for a separate condition that adds cardiac risk.
To your first appointment, bring your diagnostic report, a list of everything you currently take (including supplements) and any recent blood pressure readings.
When you’ll be referred to cardiology first
NICE lists specific features that mean you should see a cardiologist before starting (1.7.5). In plain English:
- congenital heart disease, or previous heart surgery
- a parent, sibling or child who died suddenly, under 40, from a suspected heart cause
- breathlessness on exertion compared with people your age
- fainting on exertion, or in response to fright or noise
- palpitations that are rapid and regular and start and stop suddenly
- chest pain that sounds cardiac in origin
- signs of heart failure, or a heart murmur
- blood pressure in the hypertensive range for adults (as defined in NICE’s hypertension guideline)
A referral doesn’t rule out medication; it means the heart question is answered first.
How titration works, review by review
Every titration follows the same cycle. You start on a low dose and take it for a set period while recording how you feel. Then a review decides whether to increase the dose, hold it, reduce it or switch to a different medicine. The cycle repeats until you and your clinician agree the dose is right.
NICE asks for two kinds of monitoring during this phase. First, symptoms, impairment and side effects should be recorded at baseline and at each dose change on standard rating scales, with progress reviewed regularly by a specialist, “for example, by weekly telephone contact” (1.7.26). Second, heart rate and blood pressure should be checked before and after each dose change, and every 6 months (1.8.9).
What happens at each stage
| Stage | What you do | What the clinician checks | NICE ref |
|---|---|---|---|
| Baseline | Complete a rating scale; have blood pressure, pulse and weight recorded | Full assessment of diagnosis, mental and physical health | 1.7.4 |
| Each dose change (review) | Keep a symptom and side-effect log; record blood pressure and pulse | Effect on symptoms, side effects, blood pressure, heart rate | 1.7.26, 1.8.9 |
| Stable dose reached | Continue the agreed dose | Dose optimisation achieved | 1.7.27 |
| Every 6 months | Weight, blood pressure and heart rate checked | Weight, blood pressure, heart rate | 1.8.5, 1.8.9 |
| At least once a year | Attend a medication review | Benefits, side effects and whether to continue | 1.10.1 |
The log you keep between reviews matters more than people expect. A note of when you took the dose, when it seemed to wear off, how you slept and what you ate gives your clinician far more to work with than “it’s fine, I think”.
What a 15-minute titration review covers at HSMH
Our titration reviews are listed on our pricing page as a 15-minute “review of medication and side effects”, which includes issuing your new prescription. In practice, your clinician goes through your symptom log and any side effects, checks your blood pressure and pulse, and agrees the next step with you.
You can have reviews by video or in person at 10 Harley Street. In person, your blood pressure and pulse are measured by the clinician; online, you take your own readings beforehand. Both routes follow the same monitoring steps, so choose whichever suits your schedule.
Who needs a slower titration
- Neurodevelopmental: autism, tic disorders, learning disability.
- Mental health: anxiety disorders (including OCD), bipolar disorder, depression, eating disorders, post-traumatic stress disorder, substance misuse, and others.
- Physical health: heart disease, epilepsy, acquired brain injury.
A slower titration usually means smaller steps and more reviews, so it is worth factoring into your budget if any of these apply to you.
How long does ADHD titration take, and how many appointments?
NICE sets no fixed number of titration appointments, and no fixed timeline. The length depends on three things: how quickly you respond, whether side effects need managing, and whether you need to switch medicine.
The biggest single variable is a switch. NICE suggests considering a change to a different stimulant after a 6-week trial at an adequate dose that hasn’t given enough benefit (1.7.12–1.7.13). So if the first medicine doesn’t suit you, one switch can add roughly another six weeks.
For context, providers report a range of typical durations. One large online provider quotes 12 to 16 weeks for NHS-funded titration and about 12 weeks privately; another private clinic says it takes “at least 3 months” to stabilise. These are reported figures, not promises, and your own timeline may be shorter or longer.
At HSMH, [CONFIRM: HSMH typical number of reviews and interval, e.g. “most adults need X–Y reviews, Z weeks apart”]. Your clinician can give a clearer estimate once they’ve seen how you respond to the starting dose.
NHS and Right to Choose titration waits vs private
The wait to start titration can be longer than titration itself. There are no official statistics, but Healthwatch England found average waits of 23.5 to 30.7 weeks at one NHS trust in London, and up to 10 months between assessment and the start of titration at one large Right to Choose provider. Survey respondents described waits of up to two years.
Private titration can usually start soon after a private diagnosis, but it means paying for each review. For what happens once you’re stable, including the GP side, see ADHD shared care and what happens if your GP refuses.
What if the side effects are a problem?
First, don’t stop your medication or change the dose on your own. Contact your prescriber, describe what’s happening and when it started, and let them decide the next step. Many side effects can be managed with a small change rather than stopping.
Depending on what you report, your clinician may hold the dose, reduce it, change when you take it, or switch you to a different medicine. NICE gives specific guidance for the most common issues:
- Raised heart rate or blood pressure. If you have a sustained resting heart rate above 120 beats per minute, an irregular heart rhythm, or a systolic blood pressure above the 95th percentile (or a clinically significant rise) on 2 occasions, NICE says the dose should be reduced and you should be referred to an adult physician (1.8.11). Routine blood tests and ECGs aren’t needed unless there is a clinical reason (1.8.10).
- Reduced appetite or weight loss. Taking medication with or after food, eating extra meals early in the morning or late in the evening when the effect has worn off, and dietary advice can all help; changing medicine is also an option (1.8.6). For adults, NICE suggests monitoring BMI if weight changes, and changing medicine if it persists (1.8.8).
- Sleep problems. Track your sleep, for example with a sleep diary, so the medication can be adjusted (1.8.17).
- Tics. Your clinician will consider whether the tics are linked to the medicine and how much they affect you. If they are, NICE suggests reducing the dose, changing medicine or stopping (1.8.13–1.8.14).
- Worsening behaviour. If your behaviour gets worse on medication, NICE advises adjusting the medication and reviewing the diagnosis (1.8.18). Tell your clinician about changes in mood too, even if they seem minor.
- No response at all. If symptoms haven’t responded to one or more stimulants and a non-stimulant, NICE recommends a second opinion or referral to a tertiary ADHD service (1.7.16).
Safety first. HSMH is not an emergency service. If you have chest pain, faint, or feel seriously unwell, call 999. For urgent medical advice that isn’t an emergency, call NHS 111. If you are thinking about suicide or harming yourself or others, call 999 immediately.
How much does private ADHD titration cost?
Private titration is charged per review. Here are our current titration fees:
| Appointment | Length | Virtual | In person (10 Harley Street) | Includes |
|---|---|---|---|---|
| Medication titration assessment (review) | 15 minutes | £150 | £250 | Review of medication and side effects; issuing of new prescription |
Because NICE sets no fixed number of reviews, the total depends on how many you need. The table below is arithmetic only, to help you budget. It is illustrative, and your clinician will advise on your own plan.
| Number of reviews | Virtual (£150 each) | In person (£250 each) |
|---|---|---|
| 3 | £450 | £750 |
| 4 | £600 | £1,000 |
| 5 | £750 | £1,250 |
| 6 | £900 | £1,500 |
Book a titration review: £150 online or £250 at Harley Street · see all fees
What the review fee doesn’t cover. The medicine itself is paid for separately at the pharmacy, and the amount varies by medicine and dose; see how much ADHD medication costs each month. A shared care request to your GP at the end of titration is a separate step, so ask about it when you book.
When you compare ADHD titration services, check what each fee includes: appointment length, whether a prescription is issued at the review, and whether in-person visits are available.
Other HSMH fees that may apply:
- Adult ADHD assessment: £715 virtual, £1,200 in person, if you haven’t been diagnosed yet.
- Transfer of care: £350 virtual, £450 in person, for people moving titration or prescribing from another provider. It includes a review of your previous diagnosis and medical records.
For the whole picture, from assessment through titration to the first year of treatment, see our full first-year cost breakdown.
When titration ends: stable dose and shared care
Titration ends when you and your clinician agree the dose is working: your symptoms have improved in ways that matter in daily life, and any side effects are tolerable. At that point, NICE says prescribing and monitoring should move to “Shared Care Protocol arrangements with primary care” (1.7.29).
In practice, your specialist writes to your GP to request shared care. At HSMH, your specialist prepares the shared care letter with your diagnosis, medication, dose and monitoring information. If the GP agrees, they take over routine prescribing, and your specialist remains involved, stays available to your GP for advice and carries out your annual review.
GPs can decline shared care, and the decision is theirs. If that happens, see ADHD shared care and what happens if your GP refuses for your options.
Monitoring continues after handover. NICE recommends checking weight every 6 months in adults (1.8.5), heart rate and blood pressure every 6 months (1.8.9), and a specialist medication review at least once a year to decide whether to continue (1.10.1).
Private or NHS titration: which route fits you?
The right route depends on where you are now.
- You’ve been diagnosed privately and want to start now. Private titration with the clinic that diagnosed you is usually the most direct path, since your specialist already knows your history.
- You’re on an NHS or Right to Choose list with a long titration wait. You may be able to pay for private titration instead, but check first what happens to your place on the existing list.
- You’ve already started titration elsewhere. A transfer of care appointment (£350 virtual, £450 in person) reviews your diagnosis and records so we can take over.
If you haven’t been diagnosed yet, titration can’t start. Our private ADHD assessment page explains what’s involved.
Frequently asked questions
How long does ADHD titration take?
It often takes several weeks to a few months, depending on how you respond and whether side effects need managing. If the first medicine doesn’t work well enough, NICE suggests considering a switch after a 6-week trial at an adequate dose, which can extend the process.
How many titration appointments will I need?
NICE sets no fixed number of titration appointments. NICE advises slower titration with more frequent monitoring if you also have conditions such as autism, anxiety, depression, heart disease or epilepsy, which can mean more reviews.
How much does ADHD titration cost privately?
At HSMH, each 15-minute titration review costs £150 online or £250 in person, and includes issuing your new prescription. The medicine itself is paid for separately at the pharmacy.
Do I need an ECG or blood test before starting ADHD medication?
Not routinely. NICE says an ECG is needed only if you have specific cardiac risk features, such as fainting on exertion or a family history of sudden cardiac death under 40. It also advises against routine blood tests unless there is a clinical reason.
What happens if I get side effects during titration?
Tell your prescriber rather than stopping on your own. Your dose may be held, reduced or changed, or you may switch medicine. If your resting heart rate stays above 120 beats per minute, or your blood pressure rises above set thresholds on 2 occasions, NICE says the dose should be reduced and you should be referred to a physician.
Can my GP take over after private titration?
Once your dose is stable, your specialist can ask your GP to share your care, as NICE recommends. GPs can decline, so it is worth reading about shared care and what happens if your GP refuses before you start.
I’m on an NHS or Right to Choose titration waiting list. Can I titrate privately instead?
Yes, private titration is open to adults with a valid ADHD diagnosis. If you were diagnosed elsewhere, a transfer of care appointment (£350 online, £450 in person) reviews your previous diagnosis and records first. Before you switch, check with your current provider what happens to your place on their list.
