Guanfacine is approved to treat ADHD in the United States and several other countries.
Technically, extended-release Guanfacine is approved because that's what was used in the trials. The brand name is Intuniv and the generic is Guanfacine ER.
The generic guanfacine (non-ER) can also be used, though technically off label. The only difference is that it must be dosed twice a day instead of once a day and the absorption is different so you can't do a 1:1 translation of your dose to the ER.
Now that Guanfacine ER is generic and cheap, you might want to consider it for once daily dosing.
The non-stimulant medications are very good, but require some patience to get started with. Too many people give up in the first week or month because the side effects haven't settled yet. Straterra (Atomoxetine) is another one that can take 1-2 months for good efficacy. Clinical trials show the positive effects continue to build over the course of a year. Surprisingly, Atomoxetine has a lower relapse rate after discontinuation too, suggesting it might be making some long-term positive changes to the brain. This is a nice contrast to stimulants, where the patient becomes essentially dependent on the medication and can go through a protracted rebound if they ever have to discontinue.
Can Guanfacine be taken pro re nata like stimulants? If so, how long is the duration on average?
One reason I have never considered the blood pressure medications is because, and correct me if I am wrong, if one takes them too consistently for too long, then sudden cessation can be dangerous and/or deadly.
> The non-stimulant medications are very good
Define very good. From what I have gathered during my browsing of research papers of varying quality, it seems that that non-stimulant options are perhaps at the level of "better than nothing."
If I remember correctly, those who do well on MPH tend to do better on Atomoxetine, but even then, it's no guarantee. I've also read plenty of anecdotal evidence from people using Atomoxetine, and it seems like a large majority either cannot even make it past a few weeks due to intolerable side-effects.
Also, the wikipedia page for Atomoxetine is not very reassuring with the statement:
A 2020 meta-analysis found that atomoxetine was associated with anorexia, weight loss, and hypertension, rating it as a "potentially least preferred agent based on safety" for treating ADHD.
What I really want to see if more head-to-head drug trials with all these medications and non-pharmaceutical alternatives.
For example, how much more effective on average are stimulants than non-stimulants? Are things like caffeine, nicotine, or both combined more effective than non-stimulants? What about compared to stimulants?
All I can ever find is research supporting if a medication is successful in reducing symptoms compared to a placebo. I just want to see them all ranked against themselves. Of course, I understand individual experiences would vary wildly, but I do think there is a potential for some utility in this data.
I can't take stimulants for many reasons, but mostly they just make me a miserable A-hole to live with so I tried Atomoxetine/Strattera which worked for a few months and then my anxiety went from 0-1000.
Even getting in a small argument with my kids would increase my heart rate and blood pressure to unsafe levels. However, it did help me focus and pay attention, it also helped me kick my Marijuana habit (Legal state) which looking back just fueled my ADHD symptoms. It was also being used as a crutch to avoid dealing with my emotions and problems in life which just added to my anxiety.
Going back to the studies, another issue is that these medications can vary wildly from person to person based upon our own perceptions, experiences, and other comorbidities combined.
I’m on guanfacine and I’ve ceased it several times without issue. (Due to running out) It’s discouraged but my understanding from researching it is that’s more as a precaution. The bp drop from ceasing is rarely dangerous.
Started on atomoxetine in February - I was 47 - the difference it has made with regards to staying on task, and short term memory is staggering. Doesn't really help with motivation though, sadly.
I wasn't aware of the long term positive changes, perhaps this is what my psych should have said instead of giving me an analogy of floating down a river and wanting me to carry on down that same stream without the meds...
It really does vary wildly from person-to-person. I know folks for whom atomoxetine did wonders, but 4 months on it for me had almost no improvements in my symptoms but a bunch of minor side effects.
Like lots of medications, you really do just have to try out several until something works well with your particular body.
Guanfacine is approved to treat ADHD in the United States and several other countries.
Technically, extended-release Guanfacine is approved because that's what was used in the trials. The brand name is Intuniv and the generic is Guanfacine ER.
The generic guanfacine (non-ER) can also be used, though technically off label. The only difference is that it must be dosed twice a day instead of once a day and the absorption is different so you can't do a 1:1 translation of your dose to the ER.
Now that Guanfacine ER is generic and cheap, you might want to consider it for once daily dosing.
The non-stimulant medications are very good, but require some patience to get started with. Too many people give up in the first week or month because the side effects haven't settled yet. Straterra (Atomoxetine) is another one that can take 1-2 months for good efficacy. Clinical trials show the positive effects continue to build over the course of a year. Surprisingly, Atomoxetine has a lower relapse rate after discontinuation too, suggesting it might be making some long-term positive changes to the brain. This is a nice contrast to stimulants, where the patient becomes essentially dependent on the medication and can go through a protracted rebound if they ever have to discontinue.