Reader’s Question

My son has Attention Deficit Hyperactivity Disorder. I’m frustrated because we’re still searching for a medication that is a good fit for him. He has been on Ritalin LA, Concerta, Focalin, Daytrana Patch, and Strattera. The problem with the Ritalin-type drugs is a blinking issue, which is much like a tic. This was interfering with school to the point that his hyperactivity seems mild to teachers in comparison to this tic-like behavior. On the Strattera, it is as though he is on nothing with respect to helping him focus, but his mood is significantly affected (with suicidal comments, etc.). So now, he’s being tried on Guanfacine. But I’m concerned that it may work similarly to the Strattera. His pediatrician said that it could be used in combination with either the patch or another drug. I’m curious about how, exactly, Guanfacine works to help with ADHD. Is it more like Strattera or like one of the Ritalin-type drugs? The Ritalin-type drugs seem to work wonders with his ability to focus and do his school work, but he didn’t eat or sleep. (He got to sleep in a timely fashion but was hard to wake in the morning.) And, of course, he had the tic issues. The tics were most noticeable with the Concerta and Daytrana! What to do?

Our Clinical Psychologist’s Reply

You’ll find a fairly comprehensive article about Guanfacine here: About Guanfacine HCl, Sold As Tenex, Estulic or Dipresan. Tic-like behavior is not listed among its known common or rarer side effects.

Guanfacine is like Strattera only in the sense that both drugs affect the levels of the neurotransmitter norepinephrine. However, Guanfacine belongs to the general class of medicines called antihypertensives and was primarily designed to treat high blood pressure. Strattera is a “selective” norepinephrine reuptake inhibitor and was designed as an antidepressant drug because of its action to increase levels of norepinephrine in the brain.

Guanfacine has found to be effective in reducing ADHD symptoms alone or in combination with stimulants. It is sometimes used as an alternative medication, especially in the 30% of children who for some reason cannot tolerate stimulants or experience undesirable side effects. However, drugs like Guanfacine sometimes don’t sufficiently improve attention deficit or distractibility.

As you are discovering, when it comes to treating ADHD effectively, sometimes there simply is no “magic pill.” Many times the optimum treatment regimen comes by trial and error and involves maximizing the potential benefits while minimizing risks and undesirable side effects. Be patient and work closely with your doctor. And while there may be no “perfect” solution, in the end, you’ll likely find the optimum combination of medications that provide at least some measure of symptom relief while posing the lowest overall risk.