Do I look fidgety to you?

January 31, 2012 1:48 PM

Is Tenex (Guanfacine) a reasonable first choice of meds for adult ADHD, primarily inattentive?

Before the famous ADD thread, it never occurred to me that I could have ADD. After --OMG! almost two years!-- of foot-dragging and getting used to the idea, I have a diagnosis.

I think. I saw a psychiatrist and he gave me a prescription. I guess that means he thinks I have it, but he never said as much.

So, I know that drug-seeking is a big issue with the stimulant medications, and that resonsible doctors don't hand out Adderall scrips at the drop of a hat, but I was a little surprised to be given Tenex, which is an off-label blood-pressure medication. My quick Googling suggests that while some people have success in treating ADHD with it, it does more for hyperactivity and impulsiveness, which are not really my problem. I'm pretty much the absentminded professor: disorganized, procrastinating, mind forever in search of the shiny.

Has anyone had experience with this medication for ADHD-inattentive? I'm willing to give it a go, but I wonder if this psych wasn't really listening and thinks I have a more "typical" ADHD presentation?

I've heard so many comments, here and elsewhere, about how an adult diagnosis of ADD and subsequent treatment "changed my life" and I'm eager to get to that life-changing part right away, not spending months trying out meds that will make me sleepy and resolve my (nonexistent) facial tics, rather than improve my concentration and executive functioning. Should I ask for something else? Or will that be seen as sketchy drug-seeking?

I'm 41, female, no other conditions except mild anxiety.

posted by anonymous to Health & Fitness (4 answers total)

IANAD:

Guanfacine is being prescribed more and more frequently for ADHD, so I would not say that it's totally odd as a starting point. Prescribing for ADHD is a bit more art than science. It's difficult to know exactly which medication will work best for a particular person and it's not uncommon to try a few before you find one that works best. Providers often have a particular medication they prefer starting with because they find it's best for whatever reason. I'm wondering if the mild anxiety might be why your psychiatrist decided to start with this rather than a stimulant. Sometimes people find that they feel a bit more anxious on stimulants, while other people find they're less anxious because they're more focused, not missing deadlines, etc., etc. If you have concerns, absolutely talk to your physician. If he/she isn't willing to talk to you, you should absolutely find someone who is willing to do so. I don't think it's drug-seeking to discuss the pros and cons of treatment options.

I'd also recommend looking into working with a coach/therapist or reading some books on adult ADHD. The medication helps with focus, but you will also need to learn how to use that focus in the best way.

Good luck to you!
posted by goggie at 2:07 PM on January 31, 2012

Guanfacine is one of those happy discoveries where a product designed to treat A has a side effect that makes it a great treatment for B. (The other example that everyone has heard of being Rogaine.) The nice thing about guanfacine is that it doesn't raise your blood pressure (in fact, it does the opposite) so all those horrible catastrophic issues associated with high blood pressure aren't an issue with guanfacine. (Also, it's easier to go out and buy 50 caliber bullets than most of the stimulant based ADHD medications, so there is a major convenience issue.)

If you're one of the few people out there suffering from low blood pressure this might be an issue, but otherwise, I'd at least give it a try - if it doesn't work for you, it doesn't work for you, but there are people who've found that this or that stimulant didn't work for them.

(In fact, I'd like to replace the blood pressure med I'm on with Guanfacine just to see what happens and I have pretty much the same issues you do.)
posted by Kid Charlemagne at 3:20 PM on January 31, 2012

Mod note: This is a reply from an anonymous commenter.

I am an ADD sufferer, primarily inattentive type. For this I take Adderall, and it's absolutely amazing the difference it makes in me being able to concentrate on a task until it's finished. I also have a mild tic disorder that's exacerbated by the Adderall. It manifests itself in the form of repetitive movements of my tongue and toes, and intrusive thoughts like bits of songs, or counting behavior. To combat that, my doctor prescribed Tenex and it seems to work well. The best way to describe its effects is that it tones down some of the chaos going on in my mind.

The thing is, that chaos is NOT what's causing me to not be able to pay attention. The tics are at worst annoying and socially embarrassing. Rather it's the overwhelming feeling of boredom and frustration that I get when I try to stick with a task for any length of time that causes my rapidly shifting attention. That's where the Adderall helps in spades.If I were impulsive/hyperactive, I could absolutely see how Tenex helping to calm chaos in my brain would be helpful for attention span. As an inattentive type though, it does nothing for me.

That said, it's totally normal to be switching around to all sorts of different medications for the first few months to try and find which one works for your ADD. Doctors generally like to start with the most mild treatment possible, yours will probably switch you to Strattera next and see how you respond. It's up to you to be an advocate for your care though. If a medication isn't working for you, don't hesitate to tell your doctor. If you feel like they aren't listening to you or are writing you off as a drug seeker, then switch doctors (preferably to a psychiatrist). I know how tough it is when you're afraid of being labeled like that, but it can be overcome. I kept repeating to myself that I just wanted to have a healthy, normal life, and eventually those fears quieted down. In the end, I found a great doctor who actually listens to me and worked with me as a team to figure out what's right for me.

posted by cortex (staff) at 4:54 PM on January 31, 2012

It's a bit after the fact and you may have already gotten your answer, but I just found this in my internet travels:

"Inattentive ADHD treatment proves to be more unmanageable for numerous psychiatrist and psychologist because people without hyperactive or impulsive symptoms will not respond to stimulants as well or in the same way as patients with the typical ADHD symptoms will...

...A lot of psychiatrists have found that a few ADHD-PI and SCT patients do much better when their ADHD-PI symptoms are treated with Atomoxetine (Strattera) or Guanfacine (Tenex). These Inattentive ADHD treatment medications act on dissimilar neural pathways that are thought to be amiss in ADHD-PI and SCT. These medicines act less on motor activity and some psychiatrists and researchers believe that they are, hence, better alternatives for treating Inattentive ADD symptoms like slow cognitive processing and working memory deficiencies."

So it seems that meds like Ritalin and Adderall may not work as well for patients with ADD - primarily inattentive, while meds like Strattera and Guanfacine will be tolerated a little better and have better results. Of course outcomes vary greatly depending on lots of things.
posted by batonthefueltank at 2:37 PM on April 8, 2012