tics, trichotillomania, stimulants | ADHD Information

Take care to start the guanfacine low and work slowly up to the target dose. This can reduce or eliminate side effects. I can cause tiredness until the body gets used to it (increasing slowly-first at night then the day doses seems to help this). I should have asked...Is the guanfacine instead of the clonidine or in addition to it? Best of luck with this.vickie39206.6202314815Well after a week of paging and leaving messages, we have finally talked to doctor. We are in agreement stimulants are NOT the way to be going with my daughter. We are going to add Guanfacine and lower her Zoloft and Ritalin dosages until the end of the year. This should help the tics and more worrisome the trichotillomania. He thinks they will not resovle competely this way though. Once school is out we are going to go to Desipramine. We did do 2 years on Nortryptiline (same family) and she did well, but was SO tired. Doc tells me no tiredness or weight gain (although she could use that) with the Desipramine. Anyone have experience with it?

It is in place of the Clonidine. She is tired on the Clonidine and it wears off at lunch time. We are putting her on the equivalent dose of Guanfacine as the Clonidine so we shouldnt have to mess with dose. He said we could just go to 3 times a day instead of 2 if need be.  We will drop her to 10mg of Ritalin if she's still "ticcy" (am sure that is not a word). At this point if she isnt tic free or minmal tics after dropping the Zoloft dose and Rtialin dose, I would just drop the stimulant and suffer through the end of the school year. By then it'd only be a few weeks.

The guanfacine lasts 6-8 hours for ADHD symptoms and is in the system much longer (half-life of 12-18 hours). We use 2mg am and 2mg pm with a 1/2mg boost on the afternoons when she will have a challenging social schedule. It really helps her be a pleasant person to be around, helps with the stress of transitions and helps her relax to sleep.

We went for guanfacine alone for a while. She was great at home and improved at school (Bs rather than the As on the combo of guanfacine and stim). We were happy with it, but after 4-6 weeks she started showing anxiety again due to frustration at school so we added back a stim (this time focalin rather than concerta). She has dyslexia as well, and the med combo seems to help her overcome the issues it causes her.

Keep us informed on your progress.

It sounds like you are treating the anxiety and have the delecate task of finding ADHD treatment that does not mess with the anxiety treatment. The use of zoloft may make it so strattera is not an option.

The shire studies showed effectiveness for ADHD symptloms for thier long acting guanfacine. When we tried with guanfacine alone (no stim) the youngest had grades that dropped slightly to Bs so we were happy. The problem was that after 4-6 weeks her anxiety increased because she knew things were harder to keep up and she no longer got the easy As. So in my daughter's case, we know that guanfacine helps with focus but not quite enough (it was like low dose stim in the early dose determinations for her). We know that for school sucess and her self esteme related to school, we need the combo of stim and guanfacine. The guanfacine does help us use a lower stim dose. We could not increase stim to a more effective dose because of weight issues and the guanfacine made it so that a lower dose of stim was effective.

Some docs go with clonidine 24/7 but it has not been as extenxively studied for  ADHD symptom releif as guanfacine, and the extra sedation of the clonidine is great for inducing sleep but not as good for some people for daytime use.

This is our experience.

 

vickie39200.6343634259We have only been on the Clonidine for a few days, but so far no tiredness. The more I read and all this GREAT feedback seems like Guanfacine may be what we should be trying. Sounds  like the new drug (? Cennexyn??)  may be a nice thought once it is approved.

Don't be surprised if your doctor is not as sold on the guanfacine as we are...my ped said, and I quote, "It sounds like you have been visited by a drug rep from the company!"  She then went on to say that she had good success with the guanfacine with her ADHD patients, and thought it would help Chase, but that she did not think it would help either his "tearful frustration" (my description of his problems...) or his appetite/weight gain....within a month he went on to cease having social issues on the bus and playground (no more coming home consumed with "tearful frustration", and he gained 3 pounds in about a month.....

So it just goes to prove that we parents, who live with the children on these meds, know best!

Oh yes we do! Thankfully we are getting medication from a psychiatrist who specializes in childhood disorders and is a psychopharmacologist. He is very open to my suggestions. It is as emotional to me as her I think with all these drug changes. The poor thing, breaks my heart to have to pick the thing that has the side effects I think she can live with!

Is it posible that she has anxiety that the meds are making worse?

It might be worth trying a non stimulant or getting the anxiety under control with a med then adding a low dose stimulant. Strattera is a non stim ADHD med, guanfacine is also used for ADHD off label and for tics (shire should get approval for ADHD later this year). Also, antidepressants are a 3rd line of treatment for ADHD symptoms and are used to relieve anxiety. You have several choices.

Co-existing disorders can really make it hard to to get to the right treatment. Keep at it, you will get there.

She does have anxiety issues. She is taking Zoloft and we just added cConidine. We are hoping the Clonidine will help with the tics. It can help with the trichotillomania, but not always. Hopefully it will work. I am just thinking ahead. She is SO thin and with tics and new trich issue, I am just wanting to think about non stimulant route. Has there been a lot of luck with the Guanfacine without the stimulant? Or Guafacine with Strattera?  We're new to the Clonidine family so we'll see. She did actually very well on Nortiptyline for 2 years, but was falling asleep in the day and she hated being sleepy. School also frowned upon her sleeping on her desk during Social Studies

You might do a search for the Shire studies with their time release tenex (name brand for the generic guanfacine).  I am pretty sure that they did some research studies on their new drug.  The guanfacine is the same med, it just does not last as long, so may be a good thing to try while waiting on the release of the new med shire is working on.

The info on the guanfacine is that it is not as effective on focus as the stim, but helps with so many of the other ADHD symptoms.....

Have you tried any other stimulants?  They all work a little differently, so if these tics are a side effect of the ritalin switching meds may help. You also want to be sure that what she's doing is truely a "tic" and not just a bad habit that any child might deal with.  I've heard people describe nail biting as a tic, but as far as I know that's just a very common nervous habit (that can be broken with some work).  What came to my mind when you said she's touching her face is myself at that age, getting pimples for the first time and touching my face all the time because I was self- concious (which of course makes that problem worse).    

The other thing I was wondering was, is she actually pulling out her hair or just pulling/tugging at it?  In your post you said "pulling at" which isn't really harmful- it could be a self- calming technique.  I scratch my scalp, whether on or off my adderall- it's very relaxing, although I try not to do it in public as I don't want anyone thinking I have lice.       

 

we have tried many stimulants. Ritalin three forms, Concerta twice (this second go around is when the hair pulling started), Adderrall and Focalin. Along with the hair pulling she also has a blinking tic, that I saw with Focalin, Concerta and is now back with the Ritalin.

She pulls her lashes and brows out, not just tugging. It is something we need to help her to stop.

My daughter age 12 has also had tics off and on when on stimulants. She also touches her face and has recently started pulling at her hair, brow, lashes.....etc., etc. We have added clonidine to her "mix", but anyone had significant luck with the non stimulant route? Her doctor is very open to making changes, but I almost feel I need to make the sugggestions. She JUST struggles so much with side effects from the Ritalin, but really cannot get through her day on no meds. HELP, I need some suggestions, she is such a mess.

Diane V