Guanfacine And Concerta (ptsd And Adhd Treatment)

[Lopezwhere'sthefire]

I read a couple much older threads on Guanfacine, but couldn't reply due to the posts age. One post asked for other using Guanfacine and asked what they thought, the other discussed the uselessness of Guanfacine proven in clinical study. I wanted to reply to both, so i'll state my case here:
(let me state that I knew I had a mental issue to identify and get treatment for, I just didn't now what it was, so I began the process of selecting mental health professionals to guide me. I originally thought I had ADHD, come to find out it can be a symptom of PTSD which is my case, so I sought treatment for ADHD originally)

After selecting a therapist, I knew i'd need a psychiatrist to prescribe any medications I might need, so I found a learning disability center with a psychiatrist on staff to determine if I had ADHD. Being a psychiatrist I figured he'd be able to diagnose anything. I now think he tends to see everything through ADHD colored glasses. Anyway, after determining I do show ADHD symptoms and also high blood pressure, he prescribed Guanfacine, (which isn't approved to treat adults over 17 yrs old for ptsd or adhd, but can be for high blood pressure, aha! a back door!). So I began 1 mg of Guanfacine and the side effects were tolerable, but kinda uncomfortable, (gas, dry mouth, fatigued), BUT...several very troublesome symptoms either faded or disappeared, restless leg syndrome= gone!, Hypervigilance=decreased, rhythmic motor issues=largely decreased, anxiety=slightly decreased.
After 10 days I stepped up to 2 mg, and side effects doubled with positive effects not really increasing. My body weight suggests I take 4 mg, (over 200 lbs), but he chose to leave me at 2 mg, anyway, we may come back to that.
My last visit I mentioned I still have a lack of focus, (addressing the adhd) when reading and doing my school work,and remaining anxiety, and asked about the viability of adding a supplemental stimulant drug to the mix. He agreed and prescribed a middle of the road dose of Concerta.
Hmm...i'm still watching my behavior and feelings closely, but honestly I think the Concerta kicked me backwards a touch, but gave me great focus. I'm somewhat disappointed now. I may ask him to increase the Guanfacine, although I know the side effects will become worse. Or I could ask for the lower dose of Concerta, or do both.
Ok.That's where I'm at. I do feel the Guanfacine addressed some things that have haunted me for over 30 years and am ecstatic over that, but still somewhat disappointed with the mix we got going on here.
Sorry to drone on, but I wanted to be thorough. Am I missing something? Is there a better way? Is this doctor ignoring the ptsd? I may seek out another dr. who specializes more in ptsd if this guy isn't in the ptsd loop. Please advise.

 

[joeylittle]

There is no medication that will treat PTSD. There are medications that manage symptoms associated with PTSD.

There are a few SSRIs that are approved for the 'treatment/management' of PTSD, but all that means is that someone bothered to do the trials that would demonstrate those drugs as 'useful' against PTSD.

What else are you doing to manage your symptoms - non-medication based tools/strategies?

Also, have you been diagnosed PTSD?

 

[Lopezwhere'sthefire]

There is no medication that will treat PTSD. There are medications that manage symptoms associated w...

Thank you for your reply Joey, I appreciate the help.
My therapist says she's certain I'm ptsd, but my psychiatrist hasn't even opened his mouth and said anything. Very vague guy. He is just writing scrips. I am doing CBT and that's going really well. I'm anxious to get more things going. (i'm typically pretty impatient guy). I'm not familar with SSRI's. I'm a complete noob. After chatting in the chatroom today with others, I think I may be on the wrong stuff. No one else is taking what i'm taking. Its hard for me to tell if my awareness, (CBT) of my behavior is keeping me from acting out with emotional outbursts, or if it's the Guanfacine. Anxiety is lessened, but still in sight. I'm kinda flailing in the deep end, so thanks for reaching out.

 

[joeylittle]

After selecting a therapist, I knew i'd need a psychiatrist to prescribe any medications I might need, so I found a learning disability center with a psychiatrist on staff to determine if I had ADHD. Being a psychiatrist I figured he'd be able to diagnose anything. I now think he tends to see everything through ADHD colored glasses.

You might want to find a psychiatrist who is more of a generalist. I also think that going out in search of a specific diagnosis can return results that look like that diagnosis, especially if the psych doesn't take much time working with you...that's just my opinion, but I think its something to be watched out for.

You certainly don't want to be on meds you don't need. On the other hand, it sounds like the meds you are currently on are doing a pretty good job. You are getting better concentration with the concerta - so, if the ADHD diagnosis is right, then between that and the guanfacine, you might have a good combo.

Managing expectations regarding meds - how well they will work, what you can expect them to do - is an important conversation to have with your prescriber. I'd recommend you:

• talk with him about those things, and either either tweak the guanafacine back up, or adjust the concerta down
• sign a release so he and your therapist can talk to each other
• ask your therapist to follow up with the psych to discuss a possible PTSD diagnosis

But in terms of your meds, see if you can find a good working combination of the two.

What trauma-focused therapy is your therapist planning on doing with you?

CBT is great, and will serve you well in many ways.

 

[Lopezwhere'sthefire]

You might want to find a psychiatrist who is more of a generalist. I also think that going out in s...

Thanks again Joey, those sound like excellent recommendations. The wife and I were just talking about either lowering the Concerta, (because I'm kinda freaking out as we speak), or upping the guanfacine to better align with my body weight. You're right, I this this P to talk with me, or listen to my T.
As far as the next plan for additional therapy, I need to ask this week. I think maybe I should find the docs email address and perhaps get this Concerta dropped to the lower dose or stop it all together. Thamks again for the help. I'll mention how it goes in here when something changes.

 

[joeylittle]

upping the guanfacine to better align with my body weight.

I'll just say, since you tried this and nothing improved but you had increased side effects - you don't need to try it again. Bodyweight is a factor, but how you metabolize the medication is another one (and it's not related to how you metabolize food). A big part of med management is making sure you change one thing at a time, so you can notice what happens, and that you go with what you've learned, even if it's not totally lining up with what you can research, or majority reports.

It's a long, sometimes very slow road, but the right combination of meds can make recovery much easier. I look forward to hearing how things progress for you.

 

[Lopezwhere'sthefire]

I'll just say, since you tried this and nothing improved but you had increased side effects - you do...

Excellent point. Perhaps we'll keep the Guanfacine where it's at and perhaps he'll add something new..I guess I'll find out soon enough. Thanks for all your input. It really does help me navigate through all this.

 

[Justmehere]

Your doctor may not bring up your diagnosis but he should. If he isn't, then you can ask him what he thinks the diagnosis is and the pros and cons of any medications to held moderate symptoms of PTSD. Be sure to keep your therapist in the loop too. Most forms of trauma throat can stir up symptoms for a short time as well.

Don't change medication amounts on your own, but check with the Doctor first.

The more you can communicate with your doctor about your symptoms, the better they can help you.

 

[Lopezwhere'sthefire]

Your doctor may not bring up your diagnosis but he should. If he isn't, then you can ask him what he...

Thanks, yeah, I was tempted to skip the Concerta this morning, but i'll do as I'm told and follow the channels/protocol etc etc.

 

[Lopezwhere'sthefire]

The Concerta has got to GO! i'm freaking out for the most part with anxiety.. called for emergency appointment tomorrow. Doc said stop the Concerta. Hate this feeling. I'm disappointed.

 

[Lopezwhere'sthefire]

It's a long, sometimes very slow road, but the right combination of meds can make recovery much easier. I look forward to hearing how things progress for you.

Your input on this thread is fresh in my mind and valued joeylittle. I'm acting on it by looking for someone specializing in the right problem with meds somewhere on the radar for ptsd, lol Thank you again for your input on this. btw, though, I think i'm gonna try and keep the guanfacine if new doc lets me. It eliminated my restless leg syndrome, (YES!), blood pressure elevation, and cut my drinking by 2/3.

 

[Lopezwhere'sthefire]

Update : have a new psy and we're starting with 10 mg of Prozac and currently keeping the guanfacine. The Concerta went bye bye almost immediately. Dry suggested some other nonstimulant adhd to try when the Prozac is established. We shall see!