Q: Tenex and Other Meds Helpful in ADHD?
I have noticed many of your viewers have an issue with ADHD as well. How do you
feel about adding in a drug such as Tenex? This may help with their
cognitive problems while perhaps dealing with high blood pressure that they may
have as part of their anxiety. Perhaps propranolol could fill this roll as well.
On the same topic I have read that Pramipexole increases the metabolism in
certain regions of the left hemisphere while not increasing it in the Amygdala.
I have noticed when I take stimulants that the positives are outweighed when the
oversensitive Amygdala gets into the picture. In fact I think this kickstart to
the Amygdala is what starts the cycling(kindling). I also wonder whether
Levetiracetam might have a roll to play here. thanks michael
Dear Michael --
You are right, ADHD and bipolar disorder overlap a great deal. In general, as
you have seen, mood experts recommend treating the bipolar first and then
treating any remaining ADHD symptoms. Importantly, there is a non-medication
approach to ADHD (although so far it has only been tested in conjunction with
stimulant treatment). It is described in the manual for patients, entitled
Mastering Your ADHD.
But if a medication is to be used, to address ADHD symptoms in people with
bipolar disorder, which should be used? So far, experience is largely limited to
the use of conventional stimulants and their long-acting counterparts
(methylphenidate/Ritalin; amphetamines/Dexedrine;Concerta, Metadate, etc.). Some
evidence supports using Wellbutrin, which used to be rather concerning to me
until recent data suggested that the risk of "switching", i.e. inducing manic
symptoms, is appears to be considerably lower with this medication than with
other antidepressants. I still worry about that. Therefore I also worry about
using atomoxetine (Strattera) in this role.
In general, however, I think experience and what little
research we have is beginning to suggest that stimulant medications do not
propose a large risk -- at least in the short run -- of worsening bipolar
disorder. We still know too little to be very confident about this conclusion,
in my opinion.
Published March, 2008
As for other medications for ADHD, such as guanfacine (Tenex), we know even
less. One could reason that a medication for blood pressure might be less likely
to be destabilizing than an amphetamine or amphetamine-like compound; that
certainly seems reasonable. But to my knowledge, we have no evidence for
propanolol as a treatment for ADHD.
The other medications you name have been around a relatively short while. So
nearly any comment is largely speculation. In general, as you may gather, my
inclination is to assume that medications present a risk until this has been
countered by a fairly lengthy period of clinical experience. As a result, I am a
"late adopter". Thank you for sharing your thoughts, as you are pioneering and
your experience may be valuable for others.