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psychiatrist's Tentative Plan...
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<blockquote data-quote="Sara PA" data-source="post: 65263" data-attributes="member: 1498"><p>Guanfacine and Juvenile Bipolar IllnesS</p><p></p><p>Authors: J.P. Horrigan, M.D. and L.J. Barnhill, M.D.</p><p></p><p>Guanfacine hydrochloride (Tenex) is an alpha-2 adrenergic agonist which has received recent attention in the field of child and adolescent psychiatry due to its apparent benefits in managing attention-deficit/ hyperactivity disorder (ADHD), tic disorders, and posttraumatic stress disorder. The initial reports noted minimal side effects. This poster details six cases of adverse responses to guanfacine, drawn from an initial clinic sample of 95 outpatient boys and girls aged 8 to 15 years who were seen in a university-based developmental neuropsychiatric clinic. In each case, the patient met formal DSM-IV criteria for ADHD while four out of six also met criteria for Tourette's Disorder. Within 72 hours of initiation of guanfacine therapy, drastic changes in mood and behavior occurred in each of these individuals, culminating in states that resembled hypomania and mania, including elevated mood, poor sleep hygiene, and hypersexuality. The dose of guanfacine ranged from l to 2 mg/day. Later investigation revealed that all of the youngsters had clinical and/or familial risk factors for bipolar disorder. The authors speculate about the possible mechanisms behind these side effects, and suggest that bipolar disorder may be a relative contraindication to guanfacine therapy.</p><p></p><p>Increased mania on Tenex can be a sign of bipolar. The prescribing information for Tenex use to contain a statement (can't remember if it was an official warning) related to this research. I haven't seen an official Tenex prescribing information for a while so I'm not sure if the wording is still there.</p><p></p><p>That said, Celexa and all the antidepressants can cause mania and ultimately mood cycling in people who aren't bipolar as well as increase cycling for people who are bipolar, particularly for children and adolescents. That's one of the reason why they aren't approved for use by children and adolescents. It often doesn't appear at first though hypomania often does. My son became hypomanic on both Celexa and Effexor within hours of taking them. Back then I thought they were miracle drugs. But after a few weeks on the Effexor and three months on the Celexa, things started going downhill. It was quite a slippery slope, ending in psychosis.</p><p></p><p>A manic child should be taken off antidepressants.</p></blockquote><p></p>
[QUOTE="Sara PA, post: 65263, member: 1498"] Guanfacine and Juvenile Bipolar IllnesS Authors: J.P. Horrigan, M.D. and L.J. Barnhill, M.D. Guanfacine hydrochloride (Tenex) is an alpha-2 adrenergic agonist which has received recent attention in the field of child and adolescent psychiatry due to its apparent benefits in managing attention-deficit/ hyperactivity disorder (ADHD), tic disorders, and posttraumatic stress disorder. The initial reports noted minimal side effects. This poster details six cases of adverse responses to guanfacine, drawn from an initial clinic sample of 95 outpatient boys and girls aged 8 to 15 years who were seen in a university-based developmental neuropsychiatric clinic. In each case, the patient met formal DSM-IV criteria for ADHD while four out of six also met criteria for Tourette's Disorder. Within 72 hours of initiation of guanfacine therapy, drastic changes in mood and behavior occurred in each of these individuals, culminating in states that resembled hypomania and mania, including elevated mood, poor sleep hygiene, and hypersexuality. The dose of guanfacine ranged from l to 2 mg/day. Later investigation revealed that all of the youngsters had clinical and/or familial risk factors for bipolar disorder. The authors speculate about the possible mechanisms behind these side effects, and suggest that bipolar disorder may be a relative contraindication to guanfacine therapy. Increased mania on Tenex can be a sign of bipolar. The prescribing information for Tenex use to contain a statement (can't remember if it was an official warning) related to this research. I haven't seen an official Tenex prescribing information for a while so I'm not sure if the wording is still there. That said, Celexa and all the antidepressants can cause mania and ultimately mood cycling in people who aren't bipolar as well as increase cycling for people who are bipolar, particularly for children and adolescents. That's one of the reason why they aren't approved for use by children and adolescents. It often doesn't appear at first though hypomania often does. My son became hypomanic on both Celexa and Effexor within hours of taking them. Back then I thought they were miracle drugs. But after a few weeks on the Effexor and three months on the Celexa, things started going downhill. It was quite a slippery slope, ending in psychosis. A manic child should be taken off antidepressants. [/QUOTE]
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