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.