Re: ADHD education of critical importance
A few months back I did a "speedread" on guanfacine and was impressed with it ADHD effacious properties especially for ADHD rebound. So I run off to my shrink, ask for guanfacine for my insomnia that I think is the result of ADHD rebound. He sends to GP and I ended up with a prescription for clonidine. Clonidine did not help me.
I suspected the reason was my shrink and GP consulted and decided clonidine would be better for me. I realized that I did not make myself clear. I went in unprepared to a sales meeting with shrink to sell the idea of guanfacine for me. I know my shrink. I know if I presented my case convincingly, he would have agreed.
I'm so glad things went south on first "Intuniv" try. It forced me to follow your good example and actually research and study the properties of clonidine and guanfacine. Both are alpha-2 norepi agonists. Guanfacine is of subtype alpha-2A. The difference in the properties between clonidine and gaunfacine has to be found in the subtype alpha-2A.
So off I went into a hyperfocused quest to get the "why." About 30 hours of study time later, I understood ONE thing about neurons. Neurons are typed to neurotransmitters.
One type of neuron is of type norepinephrine. Norepi neurons have all the norepi receptors. The different norepi subtype receptors act as logic gates. These gates control the path of norepi and its quantity from its one source to its gadzillion possible destinations.
Sooooooooo, the dif between clonidine and guanfacine is the first acts on all alpha-2 receptors, the second on just alpha-2A. The results are: Clonidine ends up at more destinations so clonidine has a much broader set of properties. One of clonidine's properties is sedation. Sedation is NOT a clonidine side effect. Clonidine can be used to sedate the side effects of stimulants.
Guanfacine, on the other hand, is much more selective on alpha-2A receptors. The norepi logic gates set the path to fewer destinations. It so happens that one of the few is the prefrontal cortex area.
Sidebar: Once the path to destination is established, norepinephrine changes role from neurotransmitter to neural hormone. A region of the brain is activated. The neuro guys can see the region "light up" using SPECT scans or fMRI's. Pretty convincing evidence that theory of action is very close to actual action.
Suppression of ADHD rebound is a NOT property of guanfacine. Guanfacine's properties include improved working memory - NOT ADHD rebound. ADHD rebound is working memory gone wild. Clonidine, on the other hand, disrupts working memory. Clonidine made my ADHD rebound worse.
Does the biology translate to guanfacine actually helping me? I wrote an email to my GP briefly explaining in lucid detail why I want guanfacine, not clonidine. Granted, we had my clonidine history now, nevertheless, two days later, her office called to tell my guanfacine prescription was called in to Walmart YESTERDAY. I think my presentation had something to do with it.
Guanfacine is working BETTER than expected. I experience no, no, no, ADHD rebound. I mean finally NO ADHD rebound. About a week later, I visited my shrink, gave him a copy of my memo to GP, and shrink said "why didn't you tell me? Yes, of course, guanfacine is for you."
For the first time in a situation like that, I kept my mouth shut. I knew I did tell him that but not in a very clear or in a convincing manner.
Actual experience proved to me the value of getting your ADHD (Adhd Doctorate for adult Humans with the Disorder) degree. I do so love that acronym. One of my best.
Now that I got my ADHD degree, I must switch back to my job that makes money, money, money. Sing along with me - "I owe, I owe, it's off to work I go."
PS I must add one more facinating thing. We have epinephrine and norepinephrine. Transistors are grouped in CPU's to form logic gates And, Or, NotAnd (Nand), NOTOr (Nor). Hmn, Epi and NotEpi (norepi). Hmn, what explains the similarity in designation. Simple. Us humans learned math first, than applied it to computer science, now we apply the same math to neuro science. My background came in handy in wrapping my warped brain around neuro basics.