Potential Treatment for “Brain Fog” in Long COVID Patients: Guanfacine plus NAC
As announced in Yale on December 13, 2022 by Isabella Backman “A new Yale case study finds that two medications used for treating traumatic brain injuries, when taken together, can mitigate and sometimes eliminate the cognitive impairments known as “brain fog,” common among people with persistent COVID-19 symptoms….Individuals with long COVID, sometimes referred to as “long-haulers,” experience symptoms that may persist for weeks, months, or even years after their acute viral infection. While symptoms vary widely, a common complaint among patients is “brain fog”—a colloquial term for significant, persistent cognitive deficits, with consistent impairment of executive functioning and working memory. Long-haulers may experience a lack of mental clarity, poor focus and concentration, memory problems, difficulty with multi-tasking, and more. Brain fog can be debilitating, but there currently are no treatment options that are approved for the condition.
Guanfacine Improves ADHD Symptoms and Academic and Social Functioning in Children
A study by researcher J.H. Newcorn and colleagues published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2013 found that eight weeks of treatment with the drug guanfacine (extended release) improved symptoms of attention deficit hyperactivity disorder (ADHD) in North American children compared to placebo. A 2015 study by M.A. Stein and colleagues in the journal CNS Drugs extended this research, determining that guanfacine also improved academic and social functioning, including family dynamics, in the same group of children.
Children aged 6–12 who had been diagnosed with ADHD received either placebo or 1 to 4 mg of guanfacine extended release either in the morning or evening. The children in both guanfacine groups showed improvements in family interactions, learning and school, social behavior, and risky behavior compared to those taking placebo. No improvements were seen in life skills or self-concept. The improvements in functioning were linked to the drug’s effectiveness in improving ADHD symptoms. Those children whose ADHD symptoms improved on guanfacine were also more likely to see improvements in academic and social functioning.
Guanfacine Improves Cognition in Schizophrenia
People with disorders on the schizophrenia spectrum often suffer cognition problems that affect skills such as the processing of information about people and social situations (social cognition) and the execution of plans (executive function). At the 2015 meeting of the Society for Biological Psychiatry, researcher Larry J. Siever reported that the drug guanfacine improved these types of thinking in people with disorders on the schizophrenic spectrum compared to placebo. Participants were enrolled in a 7.5-week training program to improve cognition.
Guanfacine Augments Stimulants in ADHD
Tim Wilens of Massachusetts General Hospital presented a poster at the 57th Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP) in October 2010 that showed that extended release guanfacine could augment incomplete responses to stimulants in children with attention deficit hyperactivity disorder (ADHD). This double-blind, placebo-controlled study of children aged 6-17 used guanfacine doses of 4mg/day or less. Those children who received guanfacine in addition to the psychomotor stimulant they were already taking were more likely to improve and more likely to reach a satisfactory remission than those taking a placebo in addition to their regular psychomotor stimulant. These results suggest that adding an alpha 2 noradrenergic agonist compound like guanfacine to a psychomotor stimulant may bring about a more complete response in ADHD.
Children with ADHD and Oppositional Symptoms Respond to Guanfacine
Researcher Daniel Connor reported at the 65th Annual Scientific Convention of the Society of Biological Psychiatry that children aged 6-12 with oppositional symptomatology and attention-deficit/hyperactivity disorder (ADHD) improved on guanfacine XR.
Doses ranged from 1 to 4 mg/day, with a mean dose of 2.9 mg/day. There was a substantial decrease in oppositionality (a finding with a moderate effect size of 0.59) and a marked decrease in ADHD symptomatology (a finding with a large effect size of 0.92). Side effects included drowsiness (in 51% of subjects), headache (22%), sedation (13%), abdominal pain (12%) and fatigue (11%). Guanfacine is not a psychomotor stimulant, like most of the treatments for ADHD are, but an agonist (activator) of noradrenergic ?2 receptors in the brain.