Tourette syndrome, as has been mentioned before, is a lifelong condition. It can also interfere in a person's ability to live a
"normal" life. One of the DSM-IV criteria for Tourette syndrome was
the condition must cause marked distress or significant impairment in social,
occupational or other important areas of functioning
Luckily, although Tourette's cannot be cured, it can be treated.
Drug class
|
Drug name
|
Retail name(s)
|
Notes
|
| Antipsychotic |
Aripiprazole |
Abilify*/Abilitat |
RISK OF TD |
| Selective Norepinephrine Re-uptake Inhibitor |
Atomoxetine |
Strattera |
ANTAGONISE |
| Anti-Depressant |
Bupropion |
Wellbutrin |
ANTAGONISE |
| Antiolytic |
Buspirone |
Buspar |
|
| Antihypertensive/Antimigraine |
Clonidine |
Catapres*/Dixarit |
|
| SSRI Antidepressant |
Fluvoxamine |
Luvox |
|
| SSRI Antidepressant |
Fluoxetine |
Prozac*/Zactin*/Erocap/Lovan |
|
| Antihypertensive/Antimigraine |
Haloperidol |
Halodol/Serenace* |
RISK OF TD |
| Oral Antihypertensive agent |
Mecamylamine |
Inversine |
|
| Stimulant |
Nicotine |
Nicabate/Nicorette/Nicotinell |
ADDICTIVE |
| Depressant |
Marijuana |
Not Legal |
ADDICTIVE |
| SSRI Antidepressant |
Paroxetine |
Aropax*/Paxil |
|
| Antipsychotic |
Pimozide |
Orap* |
RISK OF TD |
| Antipsychotic |
Risperidol |
Resperdol
Risperidone*
|
RISK OF TD |
| SSRI Antidepressant |
Sertraline |
Zoloft* |
|
| Antipsychotic |
Quetiapine |
Seroquel* |
RISK OF TD |
| Cholinergenic agent |
Tacrine |
Cognex/THA |
|
| AntiParkinsonian |
Tetrabenazine |
Tetrabenazine* |
|
| Phenothiazine (antipsychotic) |
Thioridazine
Trifluoperazine
Fluphenazine |
Aldazine/Melleril
Stelazine
Permitil/Prolixin/Prolixin
Decanoate/Prolixin Enanthate |
RISK OF TD |
| Tricyclic antidepressant |
Desipramine
Nortriptyline |
Pertofran
Allegron |
|
I have used/are using medications marked with a *
WATCH OUT: ANTAGONISE means the drug may actually make tics worse.
ADDICTIVE: means this is a highly addictive substance.
SSRI (Selective Serotonin Reuptake Inhibitor)
antidepressants are not actually treatments for Tourette's by themselves. They are primarily used to control some of the conditions associated with
Tourette's, such as OCD, panic and anxiety disorders and depression. However, low serotonin levels are an obvious sign of Tourette's and it is
believed that they cause some of the tics. As it is SSRIs don't tend to hurt Touretter's, although for a select few they drastically increase the level
of tics for the three-four week settling in period.
Taken with an antipsychotic medication, SSRIs are very useful.
They work on a feedback/elimination loop; increasing the anti-tic effects of the
drug while combating the fatigue, anxiety and depressive side effects these
medications can have. It is a powerful combination.
Sertraline appeared, to me, to be the best at minimizing tics in this
feedback/elimination loop.
Paroxetine appears to be the best at handling
panic and OCD.
The warning is that SSRIs never behave the same way twice. If you stop an SSRI for a month or longer, the next time you go on it the effect
will be totally different. In 1998, I thought Prozac was a gift from heaven. When I revisited it in 2000, I got migraines and dizziness and no
difference in my depression...go figure!
Zoloft is a very effective SSRI. If you find that other SSRIs (e.g. Aropax) cause weight gain, then you should try Zoloft. in many people it
causes weight loss, but for me it is weight neutral. This means my diet and exercise now stands a chance of shifting some of the Aropax kilos.
I give this warning in strictest confidence, but you need to know. Paroxetine drugs (Aropax is the best known one) can have weight gain issues.
Unfortunately I don't mean a small weight gain.
Over a 12 month period I went from 64kg to 80kg!
That's a gain of about 45 pounds!
I was, and am, horrified.
Even a personal trainer had not helped matters and, as wonderful the Aropax was
for my depression, I had to take my chance with a new anti-depressant as I was
risking my health.
Aripiprazole is, like most antipsychotics, used to treat Schizophrenia. The major
difference between this and other antipsychotics is that its effectiveness in
Tourette syndrome has not been properly tested. To learn a bit about drug
testing, click here.
The newest news about Aripirazole is one of dosage. It seems that too many Doctors were finding that low doses gave
people flu like symptoms described here so they gave
up. What they didn't know was that they had to give higher doses, not
lower ones.
I and many like me, are on upwards of 20mg of the stuff
and it is doing wonders. No side effects and a great curative effect.
So keep your eye out for Abilify...it's a winner in my opinion!
Seroquel is another of these new "designer" drugs.
Originally for Bi-Polar disorder, then Schizophrenia, it has not been tested for
use in Tourette's. However, logic would suggest that it would work the same way
the other anti-psychotics do. I was tested on this medication and it did
absolutely nothing! No side effects, but no effects either. I might as well have
drunk a glass of water.
Because Clonidine is primarily used for treating high blood pressure it, of
course, lowers blood pressure. This was hinted at when I went on the
medication, but I was not prepared for the five seconds of visual blackout
whenever I stood up. This medication was good for controlling the tics
but I decided to give it up when I passed out in gym class one
afternoon. After talking to Touretters I've discovered low blood pressure
is quite common amongst us. So be careful!
This is the most prescribed TS drug in the world. Something like 80% of
medicated TSers are on Haloperidol in some form. It's definitely an oldie
but a goody. Most people get some side effects from this drug, but they
are easy to put up with.
If you find Haloperidol gives you too many side effects then you'll probably
be exposed to the long and frustrating process of finding a drug that does work.
Pimozide has been referred to as the "King of Antipsychotics" in
the past. Now it is prescribed with reluctance. Pimozide is one of
the old class of drugs which tend to be more effective than the newer ones, but
with many more side effects.
Pimozide's main worries are:
- it can cause heart tremors in perfectly healthy people (prolongs the Qt interval)
- its Tardive dyskinesia risk is cumulative. While modern drugs have an overall TD risk, Pimozide's risk increases by 4% every year!
So if you've been on Pimozide for 10 years, your risk of TD is 40%.
- it can raise blood sugar levels and blood pressure, especially in females. Pimozide can also cause dystonia. Dystonia resembles TD, but is not as serious, and can be treated very effectively.
If you get these symptoms, do not panic, but it is still a good idea to stop medication and talk to a doctor
immediately.Just be aware that if you take Pimozide that
it is becoming more common for Doctors to order you to have a three-monthly EEG
to make sure your heart isn't going to stop suddenly. This is procedure, do not
be alarmed.
This med is very good for tics. I have found that it
doesn't lose its effectiveness too fast, and doesn't make you particularly
drowsy either. It can cause sensitivity to the sun, so wear lots of
sunscreen and have sunglasses handy. However it, like all meds, has some
problems.
Firstly, weight gain. On this medication I personally gained 1kg (2 pounds) a week! This is not nice in anyone's language.
Also, Risperidone is probably the most addictive antipsychotic I've been on. While there are no unusual withdrawal symptoms, even if you stop
it suddenly, there is one major problem. You can't sleep!
At 5am, two days after I switched from risperidol to another med I was still awake. It had been two days since I slept; having been
through this before, I expected to start having minor hallucinations in the afternoon, so was not worried by them.
Your doctor probably won't warn you about this, but now you know.
Nicotine use in Tourette syndrome is still being researched. A study
was done where it was found young children responded well to nicotine patches
and nicotine gum. However, it is not nicotine itself that will be used in
TS treatment ultimately. Nicotine is addictive, even in gum form, so it is
not recommended. However, it is hoped that the studies will narrow down
why nicotine works so well, and this will help researchers develop a Tourette
specific drug (something which has not been done yet)
Studies were being done into marijuana which has been found to have an almost total canceling effect on Tourette tics. These studies
are no longer in process because it has been found that it is the psychotropic (hallucinogenic) part of MJ that controls the tics, so there is no possible
derivative that could be used in medication.
WATCH OUT
An awful lot of nothing is known about this medication.
But from what I've been able to find it is a conflicting medication for
Tourette's. While its prevention of serotonin uptake is good, its
prevention of dopamine uptake is bad. I would imagine (without ever having
been on the drug) that the excess dopamine would outweigh the benefits of
serotonin and you'd get more tics on this drug than off it. However, the
anxiety level of the person being treated would effect the outcome, as less
stressed people generally have less tics. If your doctor prescribes it,
it's usually for good reason. Just keep in mind that it may make things
worse.
RISK OF TD
Tardive dyskinesia (TD) is a side effect sometimes caused by antipsychotic
medications. It is worm like movements of the tongue or jaw and
sometimes hands that can often be mistaken by a viewer as tics.
These side effects are usually listed in manuals as severe, stop medication, call a doctor.
The reason for this is Tardive dyskinesia can be permanent if allowed to
persist for too long. If it is caught quickly enough, though, it
will usually disappear.
Doctors will usually have trouble detecting TD in a Tourette patient as it is likely that new
facial tics are just part of the waxing and waning of Tourette syndrome.
However, from personal experience, TD feels very different from Tourette's. In the same way that only you know where you are itchy, Touretters tend to
know the feeling behind tics well enough that they recognise the
difference of TD.
As a general guide, TD movements are persistent. While the urge to perform a Tourette
tic is sporadic and is easily identified (and sometimes controlled), the
TD movement is ever present and there is no urge or feeling behind it.
It's a bit like finding a complex motor tic that feels like a simple
motor one, but one you can't really control.
The good news is that the directors of the North Nassua Mental Health Centre in
Manhasset, New York, have found that a combination of vitamins - namely
vitamins C, E, B6 and niacin or niacinamide - prevents TD. Over ten years they have had 11,000 patients on antipsychotics
and this vitamin regime and none of them has had TD.
If you do have TD, choline therapy is an effective way to reduce the symptoms. The
recommended drug is lecithin. Lecithin is the only medication of it's
type that doesn't have the side effect of making you smell like rotting
fish!
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The evolution of Ariprazole on this site
By Mid 2005, I had talked to 24 people (at last count) and all of them had severe
nausea, flu like fever, and a general feeling of Yuk. This sample includes
Schizophrenics who usually don't get side effects at all!
Abilify was probably the best medication for vocal tics I've ever been on, but
not really any good for motor tics. However, I felt drugged, feverish
(alternating from boiling hot to freezing cold while sitting in the one room),
and had been severely nauseas since taking
this medication for a week. At about 3am I would wake up drenched in sweat and
have to change pyjamas. And I was only on 5 mg, the smallest packaged
dose.
However, by early 2006, I moved this drug from my bad rep category in
response to this post on the forum:
"I see that you have put ABILIFY in the Bad Rep category.
My son has mild to medium tourette's and we went through the usual drugs. All
had serious zombie like side effects. Enter Abilify.
My son (26) in (sic) a changed person, he looks better feels better, has reduced his
tics to almost nothing. I think that the trouble is that people are taking too
high a dose. Initially my son took 15 mg and had serious problems with slurred
speech and insomnia. We have found that by cutting the 15 mg pill into 4 i.e.
3.75mg. that seems to be the correct dose for him (100kg).
Equally important is the time that it is taken. It would seem that the best time
is just before
going to bed.
Another friend with very bad tics has started taking Abilify and has reduced the
severity by 50%. The only side effect is insomnia, I think that is because she
was taking it in the morning.
This drug works, don't dismiss it"
This is the sort of thing I love to hear from people! I
would never have thought of cutting the dose down so much, and it looks like
most of the people who have been on it didn't either. Now we know better!
In fact, now in 2009, I've been on Abilify for almost 12 months. But rather than lowering the dose to one so tine, I've had it RAISED. It turns out that having about
40mg is much better than having 3.75.
Once you've been on the higher dose for a couple of months, it can be safely dropped to 10-15mg again, and it won't give you the awful side effects!
Who would have guessed it???
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