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 is 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 | 
|
| Selective Norepinephrine Re-uptake Inhibitor | Atomoxetine | Strattera |  ? |
| Antidepressant | Bupropion | Wellbutrin |
|
| Antiolytic | Buspirone | Buspar | - |
| Antihypertensive/Antimigraine | Clonidine | Catapres*/Dixarit | - |
| SSRI antidepressant | Fluvoxamine | Luvox | - |
| SSRI antidepressant | Fluoxetine | Prozac*/Zactin*/Erocap/Lovan | - |
| Antipsychotic | Haloperidol | Halodol/Serenace* | |
| Oral antihypertensive agent | Mecamylamine | Inversine | |
| Stimulant | Nicotine | Nicabate/Nicorette/Nicotinell | - |
| SSRI antidepressant | Paroxetine | Aropax*/Paxil | - |
| Antipsychotic | Pimozide | Orap* | |
| Antipsychotic | Risperidone | Resperdol* | |
| SSRI antidepressant | Sertraline | Zoloft* | - |
| Antipsychotic | Quetiapine | Seroquel* | |
| Cholinergenic agent | Tacrine | Cognex/THA | - |
| Antiparkinsonian | Tetrabenazine | Tetrabenazine* | |
| Phenothiazine (antipsychotic) | Thioridazine
Trifluoperazine Fluphenazine |
Aldazine/Melleril
Stelazine Permitil/Prolixin/Prolixin Decanoate/Prolixin Enanthate |
|
| Tricyclic antidepressant | Desipramine
Nortriptyline |
Pertofran
Allegron |
- |
I have used/are using medications marked with a *.
means the drug may
actually make tics worse.
For information about
click here
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.
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.
I
have 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!
Ablify 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 pajamas. And I was only on 5 mg, the smallest packaged
dose.
However, I have 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, I'm now getting as many positive feedback letters as not. It seems that you either hate or love the stuff! Certainly worth a try then.
02/03/06
Geeze, talk about eating your words! I'm now on Abilify and loving it!
For more on my current medication "games" click here.
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.
Despite all of this, it is the only drug I can bear taking. After a lot of debate with my Psychiatrist I am back on pimozide and my life has drastically improved. The only annoyance is that I need to have an ECG (electro-cardiogram) every three months, just to make sure my heart is still beating.
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)
In the same vein, 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.
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.
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* My use of quote marks here is simply a personal choice...I HATE the word normal! For most of my life I've tried to be "normal", told I was "not-normal" or "abnormal". But who is normal when you really think about it??
