Medications for Tics and Tourette Syndrome

There are a number of medications that can be helpful to decrease tic symptoms.  If you have decided to give medication a try, I recommend a psychiatrist or neurologist with expertise in tic disorders. Most experts in the area use a similar process in finding the ideal medication(s) to manage tics for a specific individual. As an individual with Tourette syndrome, or a parent making the final decision about medication, it can be useful to know about the different medications and potential side effects (see List of Medications). The two sections below, on deciding whether to use medications and on what to expect from medications, are intended as resources in this decision process. Also, in considering treatment options for tics, I encourage everyone to learn about the behavioral treatment, Habit Reversal Therapy (HRT/CBIT).

Deciding on Whether to Use Medication For Tics
The burden of the final decision about medication is on the parents or individual with tics. As a psychologist, I am often in the role of providing guidance to help people make informed decisions about medication. In this role, I start with the assumption that no one wants to use medication. However, when tics are causing life-disrupting problems and other solutions are not working, medication is a very reasonable option. 

There are two ways that tics cause life-disrupting problems, directly and indirectly. Tics are a direct problem when they interfere with day-to-day tasks, such as tics that disrupt the ability to speak fluently or tics that get in the way of reading or writing. Tics are also a direct problem when they lead to self-harm or pain, such as head butting tics or repeated tics that cause muscle pain by the end of the day (e.g. neck pain from a head-shaking tic). Tics are an indirect problem when they cause emotional distress and/or social difficulties. Emotional distress can include anxiety or depression that results from being self-conscious about tics. Social difficulties can include being teased or bullied about tics, or social rejection due to tics. 

When the disruption from tics is high, it can get in the way of basic life tasks, such as doing well in school or at work, performing day-to-day activities and forming/maintaining relationships. For children and adolescents with tics, these disruptions over time can have negative long-term consequences such as lowering academic achievement or decreasing opportunity for social learning. If the potential advantages from decreases in tics outweigh the potential disadvantages of problematic side effects, then medication becomes a good option. The challenge comes in trying to determine if the advantages seem to outweigh the disadvantages. Education about what to expect from medications can be helpful in making this determination.

What to Expect From Medications for Tics
Medications are –  unfortunately –  not a cure for tic symptoms. However, they can be really helpful to reduce tics. When medication is being used, the goal is to increase an individual’s functioning by reducing the tics as much as possible with as little side effects as possible. On paper, this sounds great. In reality, it can be challenge that takes some trial and error.

Trying more than one medication before selecting the best one is common because the same medication can work differently for two different people. A medication that reduces tics well with little side effects in one child may have no effect on tics and high side effects in another child. A psychiatrist (or a neurologist) may have to try several different medications before finding one that works best. Usually, a psychiatrist will start with medications tend to have mild side effects. If these do not work well enough, medications that have the potential for more disruptive side effects will be tried next. Unfortunately, the medications with a greater probability of more severe side effects tend to work better to reduce tics. To minimize problems with side effects, psychiatrists usually start with a small dose of a medication and slowly increase the dose over time; reductions in tics and increases in side effects are both monitored. The overall goal is to find a medication that provides the maximum reduction in tics, but keeps side effects low – at times a lengthy process. 

The main two types of medications used for tics are anti-hypertensives and neuroleptics. See List of Specific Medications for more information about these medications and their potential side effects.