What Medications Help Adults with Tourette Syndrome and Other Tic Disorders?

What you need to know

• Antipsychotic medications and alpha-2 agonists are the most commonly prescribed treatments for tics in adults with Tourette syndrome and other tic disorders.
• Patients with co-occurring obsessive-compulsive disorder (OCD) are more likely to be prescribed antipsychotic medications than alpha-2 agonists.
• Medication choices for tic disorders in adults generally align with current treatment guidelines, with newer medications like aripiprazole being used more frequently than older options.

Understanding Tourette Syndrome and Tic Disorders

Tourette syndrome (TS) is a condition that begins in childhood and is characterized by the presence of both motor and vocal tics that persist for at least one year. Motor tics are sudden, brief, repetitive movements, while vocal tics are sounds produced by moving air through the nose, mouth, or throat. Some examples of motor tics include eye blinking, shoulder shrugging, or head jerking. Vocal tics might include throat clearing, grunting, or repeating words or phrases.

In addition to TS, there are other tic disorders where individuals may have only motor tics or only vocal tics that persist for at least a year. These are known as persistent motor tic disorder and persistent vocal tic disorder, respectively.

It’s important to note that tic disorders are not just about tics. Many individuals with these conditions also experience other mental health or behavioral challenges. The most common co-occurring conditions are:

1. Attention-deficit/hyperactivity disorder (ADHD): This often improves as children grow into adulthood.
2. Obsessive-compulsive disorder (OCD): This tends to persist into adulthood for many individuals with tic disorders.

Treating Tics in Adults: Current Practices

While tic disorders begin in childhood, they often continue into adulthood, necessitating ongoing management. This study sought to understand how tics are treated in adults and whether current practices align with recommended guidelines.

The researchers examined the medical records of 192 adult patients attending a specialized clinic for Tourette syndrome in the United Kingdom. Of these patients, 187 had Tourette syndrome, 3 had persistent motor tic disorder, and 2 had persistent vocal tic disorder.

Most Common Medications

The study found that about two-thirds of the patients (66.7%) were taking some form of medication to manage their tics. The most frequently prescribed medications fell into two main categories:

1. Antipsychotic medications (also known as anti-dopaminergic medications): These were prescribed to 65 patients.
2. Alpha-2 agonists: These were prescribed to 50 patients.

All patients taking alpha-2 agonists were specifically prescribed clonidine, which was the most commonly used individual medication for tic suppression.

Newer vs. Older Medications

The researchers noted an interesting trend in the types of antipsychotic medications being prescribed. Newer, second-generation antipsychotics (like aripiprazole and risperidone) were much more commonly used than older, first-generation antipsychotics (like haloperidol and pimozide).

This shift towards newer medications likely reflects growing evidence of their effectiveness in treating tics, as well as their generally more favorable side effect profile. Older antipsychotics, while effective, are more likely to cause side effects such as sedation, weight gain, and movement disorders.

The Impact of Co-occurring OCD on Treatment Choices

One of the most interesting findings of this study was the relationship between a patient’s other mental health conditions and the type of medication they were prescribed for their tics.

The researchers compared patients who were only taking antipsychotic medications to those only taking alpha-2 agonists. They found a significant difference in the rates of OCD between these two groups. Specifically:

• Among patients with diagnosed OCD, 77.8% were taking antipsychotic medications, while only 22.2% were taking alpha-2 agonists.
• Even for patients with milder obsessive-compulsive behaviors that didn’t meet the full criteria for OCD, 65.1% were taking antipsychotic medications, compared to 34.9% taking alpha-2 agonists.

This suggests that the presence of OCD or obsessive-compulsive behaviors influences the choice of medication for tic management. Doctors appear more likely to prescribe antipsychotic medications when a patient has both tics and obsessive-compulsive symptoms.

Why This Matters

This finding is significant because it aligns with emerging research on the effectiveness of certain medications for treating both tics and OCD symptoms. For example, some studies have shown that aripiprazole, a second-generation antipsychotic, can improve both tic symptoms and OCD symptoms in adults with Tourette syndrome.

Moreover, there’s evidence that individuals with both Tourette syndrome and OCD may not respond as well to the typical first-line treatments for OCD (which are usually selective serotonin reuptake inhibitors, or SSRIs) compared to people who have OCD without tics. This could explain why doctors might lean towards antipsychotic medications for these patients, as they may provide benefits for both conditions.

Conclusions

• The medication choices for treating tics in adults generally follow current treatment guidelines, with a preference for newer antipsychotic medications and alpha-2 agonists.
• The presence of co-occurring obsessive-compulsive disorder or behaviors appears to influence medication choice, with these patients more likely to receive antipsychotic medications.
• This study highlights the complex nature of tic disorders and the importance of considering all of a patient’s symptoms and co-occurring conditions when deciding on a treatment plan.

While this research provides valuable insights into current treatment practices for adults with tic disorders, it’s important to remember that every patient is unique. Medication decisions should always be made on an individual basis, considering the specific symptoms, co-occurring conditions, potential side effects, and preferences of each patient.