Tics are sudden, repetitive muscle movements that result in unwanted or involuntary body motions and vocal sounds. Tics can be either motor/physical tics or vocal/phonic tics. Common motor tics include eye blinking, shoulder shrugging, and facial grimacing. Common vocal/phonic tics include throat clearing, sniffing, grunting, and repetitive words or phrases. Tics are quite common in childhood but tend to improve after adolescence. However, for some individuals, tics can persist or even worsen in adulthood and cause significant impairment. In these cases, medication may be used to help manage tics.
What causes tics?
Tics are neurological in origin, caused by abnormalities in the brain circuits that control movement and behavior. The exact mechanisms are not fully understood, but research suggests that problems with certain neurotransmitters like dopamine and deficiencies in the brain’s basal ganglia region are implicated. Genetics and environmental factors also play a role. In many cases, tics are associated with certain disorders like:
- Tourette syndrome
- Chronic motor tic disorder
- Transient tic disorder
These tic disorders tend to onset in childhood and follow a fluctuating course of tic severity over time. Tics also commonly occur in individuals with obsessive compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD).
When are medications used for tics?
Most children and teens with transient or mild tics do not require any medication. However, medications may be appropriate in some cases, such as:
- Tics are severe enough to negatively impact daily activities or cause social impairment
- The individual is experiencing distress, pain, or injury from frequent tics
- Tics do not improve after adolescence and continue causing impairment in adulthood
The main goals of tic medication treatment are to improve everyday functioning and reduce tic severity and frequency. Treatment also aims to minimize any adverse side effects.
What are the medication options for tics?
There are several classes of medications that may be used:
Antipsychotics
These medications work by blocking dopamine receptors in the brain. Some commonly used antipsychotics for tics include:
- Haloperidol (Haldol)
- Pimozide (Orap)
- Risperidone (Risperdal)
- Aripiprazole (Abilify)
Of these, haloperidol and pimozide are most effective for tics but can cause side effects like sedation, weight gain, and movement problems. The newer atypical antipsychotics like risperidone and aripiprazole generally cause fewer side effects.
Alpha-2 agonists
These medications act on the neurotransmitter norepinephrine in the brain. Examples include:
- Clonidine
- Guanfacine
Alpha-2 agonists may be especially helpful for tics accompanied by ADHD symptoms. Side effects can include low blood pressure, drowsiness, dizziness, and irritability.
Benzodiazepines
These medications enhance the effect of the neurotransmitter GABA in the brain. Commonly used options include:
- Clonazepam (Klonopin)
- Lorazepam (Ativan)
Benzodiazepines work quickly but may cause side effects like sedation, fatigue, and dependence with long-term use.
Antidepressants
Some tricyclic antidepressants and SSRIs may provide modest improvement in tics for some patients. Examples include fluoxetine (Prozac) and sertraline (Zoloft).
Medications for ADHD symptoms
If tics occur along with ADHD, stimulants like methylphenidate (Ritalin) or amphetamines (Adderall) may be used cautiously to treat the ADHD symptoms.
Botulinum toxin injections
Injections of botulinum toxin (Botox) into affected muscles may help reduce tic severity in very localized areas. Effects are temporary and injections must be repeated every few months.
How are tic medications selected?
There is no single best medication for tics. Doctors select medications based on:
- Type, location, frequency, and severity of tics
- Age of patient
- Presence of co-occurring conditions like OCD or ADHD
- Consideration of side effects
- Response to previous medications tried
Treatment typically starts with lower doses of antipsychotics like risperidone or alpha-2 agonists like clonidine. Benzodiazepines may be used short-term for rapid tic suppression. If the initial medication is ineffective or poorly tolerated, alternatives can be tried. Finding the most effective medication or combination often takes some trial and error.
How effective are tic medications?
No medication eliminates tics completely, but many people experience worthwhile improvement in tic frequency and intensity:
- Up to 50-60% reduction in tic severity
- Most people tolerate medication side effects
- Benefits often outweigh side effect risks
According to clinical guidelines, haloperidol, pimozide, and risperidone have the best evidence for tic reduction. But all medications tend to show variable effectiveness between individuals. Working closely with the prescribing doctor to tailor the medication regimen and dosing is key.
How long are tic medications taken?
There is no standard duration for taking tic medications. Treatment length depends on individual factors like:
- Severity and chronicity of tics
- Age and tic diagnosis
- Whether tics improve or not on medication
- Presence of co-occurring conditions like OCD or ADHD
- Degree of impairment or distress caused by tics
For transient or mild childhood tics, medication may only be used for a few months. Chronic tic disorders often require longer treatment. Periodically stopping medication to see if tics remain improved can help determine the optimal duration needed.
What are side effects of tic medications?
Common side effects of tic medications include:
Antipsychotics
- Sedation
- Weight gain
- Muscle stiffness
- Tremor
- Restlessness
Alpha-2 agonists
- Low blood pressure
- Drowsiness
- Headache
- Irritability
- Nausea
Benzodiazepines
- Sedation
- Fatigue
- Dizziness
- Dependence
Side effects are often dose-related and tend to decrease over time. Tolerance to sedation usually develops within the first few weeks. Prescribing doctors monitor closely for problematic side effects. Adjusting medication dosing or switching to alternatives can help manage intolerable side effects.
Lifestyle measures for tics
Medication works best when combined with certain lifestyle approaches like:
- Stress management – Since stress often worsens tics, relaxation techniques like yoga, meditation, deep breathing can help.
- Sufficient sleep – Adequate restful sleep is essential for managing tics and any co-occurring conditions.
- Exercise – Regular aerobic activity may help reduce tic severity.
- Avoid caffeine – Caffeine in coffee, tea, energy drinks can exacerbate tics.
- Behavior therapy – Cognitive behavioral intervention helps teach techniques to voluntarily suppress tics.
Making healthy lifestyle adjustments maximizes the effectiveness of medications for tics.
Conclusion
While no single medication works best for everyone, antipsychotics like haloperidol, pimozide, and risperidone tend to be most effective for reducing tics. Alpha-2 agonists like clonidine and guanfacine are also commonly used and help when tics are accompanied by ADHD. Benzodiazepines provide rapid short-term relief. Finding the right medication or combination is a process of trial and error. Medication works best when combined with lifestyle approaches like stress management, sufficient sleep, exercise, and therapy. With the right treatment plan tailored to the individual, tics can be managed successfully.