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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Dalewhee on September 24, 2000, at 13:47:28
My daughter has been taking Ritalin for just over a year now, and has developed a tic, involuntary blinking. We had this problem a year and a half after she took Dexadrine for ADD. At which time her docter switched her over to Ritalin but now it is happening again. She is off the medication now until I get in touch with the docter. But I am just wondering if any of you have had this problem or have any advice. She can not get through school without the medication she just can't stay focused enough to concentrate on what is going on. The difference in her school work was immediate when we put her on medication. She was not diagnoised until she was 9 she is now 11. I am getting concerned about all the medication and needing to change it so often. Any advice would be greatly appreciated. Also interested if any of you or your children developed these tics
Posted by noa on September 24, 2000, at 15:10:20
In reply to Development of tics in taking Ritalin., posted by Dalewhee on September 24, 2000, at 13:47:28
This is not all that uncommon. It is unfortunate because some of the kids could really benefit from the stimulants, but the tics are not something anyone wants them to have to tolerate.
Some kids do better on adderall, and sometimes something like wellbutrin helps if the stims are all problematic.
You might want to post this question at the chadd site. Good luck.
Posted by SLS on September 25, 2000, at 12:41:40
In reply to Development of tics in taking Ritalin., posted by Dalewhee on September 24, 2000, at 13:47:28
Cylert (pemoline) is another stimulant used for ADD. It is chosen less often now, probably because of its potential to infrequently produce liver abnormalities. Your doctor will be able to council you on the degree to which this represents a risk. However, it does work to improve attention and cognitive performance. Like many other medical decisions, I guess the potential benefits must be weighed against the potential risks. I have not seen tics mentioned as often with its use on Medline, possibly because it is not used as frequently. But Cylert is very different from both amphetamine and Ritalin, and might not produce the tics that the latter two have.
Noa's suggestion of using Wellbutrin (bupropion), an antidepressant, is a good one. There are some studies that conclude it to be effective, but I would look to the real-life experiences of a doctor to give an idea of how useful it is. Wellbutrin, too, has been shown to be capable of producing tics and exacerbating Tourette's. The properties all of these drugs have in common is that they act to stimulate nerves that use dopamine (DA) as their neurotransmitter signaling molecule. However, because they are all different from each other, each will react uniquely in each individual treated with them. so I trial-and-error is worth continuing.
Several other antidepressants are used. Tricyclics like Tofranil (imipramine) and Anafranil (chlomipramine - used when there are obsessive-compulsive components) are chosen, but seem to address the impulsive-hyperkinetic behavioral aspects of ADD rather than attention and cognition. They also have unpleasant side effects, and should be used with caution by people with heart conditions. Another drug worth mentioning is Effexor (venlafaxine). From the few studies I've come across on Medline, it looks to be effective. The dosages used were rather low: 37.5-75mg.
Just a few reviews:
1. "Antidepressants in the treatment of attention-deficit/hyperactivity disorder"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9418743&dopt=Abstract
2. "Attention-deficit hyperactivity disorder: the pharmacist's role"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8533716&dopt=Abstract
Unfortunately, many people with ADD AD/HD also have Tourette's or other tic disorder that stimulants may unmask or make worse. It is not my intent to scare you, but I think this is knowledge that you should have in your possession.Check out the website recommended by Noa and others like it. You should be able to get more thorough and balanced information there.
Hope all goes well...
- Scott
Posted by noa on September 25, 2000, at 15:42:44
In reply to Re: Development of tics in taking Ritalin., posted by SLS on September 25, 2000, at 12:41:40
Scott, what a reference guide you are!!
I would actually be interested in knowing if Effexor is tolerated by people with a vulnerability to tics or Tourettes, because it causes tic-like muscle twitches in me, at higher doses, and when not combined with serzone. It causes muscles I would never ever be able to flex volitionally, to flex fleetiningly. Paxil also caused this. With higher doses of paxil, it was so bad, my arm would flex, and shoot right up in the air when I was lying in bed.
I attribute this to an overload of serotonin, whereas I think in Tourettes, the issue is dopamine, though I am not well versed in this.
Posted by Sassy on September 25, 2000, at 16:06:18
In reply to Development of tics in taking Ritalin., posted by Dalewhee on September 24, 2000, at 13:47:28
Hi Dalewhee,
My nephew was misdiagnosed as ADD. They gave him
Ritalin, then the rest of the regime. They later
found out that he had tourettes and the Ritalin
brought out the tics.I would inquire about another medication in a different class.
I am only providing you this information because I would hate to see someone else in the same
position as my nephew.Regards,
Sassy> My daughter has been taking Ritalin for just over a year now, and has developed a tic, involuntary blinking. We had this problem a year and a half after she took Dexadrine for ADD. At which time her docter switched her over to Ritalin but now it is happening again. She is off the medication now until I get in touch with the docter. But I am just wondering if any of you have had this problem or have any advice. She can not get through school without the medication she just can't stay focused enough to concentrate on what is going on. The difference in her school work was immediate when we put her on medication. She was not diagnoised until she was 9 she is now 11. I am getting concerned about all the medication and needing to change it so often. Any advice would be greatly appreciated. Also interested if any of you or your children developed these tics
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