Lawrence Scahill, PhD, a Yale School of Medicine professor and psychopharmacology expert, discusses the best treatments for tic disorders like Tourette’s. Medications can be very effective, he says, but new behavioral interventions like habit reversal therapy (HRT) are also producing good results.
In the world of treating tics, medication and recently behavioral interventions have been shown to be effective. Let me talk about the medications first.
In the world of medication treatments for Tourette’s, there are two main classes that have been used and studied, and they are medicines that began their careers as blood pressure medications. These are mediations that have a subtle effect on a particular brain chemical called norepinephrine in the brain. And these medications turn that system down just a bit, and in some cases can have a beneficial effect on tics. I would say about half the children treated with one of these medications—clonidine or guanfacine—will show some benefit.
The other major group of medications that have been used in Tourette’s syndrome are the so-called antipsychotic medications. These are medications that were developed for the treatment of schizophrenia, hence the term antipsychotic. These medications work by blocking another chemical in the brain called dopamine. And these medications are reliably quite effective, but they do have adverse effects that make us pause. Because the medications have not been all we would like them to be, we have also been very interested in alternative approaches, particularly behavioral interventions.
Many individuals with Tourette’s syndrome will tell you that they have a feeling or an urge or a sensation before their tic. They view that sensation, they view that warning as unpleasant. So what we use in habit reversal, we exploit that premonitory urge, we exploit the idea that that actually is a signal that the tic is about to happen. And we try to train the person to become acutely aware of that premonitory urge early and then to mount a behavior that is incompatible with the tic. So if a person has a head jerking tic in response to a premonitory urge in their shoulder, we might tell them to move their head down and hold their chin to the midline. If they’re doing that, they can’t jerk their head to the side, and the idea is the premonitory urge will pass. That’s the simpleminded idea of habit reversal. Does it work? We now have two studies to show that it works. The effect, the magnitude of benefit is not as good as our best medications, but as I mentioned previously, our best medications also have adverse effects.