From: dyer@spdcc.com (Steve Dyer)
Newsgroups: sci.med
Subject: Re: ADD/Tourett's synd/Ritalin
Date: 10 Oct 92 01:32:03 GMT
Article-I.D.: spdcc.1992Oct10.013203.27533
Organization: S.P. Dyer Computer Consulting, Cambridge MA

In article <1992Oct9.174802.28152@hellgate.utah.edu> rfrazier%peruvian.utah.edu@cs.utah.edu (Robert Frazier) writes:
>I get the impression that Ritalin is a very good medication for add.

Can be.  Adult ADD is only recently been recognized as a syndrome which
might require treatment.

>The doctor won't prescribe it because my brother has had a recurring
>'tick'.  He has small spasms in his neck and shoulder muscles, that cause
>him to twitch, and he is unable to hold his head still.  He knows the 
>degree of his tick is related to his stress level.  I even experienced 
>the same thing when I was really stressed out one day.  But his lasted 
>about 6 months (twitching every day).  It still comes and goes, but he 
>mostly doesn't have the twitch now.  His doctor says that people with
>ticks that use Ritalin have developed Tourett's syndrome.  I do not know
>much about Tourett's syndrome, except the behavior it causes.  Tourett's 
>syndrome behavior seems like a way exaggerated limb and verbal tick.
>Does anybody have any info about this?

Ritalin and the other sympathomimetic stimulants like dextroamphetamine
and pemoline can exacerbate Tourette's Syndrome.  I suppose it might even
uncover a mild case of it which might have been previously undiagnosed.
But cause someone to develop it permanently who wasn't so affected before?
I sincerely doubt it, though I suppose I'd wonder what Gordon and Mark
would say.  At the very least, its deleterious effects should last no longer
than the period the medication was given.  I mean, if you saw Tourette-
like symptoms developing as someone was on the drug, you'd stop it.
You'd tend not give it to someone who clearly had the signs of Tourette's,
because it would probably make the person feel worse and not better.
Is a minor tick enough to discourage its use?  Hard to say.  Also, I
think that doctors are much more wary of using stimulants with abuse
liability in certain adults with behavioral disorders, because this
population overlaps to some degree with people who actually do use such
drugs non-medically.

>	Currently my brother has been taking 200mg of Wellbutrin, and 
>has not noticed any effects yet.  Any info on Wellbutrin or any other
>alternative medications?

The antidepressant bupropion (Wellbutrin) is popular to experiment with
because it's a member of the same stimulant family as the drugs which
work in ADD, but doesn't have their overt stimulant effects or abuse
liability.  I know it's been used to treat ADD, and I've even corresponded
by email with someone who thinks it's fantastic and has benefitted greatly
from it.  I have not followed the published literature and haven't read the
results of controlled studies of this drug in either childhood or adult ADD.
It might be wonderful or it may prove yet to be the next "caffeine" in the
treatment of this disorder (in other words, promising but ultimately a
placebo.)  This is a reminder for me to check it out when I have a chance.
Note also that 200mg/day is not a large daily dose.  450mg/day is the highest
recommended daily dose in the treatment of depression.

-- 
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer
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