Antidepressants & Tics
Antidepressants are primarily known for their role in treating depression and various anxiety disorders. They have long been a subject of intrigue and investigation when it comes to their potential side effects, which commonly include gastrointestinal disturbances, sexual dysfunction, and weight gain.
However, there is a lesser-known aspect that we delve into today—can antidepressants cause tics? Tics are sudden, uncontrollable movements or sounds, and their association with antidepressants raises important questions about the medications we rely on for mental health.
Observed Associations in Science
Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), have been hailed for their effectiveness in managing depression and anxiety disorders. In general, they are well-tolerated, but can antidepressants cause tics? There have been several case reports written on the topic, but few extensive scientific papers published. We highlight some of the most noteworthy articles below:
1. The Case of Escitalopram and Sertraline
In 2005, a case report emerged that observed the emergence of tics in individuals undergoing treatment with escitalopram and sertraline, two commonly prescribed SSRIs. These medications, known for their antidepressant properties, had, in rare instances, led to the development of tics.
The key takeaway is that the delicate balance of the dopaminergic neurotransmitter system, crucial for motor control and coordination, might be disturbed by these drugs.
2. More Than a Coincidence?
Upon discontinuing Sertraline, her condition improved remarkably, confirming a strong association between the medication and tics. Although other potential causes were investigated, the rechallenge with Sertraline resulted in the reoccurrence of tics.
The literature review part of the paper mentions finding three cases of tics associated with Sertraline in previous scientific literature. In each instance, discontinuing the medication led to significant improvement, further solidifying the connection between Sertraline and tics.
3. Latest Research - Can Antidepressants Cause Tics?
Fast forward to 2020, where a post-marketing study delved into the world pharmacovigilance database, aiming to bring further clarity to the antidepressant-tic connection. As a part of their research results, the study revealed a list of antidepressants with potential associations to tics:
- Escitalopram
- Sertraline
- Fluoxetine
- Paroxetine
- Bupropion
- Tryptophan
Interestingly, tryptophan, an alpha-amino acid metabolized into 5-hydroxytryptophan, a precursor of serotonin, showed a unique association with tics. It is marketed as an antidepressant in some countries, further deepening the mystery surrounding the pathophysiology of this rare adverse drug reaction.
While neuroleptic-induced movement disorders have been extensively studied, those linked to antidepressants remain relatively under-recognized. Why is this the case? The incidence of movement disorders caused by SSRIs is still a mystery, primarily because systematic epidemiological studies are lacking. However, some researchers estimate an annual incidence of about 1 to 2 cases per 1,000 patients.
Potential Causes
While the exact neuronal mechanisms underlying tic disorders remain a puzzle, some evidence points to the involvement of the corticobasal ganglia pathway, particularly striatum disinhibition. The role of enhanced serotonergic transmission induced by SSRIs in influencing these pathways remains unclear.
One theory presented in the previous research papers suggests an indirect dopaminergic inhibition through serotoninergic mediation may be at play when it comes to antidepressants and their connection to tics.
Antidepressants and Tics in OCD
On the other hand, for individuals with tics and co-existing obsessive-compulsive disorder (OCD), antidepressants are usually a part of the initial treatment. According to Medscape, the treatment often involves an SSRI, i.e. antidepressants such as Sertraline and Escitalopram, previously mentioned above in this article. The dosages are typically much higher than what is used in the treatment of depression. In these patients, antidepressants most likely do not pose the risk of aggravating tics.
Conclusion
So, can antidepressants cause tics? The answer most likely lies in the intricate interplay between these medications and the individual's neurochemistry. Unlike with stimulants, like Methylphenidate, it's not completely clear antidepressants may trigger new onset of tics. There are, however, individual observations reported in research. Thus, it's important to monitor patients for any emerging tics when prescribing antidepressants, especially in those already susceptible to the disorders. Further research in the area would be necessary to gain a further understanding of the connection between antidepressants and tics.
Last updated: September 10, 2023
Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness seek immediate medical attention.