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Question 23: I have read a lot lately on nicotine patches for the treatment of T's, any thoughts or info on that?? L.D., Australia.

Hello L:

Here's the scoop on the nicotine patch research --

Initial research suggested that the benefits of a nicotine patch were to catalyze the efficacy of classic neuroleptics (dopamine antagonists like Haloperidol). Basically Haloperidol (a drug that blocks dopamine) seemed to work better at eliminating symptoms if a nicotine patch was used as well.

More recent research has better explained why this is: nicotine emulates acetylcholine, a chemical in the brain which binds to certain cells (to nicotinic receptors) and tells them to produce dopamine. This seems counter-intuitive: why would something that causes MORE dopamine to be produced help to reduce tics, when most medications used for TS work to reduce or block dopamine?? The reason is because a continuous flood of nicotine, prompting increased dopamine production, eventually overloads these nicotinic receptors, causing them to shut down and no longer operate. Hence while a nicotine patch initially causes dopamine production to increase, ultimately the result is less dopamine production.

For this to work, the nicotinic receptors have to be constantly barraged. Therefore smoking is NOT effective and not a solution. Even the patch is inefficient (not to mention 70% of patients report extreme nausea from this method). Instead now researchers are looking into drugs that will replicate the GOOD effects of nicotine (shutting down DA production) but not the bad (health concerns).

One drug that is being experimented with is called ABT-418 or Mecamylamine. This drug blocks the nicotinic receptors that would trigger the release of dopamine to regulate blood pressure. Thus release of dopamine is inhibited, and dopamine levels drop.

I hope this helps L!

cheers,

Dr. Dunc.

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