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Life's A Twitch! Celebrating 15 years.
1998 - 2018
Life's A Twitch! Celebrating 15 years.

 

Question 24: I am a female from Singapore and I am 29 years old. I have been diagnosed with TS since I was 8 years old. Since then I have been on Haloperidol, now about 4.5mg per day. What are the side effects of taking Haloperidol for life in the long run? What is the link between Parkinson's disease and TS? Please help because in Singapore there is so little knowledge and awareness of TS. I saw ten doctors before I was fianlly diagnosed. C.G., Singapore.


Hello C.G.:

Haloperidol is what is called a classic neuroleptic -- it is the oldest of the drugs used to treat TS, and widely considered in the medical community as no longer the best. A whole host of other classes of medications with vastly fewer side effects and more specificity (where more specific areas of the brain and more specific chemicals are targeted rather than 'blasting' the brain in what doctors call a 'shotgun' approach). Antihypertensives (such as drugs called guanfacine or clonidine) are now most well-read physicians' first drug of choice, followed by drugs called atypical antipsychotics (such as drugs called risperidone or ziprasidone).

There are a number of side effects of classic neuroleptics like haloperidol. These can include weight gain, sedation or grogginess (called 'psychomotor slowing'), heart rhythm changes (potentially very serious -- it is important for doctors to monitor your heart by electrocardiogram when starting this drug or altering its dosage), irritability, depression, difficulty swallowing, lowered blood pressure (hypotension), dizziness, and lowered sex drive or ability to sexually function. Particularly because you are a woman, I should mention that one possible effect as well is a false positive pregnancy test (all taken from the Clinical Handbook of Psychotropic Drugs published by the Clarke Institute of Psychiatry in Toronto ON).

Of greatest concern long-term though is the development of a condition known as tardive dyskinesia (TD) -- 56% of individuals on a classic neuroleptic for longer than 10 years develop this side-effect (the risk is twice as high for women). Ironically, TD is the development of involuntary movements -- lip smacking, sucking or chewing movements, blinking, grimacing, and jerking of body parts (fingers, toes, limbs, neck, etc.).

Regarding the link between Parkinson's disease and TS, there really isn't one except that the two disorders both involve dopamine (a brain chemical involved in movement) and are opposites in a sense. In TS individuals are hypersensitive to dopamine. Therefore TS medications REDUCE dopamine in the system, or block it from working normally so that we don't have EXTRA movements. In Parkinson's, an area of the brain (called the substantia nigra) that manufactures dopamine is destroyed, meaning that there is not enough dopamine. Therefore Parkinsonian medications try to INCREASE dopamine in the system so that we are ABLE to move (one of the symptoms of Parkinson's is to be 'frozen' in place like a statue, or to have a completely unexpressive face).

I hope this helps you C! I'm glad that even though your country has little information available on TS you are still finding out all you can! Congratulations on your courage and resourcefulness -- perhaps someday you will be a pioneer, using everything you've learned to increase Singapore's awareness.

cheers,

Dr. Dunc.

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Last updated on March 25, 2022

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