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Question 44: I am a 31 year female living in the UK.... my main question to you is regarding fluoxetine. I am currently taking this drug to help with PMT but various T.S. sites state this may help with attention problems but can make tics worsen. Is there a connection, or is it just a coincidence. D.F., Lancashire, U.K.

Hi D.F.:

Kudos to you on starting to explore aspects about yourself -- it takes a special awareness and strength to do so.

Fluoxetine, or Prozac, is what is known as an SSRI (selective serotonin reuptake inhibitor). This class of drugs is used for a variety of conditions (depression, anxiety, obsessive-compulsive disorder are some) but have never been indicated for attentional problems. In other words there are far better medications that are used specifically for attentional problems (various stimulant medications, antihypertensives) that should be at least tried first.

Using the "2001 Drug Information for Mental Health" compendium as a guide, I could not find any reports that fluoxetine cause or exacerbate tics as a side-effect either. While the internet is a phenomenal tool for finding lots of information fast, it is important to ensure that the sites you get information from are reliable sources -- some good ways of gauging this is the credentials of the writer, whether the site is associated with a research, medical, or educational institution, and whether references for any 'facts' provided are supplied.

That being said, given the close relationships between conditions like TS, Obsessive-Compulsive Disorder, and Attention-Deficit Hyperactivity Disorder (in terms of co-occurrence, neurological mechanisms, chemical relationships) it is not uncommon nor surprising for the SUPPRESSION of one cluster of symptoms to result in the increased EXPRESSION of other symptoms (this is true in terms of both pharmaceutical suppression and psychological suppression). Indeed many times individuals diagnosed with TS, who choose to medicate, are put on a number of medications simultaneously (sometimes called a "cocktail") to combat the side effects and various associated symptoms that are expected to increase as a result of the intervention. Part of the process of pharmaceutical treatment is to prioritize which symptoms you want to target, and which symptoms (or side effects) you can live with and are a battle not worth fighting given the gains you've experienced.

I hope this helps D.F.!
Dr. Dunc.

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