fluvoxamine and Tics

Topics: Adult; Antipsychotic Agents; Carbon Monoxide Poisoning; Combined Modality Therapy; Electroconvulsive Therapy; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Sulpiride; Tics; Treatment Outcome

The selective serotonin (5-HT) reuptake inhibitors (SSRIs) represent the first-line pharmacotherapy for obsessive-compulsive disorder (OCD), and atypical antipsychotic drugs, which block 5-HT2A receptors, are used in augmentation strategies. Opiate drugs are also effective in treatment-refractory OCD and Tourette syndrome. The 5-HT2A-related behavior (i.e., head twitch) has been related with tics, stereotypes, and compulsive symptoms observed in Tourette syndrome and OCD.. The aim of this study was to explore whether 5-HT2A-related behavior is affected by atypical opiate drugs.. Head-twitch response was induced in mice by administration of either 5-hydroxytryptophan (5-HTP) or the 5-HT2A/C agonist (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI). Dose-effect curves of atypical opiate drugs [(+/-)-tramadol, (-)-methadone and levorphanol], morphine, and other psychoactive drugs (fluvoxamine, desipramine, nefazodone, and clozapine) were performed. Opioid mechanisms were investigated by administration of naloxone.. All the opiates tested reduced both 5-HTP and DOI-induced behavior in a naloxone-reversible fashion, atypical opiates being more effective. The effects of the other drugs depended on the protocol, clozapine being the most effective.. Combined 5-HT and opioid properties result in a greater efficacy in antagonizing 5-HT2A-related behavior. These results provide behavioral evidence to support convergent effects of the 5-HT and opioid systems in discrete brain areas, offering the potential for therapeutic advances in the management of refractory stereotypes and compulsive behaviors.

Topics: 5-Hydroxytryptophan; Analgesics, Opioid; Animals; Clozapine; Desipramine; Disease Models, Animal; Dose-Response Relationship, Drug; Fluvoxamine; Indophenol; Levorphanol; Male; Methadone; Mice; Morphine; Naloxone; Narcotic Antagonists; Obsessive-Compulsive Disorder; Piperazines; Receptor, Serotonin, 5-HT2A; Receptor, Serotonin, 5-HT2C; Stereotyped Behavior; Tics; Tourette Syndrome; Tramadol; Triazoles

One possible side effect of selective serotonin re-uptake inhibitors (SSRI) is the exacerbation of nervous tics in a 12-year-old boy treated with tiapride following prescription of paroxetine for a depressive syndrome. Potential causal factors include residual cholinergic activity of paroxetine, the observably increased drive under paroxetine, metabolic properties, and protein binding. The problem of side effects under selective serotonin re-uptake inhibitors, as well as the issues of co-morbidity and co-medication in the treatment of nervous tics and Tourette's Syndrome are discussed.

Topics: Antidepressive Agents, Tricyclic; Child; Depression; Dose-Response Relationship, Drug; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Paroxetine; Selective Serotonin Reuptake Inhibitors; Tics; Tourette Syndrome; Treatment Outcome; Trimipramine