Blinking Tics- anxiety

[Lisa764]

I am a 31 year old health female living in NY.  I was diagnosed with tourettes yrs ago(I was about 11).  I used to have it bad including vocal tics like grunting.I went to a neurologist when I was this age and she told my mom that I would most likely grow out of it which for the most part I did and I never went on meds.The only thing that stayed a little was the blinking- I always found myself blinking more than the avg person although when I was little I would blink a ton- way more than I ever did and kids would ask why I blink so much. Unfortunately, I feel like the blinking tics are starting to come back during the last year.  I am in an very hard grad program which is very stressful and I have a lot of anxiety.  It got so bad that I went to see a psychiatrist and he put me on 10mg of paxil daily for anxiety and I take xanax as needed and ambien for sleep as well.  I have never been on any meds before and I am an anxious person but never to this degree.  A few ppl have started to notice the blinking more as well- I was at a party the othe nite and a girl asked me if I wore contacts.  I said no -She said that she figured I did bec I was blinking so much.  I know it also gets worse when I am really tired which I was at the time. I recently went to the optomalagist to get an eye exam and it came back fine.  I also went to a neurologist who said that it is probably just a blinking tic since I have no other symptoms and the stress is prob the cause. He said there are meds but since I had just started the paxil with the xanax and ambien he didnt want to throw another med into the mix. It's getting to the point where I'm embarrased to go out with friends and I'm constantly asking my husband- Did I blink a lot today? School is almost over for the semester so I'm hoping it gets better but it seems like I'm doing it all the time anyway.  What would you suggest?  Should I see another neurologist?  Should I suggest another med?  Any vitamins?  I'm open to anything.  Thx.

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

As you mention, Tourrette's syndrome typically improves and even resolves with age, but as you suggest, significant anxiety and stress can certainly bring tics out again. Tics only need to be treated when they cause social dysfunction or embarassment, which it sounds like is occurring with you. There are no known vitamins that improve tics. Treating the underlying anxiety will have two benefits: reducing the tics and reducing the anxiety! This should be pursued with a psychiatrist until the appropriate anti-anxiety medication is established. Seroquel was developed as an antipsychotic agent, but it blocks dopamine, and hence is effective in treating tics. Some of its other pharmacologic properties make it helpful in both anxiety, depression, and sleep (it is sedating). There are certain side effects with it, including parkinsonism or dystonia or other involuntary movements, and excessive sedation. The risks and benefits need to be weighed against each other. Continued discussion with your psychiatrist is recommended. Evaluation by a movement disorders specialist (a neurologist with expertise in tics and other involuntary movements) may be of benefit as well. Discussion of non-pharmacologic therapies for tics (such as habit reversal therapy) could be explored as well, as well as psychological counseling to help cope with the stress and anxiety (stress management techniques etc).

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Lisa764]

Sorry just to add one thing that I forgot to mention- the neurologist that I just recently saw mentioned seroquel? I believe that could help.  He said there are some side effects and that he didnt want to start me on it without me speaking to my psychiatrist.  I did speak to my psychiatrist who said he didnt really notice the blinking that much and to just stick with the meds I have.  The neurologist mentioned possibly switching the seroquel with the ambien?  I think its weird that the psychiatrist didnt really notice the blinking because I was seeing a psychiatrist for about a couple of weeks before I switched to this new one (the last one was really rude and nasty).  The VERY first thiing the last psychiatrist asked me was how long I had this blinking tic.  So I guess some people notice it more than others but he said it was VERY obvious.