Haloperidol pill (A.D. 2000)
It was in the spring of A.D. 2000 that I told a psychiatrist about the dozens of tics I had been having uninterruptedly since about 1971; not that having them as such was a major problem, but a few of the tics were causing ever more damage. In particular this concerned banging the teeth onto each other (damage to teeth, molars, fillings, jaw joints, jaw muscles, tongue, cheeks, lips), and head shaking (neck muscles, spinal disks, brain, inside of the skull). Not meant here are tics whose damage is merely collateral, such as those that cause liquids to be spilled onto clothes or furniture while drinking, or glasses to be shattered on the kitchen unit while doing the dishes. The psychiatrist prescribed haloperidol to suppress the tics; a brief account follows.
I started with one pill of 1 milligram per day. This did reduce the tics very significantly, if not totally, right away. There were however side-effects: drowsiness, sleepiness, becoming a bit slower motorically, and having some difficulties with urinating, like not emptying the bladder fully and having to get out of bed in the middle of the night. The latter probably has to do with the muscles around the exit of the bladder which have to relax to be able to urinate, and one of which is controlled by the parasympathetic nervous system, which in turn is affected by haloperidol (but I did not know all of that at the time).
Haloperidol pill (A.D. 2000)
After one or two months, the dose was reduced to half a milligram a day, mainly because I felt I was getting too slow in my movements. The effect on the tics remained. But again a month later, about three months after starting the treatment, the worst side-effect occurred: I became depressed. It must be noted I had been somewhat depressed before beginning with the pills already, but it got much worse at this point. The enclosure of the pills said that haloperidol may make a latent depression manifest (or words to that extent), and that is exactly what happened. Around that time I stopped using the drug.
One or two years later - the depression had meanwhile been resolved with paroxetine - I was confident enough to give treatment of the tics a second chance. To avoid getting depressed again, this time haloperidol in liquid form was prescribed, such that one drop was a tenth of a milligram. I began with 0.2 mg a day. This reduced the tics to satisfaction (but not fully), without noticeable side-effects. I kept this up for one or two years, sometimes going to only 0.1 mg a day. Eventually I stopped using it altogether, partly because I did not like the idea of having to use medication every day for all of my life, and partly because I was hoping the worst tics (those that caused damage) would stay away without haloperidol too now. With such a low dose, one eventually wonders whether the substance is really effective, or it is perhaps a kind of placebo effect, and therefore one ends up thinking one could as well do without it. The tics did come back though, and have remained untreated since.
It may be noted that I seem relatively sensitive to haloperidol, and therefore a rather low dose suffices. Sensitivity to a substance differs per individual and per substance.
For clarity, the tics include, but are not limited to: head shaking, rolling the eyes backward and blinking, pulling faces, violently banging the teeth onto each other with brutal force, coughing, throat clearing, various dry and wet throat sounds, swallowing air, shaking the hands and wrists, arm and shoulder movements, and various combinations from all of that. For further clarity it is pointed out that compulsions and obsessions are not tics, and therefore not mentioned here.
Remarkable is that the tics mainly occur when alone or in the presence of persons I have known for a long time; they stay largely away in formal situations or in the presence of relative strangers. As a result, the psychiatrist could not observe the tics (or only in a very mild form), and that is probably the only reason why no diagnosis of Tourette syndrome - which this beyond doubt is - has been issued. To avoid confusion one is reminded that the shouting of profanities or other words, for which Tourette is famous, only occurs in a small minority of patients, and that the "vocal tics" are mostly coughing, throat clearing, and various throat sounds. Even medical doctors may not know this (and erroneously think the uttering of words is required for the diagnosis), and that may be one of the reasons why the syndrome is sometimes missed.
Noteworthy about the banging of the teeth is that it differs from "teeth grinding" in that it is done while awake, whereas regular teeth grinding is mostly done in bed while asleep. Therefore the usual therapies for teeth grinding, such as tooth protectors worn in the mouth at night, are useless for Tourettic teeth banging if the latter occurs in the daytime. I have actually tried a hockey tooth protector, but it impairs one's ability to perform normal daily tasks such as drinking, eating, and talking (even to oneself).
Then, it is important to note that the tics, contrary to what people think, are related to being at ease, relaxed, oneself. The more at ease and oneself, the worse the tics get and the more there are of them. The persistent notion that tics betray "nervousness", "tension", or "being uneasy" is gravely mistaken, is the exact opposite of what is the case. There exist no doubt many for whom this is the same, but not all have the gift of the word to explain it as clearly as has just been done. It is herewith made known. The same goes for the phenomenon that tics stay away in formal situations or in the presence of strangers; that is hard and awkward to explain, and thus hinders the making of a correct diagnosis, especially since diagnostic criteria require the tics to have been observed by a professional.
Also typical for this condition is that in different periods, different sets of tics become prominent. They alternate, as in a relay. This may give bystanders the impression that the tics are absent most of the time, and only return occasionally for a brief period. The opposite is true: There is never a single day without them, only the particular set of tics that becomes manifest changes over time. This too is difficult to make clear to who do not know it by own experience, probably because it is unimaginable to them.
While haloperidol is a neuroleptic (anti-psychotic) medication that has long been used to treat tics, more recently one has begun to prescribe alpha blockers for the same purpose. Apparently those are effective too in many cases, and with fewer and less serious side effects than one gets with neuroleptics. The effect is said to become less with time though. I have no personal experience with alpha blockers yet, and am interested to hear about it if anyone has. I am also interesed in other possible remedies against tics.