The Link Between Prozac and Tics
The Link Between Prozac and Tics
Recently it has been widely publicized in the news media that Prozac, an antidepressant and SSRI also know as fluoxetine hydrochloride, is linked to disturbing incidents of suicide and violence. However, there is another side effect, which is harder to detect that has not gotten quite so much media attention. Involuntary tics or muscle twitches affecting the face and specifically the eye area can occur as a side effect of taking an SSRI, a drug that directly interferes with serotonin levels in the brain. Tics are defined as, "... a problem in which a part of the body moves repeatedly, quickly, suddenly and uncontrollably"(1). A tic is a reminder that by taking drugs such as Prozac we are altering our natural neurological state.
My personal experience of witnessing friends and family members, adolescents and adults alike develop eye twitches and excessive blinking seemingly overnight, has prompted me to investigate the link between Prozac and facial tics. What causes them? What methods are used to treat them? And most importantly, how can our society address the problem of "transient tics" that is seemingly ignored?
On a neurological level, Prozac works by increasing "serotonin messages" (2). Serotonin is a chemical in the brain and dispersed throughout the nervous system that impacts mood. Depressed people often have unusually low serotonin levels. Fundamentally, brain cells are engaged in the activities of sending and receiving information in the form of chemical messages. In Prozac Backlash, Dr. Glenmullen explains this process of sending and receiving, and explains that the way the drug works to increase serotonin is through a process of disallowing "reuptake" of serotonin. He defines "reuptake" as a mechanism through which excess serotonin that is not utilized, is taken in by the same cell, which sent the chemical message in the first place (2). To understand Glennmullen's example it helps to picture a college student cleaning up a messy dorm room with clothes strewn everywhere. Some of the clothes on the floor will be worn and others will be put back in the closet. Ultimately, this process of disallowing "reuptake" or re-absorption of the chemical allows for the proliferation of the chemical serotonin in the body. The end result will hopefully be a happier mood. Trouble arises when neurological consequences occur such as facial tics. Or as Glennmullen explains, "Whenever the drugs step on the chemical gas pedal, the brain tries to slam on the brakes. The result is jerking, stop-and-go oscillations in brain activity that can go out of control" (2). It makes sense that the brain would be resistant to unnatural activity, and thus when a person develops facial tics from Prozac, these are really a neurological coping mechanism.
Dr. James Robert Brasic and Brian Bronson cite dopamine in their recent article, "Tardive Dyskinesia" (3) as a chemical related to motor functioning, and the main culprit responsible for the transient tics. In this article the doctors attribute the problem to a lack of the presence of dopamine, as it is being continuously barricaded or obstructed while the patient is taking Prozac (3). The question I was left with was how long does it take for dopamine amounts to stabilize after the person has stopped the SSRI? Could finding out this information help us to know how long a Prozac induced tic will persist, or if it will persist even after Prozac dosage has been either significantly lowered or discontinued altogether? Might the fact that the barricades for dopamine that the medicated patient has formed take a long time to dissipate? Could this lengthier period be the reason tics persist when the Prozac is no longer being ingested?
Besides simply waiting or hoping that the facial tic will go away, cognitive behaviorists and school psychologists can work together to help children and adults who suffer from this side effect to deal with them. An article entitled "Habit Reversal. A Treatment Approach for Tics, Tourettes's Disorder and Other Repetitive Behavior Disorders" written by Dr. Michelle Pearlman, details important techniques that can help to counteract the tic. Primarily, she emphasizes that developing a sense of awareness that the tic is occurring and developing a "counter-behavior" to replace the tic can help the student (4). Interestingly, in my experience it seems that people who have the tics are not even aware of them.
My friend approached me one day visibly distressed, that the night before his mother had pointed out to him that he had developed an eye tic on the left side, which looked like squinting. The problem is that because stress can make tics worse, it would seem that alerting someone of the fact that they have a tic when it might not be treatable, might increase stress levels resulting in a worse, more pronounced tic. However, a person living with an obvious facial tic does have the right to know about it so that they can do everything possible to get off the medication or to find some other way of treating it.
The treatments listed for tics brought on by taking Prozac seem to have both a rudimentary and trial and error theme. The Internet resource emedicine.com cites anti-Parkinson medication in order to keep people who decide to stay on the Prozac tic free (3). However, taking other medications can result in even more side effects. Another Internet site prozactruth.com discusses the implications of using Lecithin and Vitamin E. The web site compares the occurrence of the tic to a short circuiting in the brain. The site explains that, "many parts of our bodies are composed of positive and negative terminals, the same as an electrical switch. If you reverse the polarity, changing the negative to positive or changing the positive to negative, the switch will not work or will short out. The same is true within our body" (5). However, it seems that there is really no scientifically definitive solution in how these tics can be treated or prevented, except not to take Prozac in the first place, and also to learn from previous experiences with the drug.
In my first web paper on epilepsy, through my research I learned that once a person has a seizure they are more likely to have another one (6). Certain neurological pathways have been forged. It appears that this chance of recurrence being dependent upon previous behavioral episodes might also be the case with tics caused by taking SSRIs. Once the patient has exhibited the involuntary muscle twitch chances are it will happen again. It becomes a neurological habit. It is a prime example of brain change literally equaling behavior. Similarly, if the patient is taken off the drug and then put back on, chances are if they exhibit the tic the first time they will exhibit it the second time around as well as Glenmullen's case studies exhibit (2).
Though taking Prozac can sometimes be unavoidable, if a patient knows of the risks involved before beginning a trial of the medication and knows the red flags to watch for, it seems that this might mitigate the risk of the possibility of a lifelong, debilitating tic occurring. However, Eli Lilly the company behind Prozac does not make this information readily accessible. On their website prozac.com, running a search for "tics" yields no results. The probable reason behind the company's avoidance of the word "tic" is that society has attached a certain stigma to it, that people who exhibit involuntary muscle twitches are different or not normal. The stigma surrounding tics is similar to the one attached to epilepsy, the origination being that in ancient times epileptics or people who exhibited loss of motor control were thought to be evil or possessed (6). The idea of losing control of motor functioning is frightening. The possibility that a pill that is supposed to make you feel better could potentially ruin your life, your self- esteem, or your ability to socialize and enjoy life, is shocking and definitely would not help Eli Lilly's Prozac sales.
The emotional impact of having a transient tic obviously varies. The people I know who have tics from Prozac and Zoloft live their lives normally without any obvious disturbances. However, the fact that our society either ignores these "transient tics" or treats tics brought on by medications as though they are not serious, is a dangerous problem in itself.
Society dictates that it is rude to either point out a tic or to stare at someone who has one, but the other extreme of completely ignoring a tic is equally destructive. Are these tics brought on by Prozac ignored and overlooked because they are easier to conceal than other side effects? Are people more reluctant to acknowledge and discuss them because of the idea that they might be evidence of neurological brain damage as suggested in Prozac Backlash (2)? It seems that people are either so desperate to be helped by the drug Prozac that they are willing to endure the side effect, or that our culture has simply decided to turn it's back on virtually undetectable facial tics, because they are not deemed to be a "serious side effect". Often they do not incapacitate the patient, and are therefore might be viewed by Eli Lilly as not being worthy of being listed (7).
However, there are certain approaches that might combat this ideology and allow patients to be better informed, as well as to draw attention to how undeniably prevalent facial tics are as a result of Prozac usage. A documentary with consent from participants would be an interesting way to go about examining the scope of facial tics. Being confronted with an image of someone ticing is much more powerful than reading about it as a side effect on a pill bottle label anyway. Besides drawing attention to the prevalence of facial tics, it might as also be informative to conduct an informal, anonymous survey of how many people in Manhattan who are using Prozac either have been told that they have facial tics or have noticed them themselves.
Books like Prozac Nation by Elizabeth Wurtzel (8) and Prozac Backlash, detail the dangers of taking the medications and the frightening array of side effects that can occur. Though these books are definitely an invaluable resource, and describe in-depth accounts of patients who have suffered from facial tics, they seem to scare people as a tactic to have them not take the medications in the first place. The problem with this approach is that people can justify the fact that this type of side effect has happened to others, who probably didn't really need the medication in the first place. Readers can rationalize that they are taking Prozac in a controlled way and need to take it in order to function. By engaging in this type of thought process readers can distance themselves from the case studies Glenmullen writes about and Elizabeth Wurtzel's experiences on the drug. Therefore it is imperative that our society takes transient facial tics seriously, as they are a sign that something is wrong in the brain, or more specifically that misfiring is occuring. Ultimately, the field of tics related to Prozac usage needs to be studied a lot more in depth before we understand fully why people get these tics and how they can be controlled or eradicated once and for all.
1)Definiton of "tic" on psychnet-uk, a website that defines what a tic is.
2)Glenmullen, Joseph. Prozac Backlash. New York: Simon and Schuster, 2000.
3)"Tardive Dyskinesia" , an article by James Robert Brasic and Brian Bronson.
4)"Habit Reversal. A Treatment Aproach for Tics, Tourette's Diorder and Other Repetitive Behavior Disorders", an article by Dr. Michelle Pearlman.
5)prozactruth.com, a website that describes supplements and vitamins that could combat tics as well as personal stories.
6)Serendip Home Page, the first Web Paper assignment.
7)Eli Lilly's Website, a website run by Eli Lilly.
Comments made prior to 2007
I took Zoloft for about 7 or 8 years & I have developed a very bad case of facial & eye tics. I feel that they are a direct result from taking the Zoloft. Is there anything that I can do to get rid of them? I am getting desperate! ... Janice, 3 October 2006
Just wondering if you've come across anyone who's child (not on an SSRI) has a facial tic, and they happened to have taken an SSRI while pregnant ... Christine, 14 November 2006