Abstract
Three children with Tourette's syndrome and comorbid attention-deficit hyperactivity disorder, obsessive-compulsive disorder, and depression were treated in open clinical trials with a combination of a psychostimulant (methylphenidate) and a tricyclic antidepressant (imipramine). Clinical observations and standardized rating scales suggested that this drug combination produced beneficial effects on the tics as well as other symptoms. Adverse effects were minimal. These open trials were conducted without controls, drug withdrawal, or placebo, so these preliminary results must be considered only suggestive. Further investigation is needed to clarify the potential safety and efficacy of this drug combination in treating Tourette's syndrome with comorbidity.
It is plausible that the apparent improvement in tic symptoms was a secondary benefit resulting from the improvement in the comorbid conditions. That is, it is unclear whether this drug combination would have been effective for treating tic symptoms in the absence of the comorbid disorders.
The use of psychostimulants and tricyclic antidepressants has been controversial due to the mixed reports of their effects on tics (amelioration, exacerbation, or precipitation). The possible role of comorbidity in influencing the effects of these agents on tic symptoms remains poorly investigated.
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