Expert: Dr Billy Levin - 2/7/2010

Question
QUESTION: Hi Doctor. I think I have found out what my broblem is. I was origally diagnosed with Tourette Syndrome and ADD. My eyes always blink with a twitch but seemed to get better over the years. Now as I told you I am on 50mg ritalin per day for about 20 years. Perhaps over the years the rialin has aggrivated my twitch without me knowing and now it has damaged my eye muscles because my eye muscles are terribly sore and tense and i still have a slight eye blinking twitch. I cant understand why my psychiatrist didnt tell me. He knows I was diagnosed with Tourette. Now my life is ruined because I will have to stop Ritalin.

ANSWER: ADD/ADHD is often associated with Tourettes. The older concept that you cannot treat ADHD and Tourettes together no longer existe. In  most cases it is possible to treat both conditions simultanously and successfully. Ritalin does not cause  the Tics and the Tics are not likely to  damage eye muscles. In cases where it is deemed not practical to carry on with Ritalin, Strattera may be used. Either way your life is not likely to be  be ruined by the treatments. However if you are feeling depressed an antidepressant might be indicated.

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QUESTION: I have been on so many different coctails of meds with the Ritalin over the years and Ritalin has been the only successful drug that helped me. I am just concerned that it will harm me after using it for so long (almost 20 years) and just horrified at the fact that I might get allergic to it or be forced to come off of it. The reason being I suffer terribly from confused spells, headaches and skeltal muscle tension especially around my eyes. However I am also OCD and suffer terribly from stress. I just have days where I get weird feeling in my head and feel totally detached from my mind.

Answer
There are no long term  serious side effects to the prolonged correct use of Ritalin under expert medical supervision. You cannot, after so long become allergic to Ritalin. The concerns of yours could be very easily answered by your treating doctor to give you reassurence that if you need treatment ,it is safe to continue. However ,from your description your medical treatment needs revision. Please consult with your treating doctor.