Why am I so twitchy?

February 4, 2009 6:54 AM

Why am I so twitchy?

I've always been the stereotypical fidgeter, of the obsessive pen-clicking, finger-tapping, leg-jiggling variety (I'm very fun to share an office with). I see a lot of people doing this and think it's a fairly common quirk.

But I have these other weird fidgets, too, and they've gotten worse recently. The first kind (leg-jiggling, etc.) I don't tend to realize I'm doing until the person sitting next to me tells me to cut it out. The other ones, though, are more like compulsions. They mostly involve flexing or stretching a muscle in a specific spot. It's like scratching an itch - if I resist, I feel a little crazy, and the more I think about them, the worse they get. It's to the point where I've become slightly self-conscious about my twitchiness, especially because I've had significant others ask me about it when we're falling asleep and I just have to explain to them that I'm weird.

I've wondered whether or not it's a Tourette's-like thing, especially because Tourette's is often comorbid with ADHD and OCD, and - surprise! - I have both. One thing I'm not clear on, though, is whether or not the Tourette's tics are "intentional," or whether they just happen on their own, like myoclonic jerks (which I also get occasionally). I'm very conscious of these and can resist the urges, though I feel like AAARRRGGGHHH inside until I just give in. I don't really have any significant vocal tics, either, except when I remember something really mortifying. I also think it sounds similar to Restless Leg Syndrome, but it definitely doesn't only happen in my legs. Or maybe RLS is a cousin of Tourette's?

Other things: The twitches began happening more frequently when I started taking Adderall for ADHD, which makes sense if they're related to a dopamine increase. I don't understand, though, why Tourette's would be related to ADHD if Tourette's is correlated with too much dopamine and ADHD is correlated with too little, and why the twitches and fidgets would get worse as the ADHD improved. Also, I've noticed that the compulsive twitches (and the myoclonic jerks, for that matter) get WAY worse on the rare occasions that I smoke marijuana, to the point that it kind of freaks me out.

Other possibly relevant information is that, along with the Adderall, I take Lexapro and Wellbutrin for depression, anxiety, and OCD. And hell, I may as well throw in that I had temporal lobe epilepsy as a kid. My brain is a big bag of endless thrills.

I also wasn't kidding when I said thinking about the twitches makes them worse - writing this question will have me popping and locking for the next two hours. AAARRRGGGHHH *twitch*

posted by anonymous to health & fitness (8 comments total)

I have a twitch. Reading your question totally prompted it, too. Went through the standard battery of tests, no epilepsy, no nothin'. But I was also dxed with severe anemia last month and since being better about taking my iron, my twitchiness has decreased. A little reading seems to implicate iron deficiency in some cases of RLS.

FWIW, I also take a B complex and cal-magnesium for my nerves, because I know stress makes my twitchiness worse.
posted by cobaltnine at 7:05 AM on February 4

From what I've read (which is ONE article about trying to help kids control Tourette's) it is an "intentional" thing where you feel like you have to do foo or baz or else. However, the fact that you started noticing the symptoms after you started taking Adderall would be an angle to investigate; don't write it off because of the dopamine increase, because an individual human brain is a very quirky place and not all the usual rules apply equally across the board.

I'd mention it to your doctor -- and make sure your doctor also knows about all the other medication, and the epilepsy. For all you know your brain could have some kind of weird perfect-storm kind of situation where having a history of epilepsy and that specific combination of medication could cause these unique side effects; this is where they get episodes of House, if you think about it, where they have a patient with weird unexplainable symptoms and then suddenly someone discovers a unique set of factors that make everything suddenly make sense (would someone undergoing drug trials have these symptoms? No. But someone undergoing drug trials who also has a bezoar? THAT explains it!).

It's clearly frustrating you, so it's definitely worth bringing up to your doctor. Good luck.
posted by EmpressCallipygos at 7:08 AM on February 4

Yes, the twitches with Tourette's are similar to how you describe them. You may not notice you are doing it, but if you do notice and try to stop, you go crazy until you let it happen. Like you said, it's like scratching an itch. But there are other qualities that define Tourette's twitches - they are usually (but not always) in the face and neck, they change location and get better and worse over time, and a diagnosis usually requires that you have at least one vocal tic (often coughing or clearing the throat). In some patients, they also get worse with stimulants like Adderrall.

So yes, it could be Tourette's, but it could easily be something else. So talk to your doctor about it and see what they say. You may want to ask for a referral to a neurologist if you don't already have one.
posted by thejanna at 7:19 AM on February 4

From the wikipedia article on Wellbutrin: "According to a retrospective case series published in 1993, bupropion treatment may exacerbate tics in children with co-occurring ADHD and Tourette syndrome.[55] No further research of this side effect has been conducted."

^ Spencer T, Biederman J, Steingard R, Wilens T (1993). "Bupropion exacerbates tics in children with attention-deficit hyperactivity disorder and Tourette's syndrome". J Am Acad Child Adolesc Psychiatry 32 (1): 211–4. PMID 8428875.

The article is old, but if you bring it to your doctor they may be able to point to more recent research that either supports or disproves this and determine if this is what's going on. (I was actually reading about the side effects of Wellbutrin yesterday because I've been unusually jumpy lately.) In any case, write down your symptoms in a timeline so your doc can try to pinpoint why things have changed. Hope this helps!
posted by Mouse Army at 7:21 AM on February 4

As you've noted, people with ADHD and/or OCD are much more likely to have Tourette Syndrome, as well as the reverse. However, it's also common for them to have SYMPTOMS of the other disorders without having a full-blown diagnosis. This sounds like what you're experiencung.

Term to google/commit to memory: Tourette Spectrum. This is the super-fun rainbow of disorders such as ADHD, OCD, and TS. You can have uneven helpings of them, a little of this and a lot of that, full-blown this and non-existant that, occassional tics and obsessive sorting.

I have Tourette syndrome. I described what it feels like to have tics here. You did a good job of describing them, I think. I wouldn't worry too much about how intentional or not they are; they sound like tics to me. Sometimes I'm conscious of tics, as well, and stop them, but I get the ARRRRGH until I give in. The fact you let it happen doesn't make it any less involuntary.

I am not a doctor. But I do have hella TS, and I do every single thing you do. When I think of something that makes me anxious, I blurt out noises(ok, well, long loud strings of sailor-swears). Thinking about it makes it worse (writing that sentence just set off some neck-twisting eye-blinking).

Since this is Ask Metafilter, I don't want to be all handing out diagnoses like they was candy. I'm not convinced you have Tourette Syndrome. You most definitely have nervous tics. The criteria for hanging out with Gilles de la Tourette includes vocal tics, which you have some of, and a duration of symptoms longer than a year. Whether or not you have "actual" Tourette doesn't really matter, honestly, since all it changes is A) what you call it and B) how you treat it. I will warn you that doctors are pretty lame about diagnosing Tourette, since most of them don't know much about it, and there's a pretty good chance they've never met/treated anyone else with it. Whether you call it Tourette Syndrome or Chronic Tics or a Nervous Tic Disorder, your symptoms are not going to change.

This is all opinion, but I would NOT get on medication for TS. Please, please, please don't ask your psychiatrist to put you on another pill. No offense, but you're already on quite a cocktail.* The drugs commonly used for TS are Orap, Risperdal, Haldol, and probably some more I can't remember because I was so doped up I was drooling when they tried these out on me. These are nasty antipsychotics which "happen" to "kind of work" for Tourette Syndrome. Again, this is all opinion, but I have worse tics than you do (bragging rights! not) and I don't take medication. It is not worth it to take medication for Tourette Syndrome unless the tics severely interfere with your life (physical pain, difficulty holding down a job).
posted by Juliet Banana at 8:50 AM on February 4

Talk to your doctor. It could very well be a side effect of one of your medications or a dosage may need to be adjusted. Hell, print this out and take it to your next appointment.
posted by threeturtles at 10:11 AM on February 4

Why am I so twitchy?
Because you are using amphetamines.
IANAD but I'm pretty sure you'll stop feeling/behaving like a tweaker if you just take a little less.
Or maybe a lot less? Just start off with less and go from there :)
posted by mu~ha~ha~ha~har at 2:53 PM on February 4

This is a little left field maybe, but do seriously exercise? I run and I get twitchy if I don't run. I have no idea if serious aerobics might make a difference, but I can't imagine it would hurt.
posted by IndigoJones at 5:57 PM on February 4