My 12 year old son was diagnosed with Tourette's 3 days ago, and I have a lot of questions. This may get a little long, so I apologize in advance, but I feel that it is important to understand the whole picture when asking for and giving advice.

He has always had a bad temper, but about 6 months ago I noticed that things had been getting a lot worse. 3 months ago he tried to attack my older son with a kitchen chair, pretty much without provocation. This prompted me to seek counseling with one of the local community mental health organizations.

I'm also a few months away from graduating with my Associate's Degree in nursing. When studying psychological nursing last semester I was first exposed to what ADHD is and isn't, which happened to come up in class shortly after he had started the therapy. I had a lot of preconceived notions about the disease, and few of them were positive. After learning the DSM-IV criteria I realized that my son fit the diagnosis. There was another near-violent incident between him and my older son, so this made me much more open to the possibility of a med evaluation. I scheduled an appointment with the psychiatrist affiliated with the community organization.

After a 2 month wait, we finally had our appointment with the psychiatrist Thursday evening. We sat in his office and he introduced himself and asked a couple of general questions. Then he blurted out "Well, you have not been here for 5 minutes, yet I can tell you exactly what is wrong with your son. He has Tourette's syndrome." This totally floored me. I didn't know much about the disease, and was shocked that he would/could give a diagnosis so quickly without really gathering any information. He was basing it entirely on my son't facial twitches, which I have just ignored as mildly distracting for some time. I took him to the eye doctor's a month or so ago for excessive blinking, and he just blamed it on dry eyes. My main concern has been the violent mood swings and other symptoms of the ADHD. He continued to ask us questions for 20 minutes or so and then told us that he was going to give my son a script for tofranil and clonidine. He said that the only side effects might be dry mouth and constipation.

When I got home I decided to do some research. Because I am in college it is easy for me to locate journal articles, and almost 2nd nature to research that way. I was familiar with the clonidine because it is commonly prescribed in adults for blood pressure, but I was unfamiliar with the tofranil. When I realized that it was a tricyclic antidepressant, warning bells began going off in my mind. The extrapyramidal side effects scare the snot out of me.

I have also noticed that my son exhibits a lot of the behaviors of hoarding, which I know is closely related to OCD. I'm just really upset because I don't think that the doctor did a thorough enough evaluation to write a script for such a potentially dangerous drug when there seems to be much safer alternatives out there.

So, I decided to hold off on filling his script, and plan on calling the doc tomorrow with my questions. The tics that my son has are what I would consider more of a minor to moderate annoyance, but the emotional issues are more of a priority. He mainly just blinks and occasionally twitches he cheeks. I haven't noticed any vocal tics at all, but both of my boys said that he does clear his throat a lot. (I asked if either of them had noticed him making random noises for no real reason) And he said that sometimes he clears it because it feels dry, and sometime he just does it because he can. The research I've seen seems evenly divided about whether stimulants will make the tics worse, stay the same, or go away altogether. I saw no current documentation of tofranil being a first-line treatment for Torret's which is another concern. So, here are my questions:

1) Am I overreacting about the tofranil?

2) Has anyone used Strattera successfully with Tourettes?

3) Has anyone successfully used stimulants without the tics getting worse?

I have explored the TSA homepage and found that very helpful. I would greatly appreciate any input and opinions. I just want my son to be happier and help him through the social issues that he has been experiencing. He does well in school, and has never been a discipline problem. He just has problems focusing on the task at hand and relating to others. When he loses his temper, he says that he feels like he is totally separated from himself and cannot control what he's doing. He's a beautiful little boy but very confused and scared by all of the things he has going on in his mind. I'm beside myself with worry and don't want to do something to him that can have life-long negative consequences.