TCAs increase the quantity of neurotransmitters , such as serotonin and norepinephrine, in the central nervous system. They block specific serotonin (SERT or 5-HTT) and norepinephrine transporters (NET). When affected, these transporters cannot play their part in the reuptake of neurotransmitters, which increases the concentration and ultimately has an effect on mood . Some TCAs bind with SERT and some bind with NET. Clomipramine, for example, is a potent binder of SERT, but it is a weak binder of NET. Desipramine, on the other hand, is a strong binder of NET.
Positive reinforcement programs appear to be most helpful in the management of tic disorders. Target behaviors may be categorized into two groups: (1) skill deficiencies, or areas that initially require concentration to build social and academic skills; and (2) behavior excesses, in which the goal is to help the patient decrease the frequency of these behaviors. Caution should be exercised in the management of behavior excesses, since some children who undergo behavior modification to directly target the Tourette's syndrome symptoms have an exacerbation of symptoms. 29