Selecting a Treatment Option for Tardive Dyskinesia

Photo Credit: Cagkansayin

A recent article in Primary Care Companion for CNS Disorders discusses the risk factors, monitoring strategies, and treatment options for tardive dyskinesia.

Tardive dyskinesia (TD) is a movement disorder that most commonly affects the face and limbs. Certain groups, including older adults, women, and patients on long-term first-generation antipsychotics, are at higher risk of developing TD.

According to an article published in Primary Care Companion for CNS Disorders, early recognition and prompt intervention is the cornerstone of TD management. Early detection using the Abnormal Involuntary Movement Scale is crucial for managing TD before it becomes irreversible. The primary treatment strategies include medication adjustments, TD therapeutics, and other agents.

Medication Adjustment

This may involve discontinuing the offending agent or switching to a lower-risk antipsychotic like clozapine. In some cases, lowering the dose may help alleviate symptoms.

VMAT-2 Inhibitors

These include deutetrabenazine and valbenazine, which are FDA-approved medications that reduce presynaptic dopamine levels, thereby decreasing TD symptoms. Tetrabenazine, an older drug, is also effective for TD but is associated with more adverse effects.

“VMAT-2 inhibitors are effective in reducing TD symptoms, but caution is needed in older adults due to potential side effects like gait disturbances,” says Alex Dimitriu, MD, in an interview with Physician’s Weekly.

Other Pharmacologic Treatments

Benzodiazepines, such as clonazepam, are effective for dystonia-predominant symptoms. Amantadine has also shown efficacy, although mostly in short-term use. Gingko biloba extract may help reduce symptoms, but more research is needed for conclusive evidence.

Non-Pharmacologic Interventions

Non-pharmacologic interventions include deep brain stimulation, which targets the globus pallidus or subthalamic nucleus and has shown success in severe cases. Botulinum toxin injections are another option, although their efficacy is limited and inconsistent, making them more suitable for localized dystonia.

“Sometimes stopping the meds can resolve it, but for some patients, we have to try other medications that may reduce the symptoms,” Howard R. Weeks, MD, says.

Importance of Patient Education and Communication

Effective communication between healthcare professionals and patients is essential for managing TD risk. Educating patients about the potential risks of antipsychotic medications, including the possibility of developing TD, helps them make informed decisions about their treatment.

“The most important thing to understand is that [patients] should have a conversation with their treating provider,” Dr. Weeks says. “There are always risks to taking any medication, but there’s also risk for not treating psychiatric disorders. True psychotic disorders are extremely critical to treat, and untreated psychotic disorders can have much more significant health ramifications.”