Tardive Dyskinesia: A Guide for Patients on Antipsychotic Medication
Introduction:
Tardive Dyskinesia (TD), a potentially permanent movement disorder, is a potential risk associated with the use of atypical antipsychotics, a concern relevant to all patients, irrespective of their age, the dosage, or the specific type of medication used. While newer “atypical” antipsychotics are potentially associated with a lower risk of developing TD compared to older antipsychotics, the risk remains non-negligible.
In my clinical practice, I have encountered a case where a young patient under the age of 18 developed TD after being on these medications for most of her life and at high doses due to severe behavioral issues. Conversely, I have also worked with patients who have used these medications for many years without developing TD. This highlights the unpredictable nature of TD and the importance of individualized awareness and monitoring. However, it's important to note that some medications in this class pose a higher risk than others, and both the duration and dosage of the medication typically have a significant impact as well.
Symptoms of TD:
Here are some common symptoms that you might notice if you or someone you know is affected by TD:
Rapid, Jerky Movements: You may see quick, involuntary jerking or twitching of the arms and legs.
Facial Grimacing: This involves making involuntary faces that might seem like expressions of pain or discomfort.
Tongue Movements: Unexpectedly sticking out the tongue repeatedly.
Mouth Movements: Engaging in sucking movements or making fish-like motions with the mouth.
Lip Smacking: Repeatedly smacking the lips together, often without realizing it.
Hand and Foot Tapping: Continuously tapping or moving the hands or feet, similar to a rhythmic motion.
Upper Body Movements: Involuntary movements that can occur in the hips or upper body, which might look like squirming or shifting.
Excessive Blinking: Blinking the eyes unusually often.
Puffing Out the Cheeks: Involuntarily puffing the cheeks in and out.
Uncontrolled Noises or Facial Expressions: Making noises or showing facial expressions that you can't control.
These symptoms can vary in intensity and may occur frequently throughout the day, significantly impacting daily activities and quality of life. This video shows a gentleman with severe TD.
Pathophysiology:
Tardive Dyskinesia (TD) is a movement disorder characterized by involuntary, repetitive body movements. This condition primarily affects the facial muscles but can also involve the limbs, fingers, and trunk. TD results from long-term use of antipsychotic medications, which block dopamine receptors in the brain. Over time, this blockade can lead to neurological imbalances that manifest as the uncontrollable movements typical of TD.
% of Patients That Get It:
While TD does occur in a subset of patients using antipsychotic drugs, it's important to contextualize that many studies capturing a 10 to 30% prevalence include older medications, which are typically associated with higher risks. With newer atypical antipsychotics, there may be a reduced risk of developing TD. The likelihood and severity of TD can also vary depending on how long the medication is used and the specific type of antipsychotic prescribed.
Risk Factors and Highest Risk Neuroleptic Medications:
Risk factors for developing TD include prolonged use of antipsychotics, older age, and the specific type of antipsychotic medication used. First-generation antipsychotics, such as haloperidol and chlorpromazine, carry a higher risk of inducing TD. Second-generation antipsychotics like olanzapine, quetiapine, and aripiprazole, to name a few, are associated with a lower risk but are not entirely risk-free.
Potential Treatments (Approved Medications):
The primary approach to managing TD involves modifying the antipsychotic treatment either by reducing the dosage or switching to a different medication.
Clozapine is recommended for patients who continue to require antipsychotic treatment as it has a significantly lower risk of causing TD.
The FDA has approved two medications specifically for the treatment of TD: Valbenazine and Deutetrabenazine, both of which are vesicular monoamine transporter 2 (VMAT2) inhibitors. These medications have demonstrated effectiveness in reducing symptoms in clinical trials, offering hope for those affected by TD.
Potential Supplement Treatments (Ginkgo Extract):
Tebonin, a ginkgo extract known generically as EGb 761, has shown promise in managing symptoms of Tardive Dyskinesia (TD). Additionally, it has been found beneficial for conditions like tinnitus, vertigo, cognitive decline, and symptoms of dementia. The American Academy of Neurology has recognized Tebonin as one of four standard treatments for TD, highlighting its potential in both neurological protection and symptom management.
Sources:
https://www.ncbi.nlm.nih.gov/books/NBK448207/
https://medilib.ir/uptodate/show/83900
https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Tardive-Dyskinesia/
