8 Tardive Dyskinesia Treatment Options
Tardive Dyskinesia (TD) is a neurological disorder characterized by repetitive, involuntary movements, typically involving the face, tongue and limbs. This condition is often a side effect of prolonged use of certain antipsychotic medications or other dopamine receptor-blocking drugs. Managing TD involves addressing the underlying causes, adjusting medications and exploring effective treatments. Below, we discuss the most commonly used treatment options, starting with Austedo, a well-known medication for TD.
1. Austedo (Deutetrabenazine)
Austedo is an FDA-approved medication specifically designed to treat TD. It works by reducing the levels of dopamine in the brain, which helps alleviate the involuntary movements associated with the condition.
Benefits
- Proven efficacy in reducing the severity of TD symptoms.
- Taken in tablet form, typically twice daily, making it convenient for most patients.
Side Effects
- Potential side effects include drowsiness, fatigue and nausea.
- Rarely, it may worsen depression or lead to suicidal thoughts, so monitoring by a healthcare professional is essential.
Austedo is often the first line of treatment for TD due to its targeted mechanism and positive clinical outcomes.
2. Ingrezza (Valbenazine)
Another FDA-approved treatment for TD, Ingrezza, is a vesicular monoamine transporter 2 (VMAT2) inhibitor like Austedo. It reduces the release of dopamine, helping control the uncontrollable movements associated with TD.
Benefits
- Once-daily dosing for convenience.
- Significant improvement in symptoms within a few weeks for many patients.
Side Effects
- Common side effects include fatigue, dry mouth and dizziness.
- Rarely, it can cause heart rhythm abnormalities, so periodic monitoring may be necessary.
Ingrezza is widely used for its simplicity and demonstrated effectiveness in clinical trials.
3. Botox (Botulinum Toxin Injections)
For patients with localized or severe muscle contractions, botulinum toxin injections, commonly known as Botox, can offer relief. Botox works by temporarily paralyzing the overactive muscles that cause involuntary movements.
Benefits
- Highly effective for targeting specific areas, such as facial muscles.
- Effects typically last 3–4 months, after which additional injections may be required.
Side Effects
- Temporary weakness in the injected muscles.
- Rare risk of toxin spread, which can cause systemic effects like difficulty swallowing or breathing.
Botox is particularly useful for patients who do not respond well to oral medications.
4. Adjusting or Discontinuing Offending Medications
One of the first steps in managing TD is to evaluate the medications that may have caused the condition. Antipsychotic medications, particularly first-generation drugs, are often implicated.
Options
- Switching to a newer, atypical antipsychotic, which has a lower risk of causing TD.
- Gradually discontinuing or reducing the dose of the offending medication, under medical supervision.
Risks
- Adjusting antipsychotic medication can lead to a resurgence of the underlying mental health condition. Close monitoring by a psychiatrist is crucial during this process.
Medication adjustments are often combined with other treatments to ensure symptom relief without compromising mental health stability.
5. Benzodiazepines
Benzodiazepines, such as clonazepam or diazepam, are sometimes prescribed to help reduce TD symptoms. These medications have muscle-relaxant and sedative properties that can lessen the severity of involuntary movements.
Benefits
- Rapid onset of symptom relief.
- May be particularly useful for anxiety or agitation associated with TD.
Side Effects
- Sedation, dizziness and the risk of dependency with long-term use.
- Not suitable for all patients, especially those with a history of substance abuse.
Benzodiazepines are often used as a short-term solution while other treatments are initiated.
6. Anticholinergic Medications
Anticholinergics, such as benztropine, are sometimes used to manage TD, although they are more commonly prescribed for drug-induced Parkinsonism. They work by balancing the levels of acetylcholine and dopamine in the brain.
Benefits
- May help reduce mild symptoms in some patients.
Side Effects
- Dry mouth, blurred vision, constipation and confusion, especially in older adults.
- Limited efficacy in severe cases of TD.
Because of their side effects, anticholinergics are not a first-line treatment but may be used in specific cases.
7. Lifestyle and Behavioral Therapies
Non-medication strategies can also play a vital role in managing TD symptoms. These include:
- Physical therapy. Helps improve muscle control and reduce stiffness.
- Speech therapy. For patients with TD affecting the tongue and facial muscles, speech therapy can improve communication.
- Stress management. Techniques such as yoga, meditation and mindfulness can help reduce stress, which often exacerbates symptoms.
These approaches are typically used alongside medication to provide comprehensive care.
8. Deep Brain Stimulation (DBS)
For severe, treatment-resistant cases of TD, deep brain stimulation may be considered. DBS involves implanting electrodes in specific brain areas to regulate abnormal activity.
Benefits
- Significant improvement in symptoms for some patients.
- Potential to improve quality of life in cases where other treatments fail.
Risks
- Invasive procedure with risks such as infection or bleeding.
- Requires regular follow-ups and device adjustments.
DBS is generally reserved for the most severe cases of TD.
Final Notes
Tardive Dyskinesia can significantly impact a patient’s quality of life, but a variety of treatment options are available to manage the condition. Austedo and Ingrezza are often the first choices due to their effectiveness and FDA approval. Additional treatments, such as Botox, medication adjustments or behavioral therapies, can complement these options.
For patients with severe or refractory TD, interventions like deep brain stimulation may provide relief. Consulting with a healthcare provider is essential to develop a tailored treatment plan that addresses the severity of symptoms and individual needs.