Tardive dyskinesia: How it's treated

Treatment for tardive dyskinesia — a nervous system disorder that causes repeated, uncontrolled movements — is first based on the idea of preventing the condition.

Tardive dyskinesia is caused by ongoing use of antipsychotic (neuroleptic) drugs or the anti-nausea drug, metoclopramide. Doctors should prescribe these drugs with caution and monitor you for signs of tardive dyskinesia often.

If you begin to show signs of the condition, your doctor should carefully assess your symptoms and treatment options. These steps provide the best chance of reversing your symptoms, which can become permanent.

Preventing tardive dyskinesia

The best treatment for tardive dyskinesia is to prevent it in the first place. To help prevent the condition, your doctor can limit your use of the drugs that cause it, when possible. Your doctor can also prescribe the lowest dose possible that's still effective at treating your condition. And your doctor can take you off a drug, when possible, to ensure you use it only for the amount of time truly necessary to manage your condition.

It's also important that your doctor frequently monitor you for signs of tardive dyskinesia while you're taking a drug that can cause it. This can help your doctor catch the condition early, so that he or she can take steps to reverse symptoms to keep them from becoming permanent.

While taking antipsychotics or metoclopramine, it's also usually best to avoid taking anticholinergic drugs — which include some antidepressants, antihistamines and other medications. That's because these drugs may worsen tardive dyskinesia symptoms.

Treating tardive dyskinesia

When you already have tardive dyskinesia, treatment may start with stopping the drugs that are causing your symptoms. If your symptoms are mild and not very troublesome, this may be the only treatment needed. But you should never stop taking an antipsychotic drug without talking to your doctor first. When it's not possible to stop, because you need to continue taking an antipsychotic, treatment options may include:

  • Newer (second-generation) antipsychotics. If you're currently taking an older (first-generation) antipsychotic and your tardive dyskinesia symptoms have just started, your doctor may suggest switching to a newer type of antipsychotic, such as clozapine or quetiapine. Newer types may be less likely to cause tardive dyskinesia. However, these also have possible side effects that need to be closely monitored, and if your tardive dyskinesia is more advanced, switching to these drugs isn't likely to lead to major improvement.
  • Drugs that reduce symptoms. Certain drugs called vesicular monoamine transporter 2 inhibitors may help ease tardive dyskinesia symptoms. Examples include valbenazine (Ingrezza), tetrabenazine (Xenazine) and deutetrabenazine (Austedo). These drugs help by depleting the brain's storage of dopamine — a chemical messenger.

    For those with mild tardive dyskinesia who also have anxiety, low doses of benzodiazepine drugs, such as clonazepam (Klonopin), may help ease symptoms.

    And for those whose abnormal movements only affect a specific area — such as the neck or eyelid muscles — botulinum toxin (Botox) injections in that area may help relax the muscles.

    Other drugs also may help reduce symptoms of mild tardive dyskinesia, but more research is needed. Examples include amantadine (Gocovri), vitamin B-6 and Ginkgo biloba.

  • Deep brain stimulation. This treatment may help ease the symptoms of severe tardive dyskinesia that doesn't respond to other treatments. Deep brain stimulation involves implanting electrodes within certain areas of your brain. The electrodes create electrical impulses that can affect certain cells and chemicals in the brain.

    The amount of stimulation in deep brain stimulation is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire that travels under the skin connects this device to the electrodes in the brain.

Also know that once tardive dyskinesia has become an ongoing (chronic) condition, continuing to use antipsychotic drugs may not worsen the condition.

Understanding your options

If you're at risk of tardive dyskinesia, talk to your doctor about what you can do to prevent it. And if you notice signs or symptoms, share these with your doctor promptly. Prevention and early treatment are your best chances at reversing tardive dyskinesia.

If your tardive dyskinesia is more advanced, but your symptoms don't bother you, you may not need treatment. But if your symptoms are bothersome, treatment can help reduce them, even if the condition can't be reversed.

June 04, 2019