- Mental Health
Tardive Diskenesia Caused by Anti Psychotics and Other Drugs
What is Tardive Dyskinesia?
Tardive Dyskinesia (TD) is a movement disorder most commonly caused by the use of neuroleptic drugs. TD usually manifests in involuntary, repetitive facial movements, mouth movements, and sometimes body movements. Here are the symptoms of TD:
- lip smacking
- facial movements
- tongue protrusion
- extremity movements
- rapid eye blinking or twitching
TD affects about 500,000 people in the United States.1 Women and people over the age of 65 are more sensitive to TD when on the offending medications. In older people the metabolism slows down and is not able to process the medication as effectively.2 Approximately 15-30% of persons who receive long-term treatment with neuroleptics are afflicted with TD.3
What Causes Tardive Dyskinisia?
TD usually occurs after longer-term use of antipsychotic and other medications as well (see list below). Often patients who take large doses of these medications are more at risk, especially with prolonged use. Tardive Dyskinesia has no cure and in many cases is a permanent condition. There are a few treatments available, but research shows they have a low success rate. In many cases, the best way to treat TD is to prevent it by monitoring the patient regularly, and keeping doses at a minimum. It is advised that at the first signs of TD, the medication should be discontinued (with doctor recommendation). With many of the neuroleptic medications, such as the antipshychotics, the discontinuance of the drug often does not guarantee that the TD will stop. In fact, in many cases the very offending medication may mask the condition, or only allow it to manifest mildly. TD may actually get worse or begin after going off antipsychotic medications. It's really a double edged sword.
Long-term use of Dopamine Antagonists can cause tardive dyskinesia. According to TD Center website, "These medications operate by blocking receptors in the dopamine pathway of the brain, which controls voluntary muscles and certain emotional response mechanisms (known as the nigrostriatal pathway)."
Medications That Can Cause TD
Here is a list of medications that can cause Tardive Dyskinesia (this is not an exhaustive list):
- Abilify (Aripiprazole)
- Clozaril (Clozapine) (may also treat the condition)
- Geodon (Ziprasidone)
- Haldol (Haloperidol)
- Loxitane / Loxapac (Loxapine)
- Mellaril (Thioridazine)
- Navane (Thiothixine)
- Orap (Pimozide)
- Piportil (Pipotiazine)
- Prolixin / Modecate (Fluphenazine)
- Risperdal (Risperidone)
- Serentil (Mesoridazine)
- Seroquel (Quetiapine)
- Stelazine (Trifluoperazine)
- Thorazine (Chlorpromazine)
- Trilafon (Perphenazine)
- Zyprexa (Olanzapine)
- Asendin (Amoxapine)
- Cocaine and other street drugs
- Elavil (Amitriptyline)
- Nardil (Phenelzine)
- Prozac (Fluoxetine)
- Sinequan (Doxepine)
- Tofranil (Imipramine)
- Zoloft (Sertraline)
- Reglan (metoclopramide)
- Compazine (prochlorperazine)
- Phenergan (promethazine)
As I said, there are few effective treatments of TD. According to brainandspinalcord.org, some doctors and practitioners suggest Vitamin E, however there is no scientific proof yet that it is effective.
There are a few drugs that may lessen the severity of TD. Tetrabenzine is one that reduces dopamine levels and sometimes has been known to calm symptoms down. Other medications sometimes helpful are:
- Miraplex (an anti-parkinson's medication).
- Benzodiazipines (tranquilizers) have had minimal success in reducing the symptoms
- Botulinum toxin
There are side effects to some these medications, so caution is needed. Clozapine (not clonidine or clonazapam) has some serious side effects and requires a lot of monitoring and regular blood work.
In the last year, the FDA has approved two new drugs for treatment of TD.4 Here is a list:
Ingrezza (valbenazine). A clinical trial of 234 people suffering from TD, after six weeks there was a significant improvement.
Austedo (deutetrabenazine). Originally FDA approved for chorea associated with Huntington's Disease, It was shortly found to help with TD.
Ken Duckworth MD, President of NAMI, offers hope with these two new medications. "I have felt a bit helpless in the past when I see people who experience TD. We didn’t have any treatment options approved by the FDA. But now we have two new tools and I look forward to learning more about these medications from my patients’ experiences and scientific literature."
What Should You Do If You Take a Medication That Causes TD?
If you take a drug that is known to cause TD, but you do not at this time have symptoms and it worries you, talk to your doctor right away, ask questions and let him know your concerns. He will be able to assess TD symptoms with something called the Abnormal Involuntary Movement Scale (AIMS) scale. This assessment should be done about every six months
1 Brainandspinalcord.org Tardive Dyskisia Treatment Options. http://www.brainandspinalcord.org/tardive-dyskinesia-treatment-options/
2 NAMI. Tardive Dyskinisia. https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Tardive-Dyskinesia
3 Drugs.com Teva Announces FDA Approval of Austedo (deutetrabenazine) Tablets for the Treatment of Tardive Dyskinesia in Adults. Teva Pharmaceutical Industries Ltd. https://www.drugs.com/newdrugs/teva-announces-fda-approval-austedo-deutetrabenazine-tardive-dyskinesia-adults-4589.html
4 NAMI. FDA Approves Medications For Tardive Dyskinesia, Ken Duckworth. https://www.nami.org/Blogs/NAMI-Blog/September-2017/FDA-Approves-Medications-for-Tardive-Dyskinesia
For More Information on Tardive Dyskinesia See These Websites
- Tardive Dyskinesia Treatment Options - Guidelines for Treating Tardive Dyskinesia
Tardive Dyskinesia Treatment options
- Tardive Dyskinesia & Reglan - Symptoms, Side Effects & Treatments
- Medscape: Medscape Access
A comprehensive over view of Tardive Dyskinesia.
© 2011 Lori Colbo