Is safe treatment present for tardive dyskinesia if pregnant?

Question

Hello doctor,

I am really worried about my 38-year-old sister, who developed tardive dyskinesia after taking antipsychotic medications for bipolar disorder over the past five years. She has these involuntary movements in her face where her mouth and tongue move constantly, and she can not control them.

The movements got much worse after her psychiatrist switched her from Olanzapine to Haloperidol eight months ago. Her neurologist started her on Deutetrabenazine, which helped reduce some of the facial movements, but now she is having problems with her hands and fingers doing repetitive motions.

The tardive dyskinesia is affecting her speech and eating; she bites her tongue frequently and has trouble chewing food properly. The worst part is that she is 20 weeks pregnant with her first baby and worried about how these medications might affect the fetus.

Her psychiatrist wants to stop all antipsychotics, but she has had two manic episodes in the past when medications were discontinued. The movements are so noticeable that strangers stare at her in public, and she does not want to leave the house anymore. Can tardive dyskinesia get worse during pregnancy? Are there safer treatments she can take while pregnant?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Tardive dyskinesia can be extremely distressing, and pregnancy adds another layer of complexity because both the mother’s mental health and the baby’s safety need to be considered.

In some women, hormonal changes during pregnancy may influence movement disorders, but data on whether tardive dyskinesia specifically worsens during pregnancy are limited. The fact that her symptoms became more severe after switching from Olanzapine to Haloperidol is consistent with what we know, since older antipsychotics like Haloperidol carry a higher risk of causing tardive dyskinesia than newer agents.

Deutetrabenazine can reduce abnormal movements, but its safety in pregnancy is not well established, so continued use requires a very careful risk–benefit discussion with her doctors.

Stopping all antipsychotics is risky given her history of manic episodes, and relapse during pregnancy can be harmful for both her and the baby.

Sometimes switching back to an atypical antipsychotic with a lower risk of movement side effects, such as Quetiapine or Olanzapine, is considered safer in pregnancy than continuing Haloperidol.

Supportive strategies, such as speech therapy and dietary adjustments, may help with chewing and tongue biting, while counseling can support her emotional well-being.

Because of the seriousness of her situation, decisions about her treatment should be made jointly between her psychiatrist, neurologist, and obstetrician to balance control of bipolar disorder, management of tardive dyskinesia, and safety for the baby.

I hope this information will help you.

Kindly follow up if you have more concerns.

Thank you.