Patient's Query
Hello doctor,
My 52-year-old mom developed tardive dyskinesia after being on Risperdal for six years for her bipolar disorder, and it is getting really bad. The involuntary movements started in her face about eight months ago with lip smacking and tongue protrusion, but now her whole head jerks, and she can not control her facial expressions.
Her psychiatrist stopped the Risperdal immediately and switched her to Lithium, but the tardive dyskinesia symptoms keep getting worse instead of better. She can not eat in public anymore because the tongue movements make it look like she is making faces at people, and it is so embarrassing for her. Tried Valbenazine but insurance denied it three times, even with prior authorization from a neurologist.
The mouth movements also affect her speech, and people have trouble understanding her, which is frustrating because she has always been very articulate. She has been stable on mood medications for years, but is now afraid to try anything new in case it makes the tardive dyskinesia worse. Her quality of life has really declined, and she barely leaves the house anymore. Are there other treatments that insurance might cover better?
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
Tardive dyskinesia (TD) can sometimes persist or even worsen for a while after stopping the medication that caused it, and in some cases, it may not fully resolve. Since Valbenazine was not approved by your insurance, another medication option to discuss with her doctors is Deutetrabenazine, which works similarly but may have different coverage depending on the insurance plan.
Some patients also benefit from older treatments like Clonazepam or Ginkgo biloba extract, though these are generally considered second-line.
Botulinum toxin (Botox) injections into specific facial muscles can help reduce visible abnormal movements in some people, and this is sometimes covered by insurance if documented as medically necessary. Speech therapy can also help with communication issues and improve clarity despite the movements.
It is important her mood disorder continues to be managed with non-dopamine-blocking medications like Lithium, Lamotrigine, or certain atypical antipsychotics with very low TD risk (e.g., Clozapine in selected cases). The choice should balance mental health stability with TD control.
Her doctors may also be able to appeal the Valbenazine denial again, providing more detailed documentation of how the condition affects her daily function, social interactions, and ability to eat and speak, as this can sometimes change the outcome.
I hope this helps.
Kindly follow up if you have more concerns.
Thank you.
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Answered byDr. Awadhesh P Singh Solanki
Medically reviewed byiCliniq medical review team
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