Can changing my antipsychotic improve my schizophrenia?

Question

Hi doctor,

I have been dealing with schizophrenia for almost 10 years and have been on Risperidone and Clonazepam. For the past few months, I have noticed unusual movements in my lips and tongue, kind of like twitching or smacking involuntarily, which my psychiatrist said might be tardive dyskinesia. I am 38 years old and also perimenopausal, experiencing irregular periods, mood swings, and hot flashes. Could these hormonal changes be making the movements worse?

I am scared that these jerky movements will become permanent or spread to my hands or neck. I read about some new medications like Valbenazine. Are they safe for women, especially with other psychiatric medications? Would switching to another antipsychotic help or worsen it? I am also planning to get my hormone levels checked. Could estrogen imbalance contribute to this? What lifestyle or dietary changes can help reduce the severity of these symptoms?

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I can understand how difficult it is to experience irregular moments, especially on the face. You are right about the diagnosis; this is TD (tardive dyskinesia). TD is caused by long-term use of antipsychotics, especially if they continue for years. Risperidone is making it worse. TD is caused by supersensitivity of dopamine receptors; therefore, even decreasing the dose will temporarily increase the dopamine and these movements. Therefore, careful management is necessary. The best evidence is to switch from Risperidone to Clozapine. Clozapine does not come without side effects. Therefore, Risperidone should be switched to Quetiapine and augmented with Valbenazine. It should be done carefully, not suddenly.

Velbenazine inhibits neurotransmitter storage and can cause sleepiness, dry mouth, depression, and Parkinsonism. It is evidence-based and effective for many people, but keep an eye on the side effects. Stress, such as hormonal changes, does affect TD and make it worse, but they are not the true cause. Most people recover if they switch the antipsychotics and initiate Valbenazine. If you keep taking Risperidone at the same dose, it may deteriorate further and involve other body parts. Stress management will also improve the symptoms, such as hormonal replacement therapy, learning deep breathing or progressive muscle relaxation exercise, evening walk for 30 minutes, taking B6 vitamin, reducing caffeine, nicotine, or other substance abuse. If you have any other questions, please feel free to ask.

I hope this information will help you.

Thanks.