How to manage tardive dyskinesia while on antipsychotics?

Question

Hello doctor,

I have been on antipsychotics for about 12 years for bipolar disorder, and around two years ago, I started getting these involuntary movements in my face and tongue that my psychiatrist called tardive dyskinesia. My AIMS score was 11 at my last evaluation.

The thing that makes this so hard is that I absolutely cannot stop my psychiatric medications. The last time I tried, I ended up hospitalized within weeks. So, I feel completely trapped between two awful options.

How does a 45-year-old manage tardive dyskinesia while still needing their psychiatric medications, because nobody seems to have a real answer for me?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Tardive dyskinesia (TD) is a difficult situation for patients.

As I do not have all the information available at the moment, I will provide you with a few options to choose from and discuss with your primary doctor.

If you are using medications other than Quetiapine or Clozapine, they can be shifted to these two, as they have an extremely low propensity for tardive dyskinesia. I would especially recommend Clozapine. It is not only extremely effective but also helps with tardive dyskinesia.

The second option is to add vesicular monoamine transporter 2 (VMAT2) inhibitors, such as Valbenazine or Deutetrabenazine, with your existing antipsychotics. Do not discontinue the antipsychotic drugs abruptly. They cause a relapse of symptoms and worsen tardive dyskinesia.

VMAT2 inhibitors are slow-acting, but they do work. However, they have some side effects, such as depressive symptoms and dry mouth.

If you have any substance abuse, cut down, as this also makes tardive dyskinesia worse. Stress is no different. If you are under constant stress, learning deep breathing or progressive muscle relaxation may help.

To guide better, you can also share a few details with me, such as:

The specific names and amounts of your medications.
Previous medication.
Substance abuse status.
Any concurrent stressors?

I will be able to help you more.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.