Pharmacotherapy for the treatment of tardive dyskinesia in schizophrenia patients

ABSTRACT

Introduction: Tardive dyskinesia (TD) is an iatrogenic movement disorder most commonly observed in patients with psychotic disorders who are treated with dopamine blocking antipsychotic medications. Treatment options are limited, and recommendations for treatment are based on a relative scarcity of evidence.

Areas covered: After briefly highlighting current mechanistic theories of TD, this review will discuss the evidence for a number of medications of several different classes that have been studied for the treatment of TD since the 1970s with an emphasis on placebo controlled trials when possible. We used a Pubmed search of primary studies, reviews, and metaanalyses on the topic of TD treatment in order to cover this topic.

Expert opinion: Treatment of TD is difficult given limited data and incomplete understanding of the mechanism. Treatment of TD must be evaluated on an individual basis with careful weight given to severity of symptoms. We suggest the use of atypical versus conventional antipsychotics whenever possible and would recommend trials with one or more of a number of additional agents starting with valbenazine.

KEYWORDS:

• Tardive dyskinesia
• schizophrenia
• antipsychotics
• tetrabenazine
• valbenazine

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Corrigendum

Article highlights

• Proposed mechanisms for tardive dyskinesia include post-synaptic dopamine receptor supersensitivity, dysfunctional GABAergic striatal neurons, maladaptive synaptic plasticity, and neurodegeneration of neurotransmitter systems within the motor pathway.

• Tardive dyskinesia treatment cases date back to the 1970s, but there have been a limited number of randomized controlled trials evaluating treatments.

• Tardive dyskinesia treatment guidelines are not always in agreement as interpretations of the limited data vary.

• Atypical antipsychotics are associated with a lower risk for causing tardive dyskinesia compared to conventional antipsychotics.

• The first treatment for TD was approved by the FDA in April, 2017.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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Funding

This paper was not funded.