Tardive dyskinesia: review of treatments past, present, and future

The aim of this article is to review the theories purported to explain the pathophysiology of tardive dyskinesia (TD) and the various agents investigated for its treatment. The methods used included a review of studies in English, a Medline search, as well as a check of references listed at the end of the articles was conducted to obtain the relevant studies for review. The results show that vitamin E appears to be a promising agent both for the treatment and prophylaxis of TD. Complete remission has been reported with clozapine, but there is a need for further studies. There are cases reported of benefits with numerous miscellaneous agents, including electroconvulsive therapy, but there are no well-designed, substantiating studies. We conclude that there is no universally effective treatment for TD. Vitamin E is promising both for the treatment and possibly prophylaxis of TD. Clozapine therapy should be considered in patients refractory to traditional antipsychotics who develop TD. Judicious use of antipsychotics and periodic monitoring remain the cornerstone of therapy. None of the atypical antipsychotics (risperidone, olanzapine, clozapine, quetiapine) have been used long enough or adequately studied for their effects on TD.