A therapeutic approach to tardive dyskinesia

An approach to treating tardive dyskinesia and tardive akathisia was tested in 33 patients. The common denominator was the elimination of antipsychotic drugs. In 7 of 8 patients with mild tardive dyskinesia and no akathisia who were treated by drug abstinence, gradual lessening of tardive dyskinesia occurred. Complete remission was seen after 2-4 years in 5 of these 8. Treatment with reserpine and discontinuance of antipsychotic drugs was useful for patients with severe symptoms of tardive dyskinesia or akathisia; complete remission with elimination of all drugs was achieved in 4 of 19 treated patients, without recurrence of symptoms. Although tetrabenazine masked symptoms in 5 of 7 patients to whom it was administered, none was able to achieve remission of tardive dyskinesia when taken off the drug. Seven of the total 33 patients received a course of levodopa; 2 of these 7 developed recurrence of their underlying psychosis. This agent should be used with caution.