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Treatment Recommendations for Tardive Dyskinesia
Lucia Ricciardi1, Tamara Pringsheim2, Thomas R E Barnes3
11 Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK.
Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie
|February 23, 2019
Summary
Preventing tardive dyskinesia (TD) is crucial. While antipsychotic withdrawal is ideal, switching to lower-D2 affinity drugs or VMAT inhibitors like deutetrabenazine may help manage TD symptoms when discontinuation isn't possible.
Area of Science:
- Neurology
- Psychiatry
- Pharmacology
Background:
- Tardive dyskinesia (TD) is a movement disorder linked to antipsychotic medication use.
- Characterized by involuntary, repetitive, and choreiform movements.
- Recommendations for TD treatment are needed.
Purpose of the Study:
- To provide evidence-based recommendations for managing tardive dyskinesia.
- To review current treatment strategies and their efficacy.
- To inform clinical practice regarding TD management.
Main Methods:
- Systematic review of studies on tardive dyskinesia treatment.
- Methodological quality assessed using the American Academy of Neurology Risk of Bias Classification.
- Evidence levels and grades of recommendation determined by the Scottish Intercollegiate Guidelines Network framework.
Main Results:
- Prevention of TD is paramount; best practices in antipsychotic prescribing are essential.
- Antipsychotic withdrawal is the primary treatment if clinically feasible.
- Switching to second-generation antipsychotics (e.g., clozapine, quetiapine) or using VMAT inhibitors (deutetrabenazine, valbenazine) may reduce TD symptoms.
Conclusions:
- Limited data exist for TD treatment, emphasizing prevention.
- Long-term safety and efficacy data for deutetrabenazine and valbenazine require further investigation.
- Availability of new treatments like VMAT inhibitors outside the USA is uncertain.
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