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Forgotten but not gone: new developments in the understanding and treatment of tardive dyskinesia

Published online by Cambridge University Press:  03 January 2017

Jonathan M. Meyer
Jonathan M. Meyer*
Affiliation:
Department of Psyshiatry, University of California, San Diego, California, USA California Department of State Hospitals (DSH), Psychopharmacology Resource Network, Patton, California, USA
*
*Address for correspondence: Jonathan M. Meyer, M.D., UCSD Dept. of Psychiatry, 4225 Executive Square, Suite 1130, La Jolla, CA 92037, USA. (Email: [email protected])
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Abstract

The broad use of atypical antipsychotics was expected to dramatically reduce the prevalence and incidence of tardive dyskinesia (TD), but data show that TD remains an important challenge due the persistent nature of its symptoms and resistance to numerous treatment modalities, including antipsychotic discontinuation. Recent insights on genetic risk factors and new concepts surrounding pathophysiology have spurred interest in the possibility of targeted treatment for TD. As will be reviewed in this article, the number of evidence-based strategies for TD treatment is small: only clonazepam, amantadine, ginkgo biloba extract, and the vesicular monoamine transporter 2 (VMAT2) inhibitor tetrabenazine have compelling data. Using new insights into the metabolism of tetrabenazine and the properties of its active metabolites, 2 modifications of tetrabenazine have been synthesized to improve the kinetic profile, and are currently involved in double-blind placebo controlled studies aimed at U.S. Food and Drug Administration (FDA) regulatory approval. The possible availability of these new agents, deuterated tetrabenazine and valbenazine, significantly widens the range of treatment choices for patients with TD. For clinicians with patients at risk for TD due to dopamine antagonist exposure, experience has shown that the problem of TD will be an ongoing issue in modern psychiatry, and that an appreciation of new developments in the pathophysiology of, risk factors for, and treatment of TD is crucial to managing this condition.

Keywords

Amantadineantipsychoticgingkotardive dyskinesiatetrabenazine
Type
CME Review Article
Information
CNS Spectrums , Volume 21 , Supplement S1: CME SUPPLEMENT , December 2016 , pp. 13 - 24
Copyright
© Cambridge University Press 2016 

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Footnotes

This activity is supported by an unrestricted educational grant from Neurocrine Continental, Inc.

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