What are the considerations for using Zoloft (sertraline) in patients with a history of tardive dyskinesia?

From the Guidelines

Caution is warranted when prescribing Zoloft (sertraline) in patients with a history of tardive dyskinesia. While SSRIs like sertraline have a lower risk of causing or worsening tardive dyskinesia compared to antipsychotics, they are not entirely risk-free 1. For patients with existing tardive dyskinesia, it is recommended to start sertraline at a low dose (25mg daily) and increase gradually while monitoring closely for worsening of abnormal movements.

Some key considerations when using Zoloft in patients with a history of tardive dyskinesia include:

• Regular assessment using standardized rating scales like the Abnormal Involuntary Movement Scale (AIMS) is recommended every 3-6 months 1.
• If tardive dyskinesia symptoms worsen, consider dose reduction, switching to another antidepressant class like bupropion, or discontinuation of sertraline.
• The mechanism behind SSRI-induced movement disorders is not fully understood but likely involves serotonergic modulation of dopamine pathways.
• Patients should be educated about potential movement-related side effects and instructed to report any new or worsening abnormal movements immediately.
• Concurrent use of other medications that can cause or worsen tardive dyskinesia (such as antipsychotics or metoclopramide) should be avoided when possible to reduce cumulative risk.

Given the potential risks, it is crucial to weigh the benefits of sertraline against the potential risks of worsening tardive dyskinesia and to closely monitor patients for any signs of worsening abnormal movements 1.

From the Research

Considerations for Using Zoloft in Patients with a History of Tardive Dyskinesia

• Zoloft (sertraline) is an antidepressant that may be prescribed to patients with a history of tardive dyskinesia, but there are several considerations to keep in mind.
• Tardive dyskinesia is a side effect of long-term use of antipsychotic drugs, characterized by involuntary movements of the face, tongue, and limbs 2.
• The exact cause of tardive dyskinesia is unknown, but it is thought to be related to increased sensitivity to dopamine in the basal ganglia 2.
• Patients with a history of tardive dyskinesia may be at higher risk of developing the condition again if they are treated with antipsychotic drugs, but the risk of developing tardive dyskinesia with selective serotonin reuptake inhibitors (SSRIs) like Zoloft is not well established.

Risk Factors for Tardive Dyskinesia

• Several risk factors for tardive dyskinesia have been identified, including:
  • Male sex 3
  • Age 3
  • Lack of insight at baseline 3
  • Time on antipsychotics during the follow-up period 3
  • Increase in negative symptoms during the follow-up period 3
  • Alcohol/drug misuse at follow-up 3
• However, the presence of individual risk factors is of little use as a screening test for subsequent clinically relevant tardive dyskinesia 3.

Treatment and Management

• There is no established treatment for tardive dyskinesia, but several approaches have been tried, including discontinuation of antipsychotic drugs, treatment with reserpine, and use of tetrabenazine 4.
• Clinicians should be aware of the risk of tardive dyskinesia and monitor patients for signs of the condition, especially those with a history of antipsychotic use 5.
• Patients with a history of tardive dyskinesia should be informed of the potential risks and benefits of treatment with Zoloft or other medications, and should be closely monitored for signs of the condition 5.