What are the treatment options for residual Tardive Dyskinesia (TD)?

From the Guidelines

Tardive dyskinesia (TD) treatment should begin with a reversible inhibitor of the vesicular monoamine transporter 2 (VMAT2), as recommended by the American Psychiatric Association (APA) 1. The APA recommends (1B) that patients who have moderate to severe or disabling tardive dyskinesia associated with antipsychotic therapy be treated with a reversible inhibitor of the vesicular monoamine transporter 2 (VMAT2) 1. Some key points to consider when treating TD include:

• The use of VMAT2 inhibitors as first-line treatment, due to their effectiveness in reducing TD symptoms 1
• The importance of individualizing treatment based on symptom severity, comorbidities, and medication tolerability
• The need for regular monitoring using standardized rating scales to track progress
• The potential benefits of non-pharmacological approaches, such as relaxation techniques, as supplementary treatments
• The consideration of switching to antipsychotics with lower TD risk, such as quetiapine, clozapine, or aripiprazole, for patients still taking these medications The APA guideline emphasizes the importance of a comprehensive and person-centered treatment plan, including evidence-based nonpharmacological and pharmacological treatments 1. Key treatment options for TD include:
• VMAT2 inhibitors, such as valbenazine or deutetrabenazine
• Alternative medications, such as clonazepam, amantadine, or ginkgo biloba extract, although these have less robust evidence
• Non-pharmacological approaches, such as relaxation techniques or cognitive-behavioral therapy It is essential to prioritize treatment strategies that reduce morbidity, mortality, and improve quality of life for patients with TD, as emphasized by the APA guideline 1.

From the Research

Treatment Options for Residual Tardive Dyskinesia (TD)

The following treatment options are available for residual Tardive Dyskinesia (TD):

• Valbenazine and deutetrabenazine are FDA-approved medications for the treatment of TD, which are vesicular monoamine transporter 2 (VMAT2) inhibitors 2, 3, 4.
• These medications have been shown to decrease Abnormal Involuntary Movement Scale (AIMS) scores and are well tolerated, with somnolence and akathisia reported as the most common side effects 2, 4.
• Valbenazine has a rapid onset of effect within 2 weeks of treatment initiation and can be administered once daily 3, 5.
• Deutetrabenazine has also been shown to be effective in reducing TD symptoms, with AIMS response rates ranging from 33% to 50% 2, 6.
• Switching from a first-generation to a second-generation antipsychotic with a lower D2 affinity, such as clozapine or quetiapine, may also be effective in reducing TD symptoms 6.
• The first-line management of TD is the withdrawal of antipsychotic medication if clinically feasible, but for many patients with serious mental illness, the discontinuation of antipsychotics is not possible due to disease relapse 6.

Key Considerations

• Clinicians should be aware of the adverse effects of valbenazine and deutetrabenazine, as well as other key differences between the two, in order to individualize treatment 4.
• Using the Abnormal Involuntary Movement Scale (AIMS) can assist clinicians in assessing progress for each patient 4.
• Preventing TD is of primary importance, and clinicians should follow best practice for prescribing antipsychotic medication, including limiting the prescription for specific indications, using the minimum effective dose, and minimizing the duration of therapy 6.