Tardive Dyskinesia - Medications & Duration of Use
Antipsychotic medications, or neuroleptics that inhibit dopamine receptors, had not been in use even five years when the first symptoms of what was eventually identified as tardive dyskinesia began to appear among mental patients that had been treated with such drugs.
A Brief History
In 1883 a chemist in Germany by the name of August Bernthsen was experimenting with a substance called diphenylamine, an antioxidant used to preserve tree fruit, in combination with sulfur. The compound of these two substances was called phenothiazine.
One of the first medical uses of Bernthsen's compound was a derivative, which was called promethazine. European medical researchers in the 1930s studied this compound for its potential not only as an anti-histamine, but as a sedative. It was found to be unsuitable for these uses, as it was only effective in doses high enough to harm the patient. However, French psychiatrists, using it in combination with other substances in attempts to find a "non-narcotic" sedative, had discovered by 1950 that use of this substance actually improved patient behavior as well as cognitive function.
The corporate predecessor to pharmaceutical megalith GlaxoSmithKline began marketing an "improved" version of promethazine in the U.S. in 1954. [3] Known as Chloropromazine (CPZ), it was sold under the brand name Thorazine, and was hailed by the psychiatric community as a more humane alternative to electroshock, insulin shock and even surgical lobotomies that had been standard procedure prior to that time. Mental patients began leaving institutions and taking up useful productive lives - until the symptoms began to appear in the late 1950s and early 1960s.
Although the use of CPZ began to wane in the 1960s, the drugs that took its place were hardly better, producing the same effects: loss of motor control and the development of bodily tics. It was not until the development of "second generation" neuroleptics in the 1970s that the incidence of tardive dyskinesia began to fall.
Unfortunately, most of these second-generation medications continue to produce the same side effects; the only difference is that the symptoms of tardive dyskinesia take longer to appear.
How Long Did You Take the Medication?
Symptoms of tardive dyskinesia appear in roughly 30 percent of all mental patients who have been treated with neuroleptics. Risk factors include gender, age and length of time the patient has been on a given medication; in general, post-menopausal women who have been taking an anti-psychotic medication for six months or longer run the highest risk of developing tardive dyskinesia. However, the disorder is not unknown in patients as young as eighteen. Nonetheless, studies going back to 1982 have confirmed that "all dyskinesias with their first onset within 6 months of ongoing antipsychotic treatment are diagnosed as TD."
Alternatives
Generally, once symptoms of tardive dyskinesia begin to appear, the damage has been done; there is no proven cure, although a number of studies suggest that the use of vitamin E may be helpful in managing symptoms in some patients.
The most effective treatment however is currently prevention. Patients experiencing such symptoms should have their medication switched as soon as these symptoms begin to appear. If the patient is being treated with a "first-generation" medication, this should be replaced with a newer "atypical" medication at the first signs of tardive dyskinesia. In addition, the patient should be given the lowest possible dosage; although such second-generation prescriptions may delay the onset of tardive dyskinesia, they do not prevent it, and may have serious side effects of their own.
© 2010 TardiveDyskinesia.com Last Modified Friday, April 23rd, 2010
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