Tardive Dyskinesia & Women

By 1957, symptoms that would eventually be identified as tardive dyskinesia began to appear in psychiatric patients who had been treated with drugs known variously as anti-psychotics, neuroleptics and/or dopamine antagonists. The latter term refers to the medication's mechanism; such prescriptions interfere with dopamine receptors on the cells associated with emotion and lower cognitive function; unfortunately, they appear to interfere with those receptors involved in voluntary muscle function as well.

These drugs, developed in France in the late 1940s while researchers were working on a "non-narcotic" sedative, were first introduced in the United States in 1954 by Smith, Kline & French (today known as GlaxoSmithKline) under the brand name Thorazine.

Those early drugs are today known as "typical," or first-generation medication. Although new drugs were developed to take their place ("atypical" or second-generation), older drugs continue to be used widely. Furthermore, the second-generation atypical drugs are not necessarily an improvement; the side-effects associated with tardive dyskinesia have not been eliminated, although they do take longer to appear.

Predisposition to Tardive Dyskinesia

Approximately 30 percent of patients medicated with neuroleptics will develop symptoms of tardive dyskinesia. Unfortunately, there has been relatively little research done in this area, and results of some of this research seems to raise more questions than answers.

A case in point is gender. It has long been thought that women - particularly those whose treatment with neuroleptic drugs was started at a later age - faced a particularly serious risk of developing tardive dyskinesia. However, recent studies are beginning to raise questions about this assumption.

It's About Age

A European study published in 1999, it was found that women treated with antipsychotics had a lower risk of developing symptoms of tardive dyskinesia when all other factors such as age, symptoms of severity and previous exposure to neuroleptics were eliminated. When it came to younger people, men actually developed tardive dyskinesia symptoms at a higher rate than women.

What does this mean? Why have we been told for the past several years that women face a higher risk of developing tardive dyskinesia if such research has indicated otherwise?

An Italian study, along with simple demographic data, holds the clue here. The Italian study, dating from the late 1980s, showed that psychiatric patients over the age of 55 were over twice as likely to develop symptoms as those younger than 55 - most commonly in the muscles of the face and in the extremities.

It is generally accepted among medical researchers throughout the world that elderly psychiatric patients are at highest risk for developing tardive dyskinesia, and several research studies bear out this fact. It is also a fact that human males die off at a faster rate than females. Although male children slightly outnumber females, this begins to change during the third decade of life. By age 50, there are nine women for every 8.5 men; this trend continues up into the 80, by which time women outnumber men by three to two.

Given this statistic, it is understandable how figures can be skewed. The bottom line: women are not necessarily more susceptible to tardive dyskinesia; they simply live longer.

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