Tardive Dyskinesia Prevention - Discontinuing Use of Antipsychotic Drugs

Since the early 1960s, it has been established that tardive dyskinesia (TD), a movement disorder primarily affecting the orofacial muscles, is due to the side effects of dopamine-inhibiting medications used to treat psychoses such as schizophrenia as well as certain gastrointestinal conditions. Tardive dyskinesia symptoms can develop in as little as two or three days after beginning treatment or may not appear until years afterward (even if the medication has been discontinued).

While discontinuing the use of such drugs when symptoms occur may seem to be the best option, it appears that with some patients, tardive dyskinesia symptoms can appear as the result of withdrawal from these drugs. In some cases, complete withdrawal from medication may not be a feasible option.

The First Course of Treatment

For most doctors who notice symptoms of tardive dyskinesia in their patients, discontinuation of medication or reduction in dosage is the first approach. Nonetheless, the difference between symptoms remaining permanent or going away may depend on how long the drug was taken and the amount of the dosage. This is a primary reason that the use of Reglan, a common dopamine inhibitor used for the treatment of acid reflux disease, is not recommended for longer than three months.

Despite research in this area, it remains unclear as to whether or not symptoms of tardive dyskinesia can appear as a manifestation of withdrawal from neuroleptic medications or if they are in fact a delayed result of the side effects of those same medications. Some physicians continue to advise patients not to stop their medication without professional advice as abrupt discontinuation of such therapy may trigger dyskinetic symptoms. This suggests that if discontinuation of the medication is indicated, the patient should be tapered off gradually.

Tardive dyskinesia affects every individual differently, and although virtually all neuroleptic (even the newer "atypical" ones) medications can potentially cause dyskinetic symptoms, each one is different. There is no set solution and patients are advised to proceed cautiously and consult their primary care provider if they feel that discontinuing their medications is the best route to take.