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Tardive Dyskinesia

Illustration

Involuntary muscle tics may be a consequence of long-term “antipsychotic” medication use. According to research or other evidence, the following self-care steps may help ease TD symptoms:

What you need to know

  • Get some extra E
  • Reduce the severity of TD by taking 1,600 IU of vitamin E every day under the supervision of a healthcare practitioner
  • Discover lecithin
  • Improve symptoms by taking 25 grams of this nutritional supplement twice a day, providing 35 grams of phosphatidyl choline per day
  • Mix in manganese
  • Prevent onset by taking 15 mg of manganese a day, or help reverse the condition by taking up to 60 mg per day under a healthcare provider's supervision
  • Manage movement with melatonin
  • With the supervision of a knowledgeable healthcare practitioner, take 10 mg of this natural hormone each night to help reduce abnormal movements

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full tardive dyskinesia article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About tardive dyskinesia

Tardive Dyskinesia (TD) is a condition of abnormal, repetitive, uncontrollable movements that develop after a long-term use of so-called antipsychotic medications used to treat schizophrenia and related psychiatric disorders. The term “tardive” (which means “late”) is used because the condition appears only after long-term use of these drugs, which include chlorpromazine (Thorazine), thioridazine (Mellaril), and trifluoperazine (Stelazine). Dyskinesia means “abnormal movement.”

The uncontrollable movements of TD can interfere greatly with a person’s quality of life. TD may gradually diminish in severity after the medication is discontinued, but all too often the problem is permanent, persisting after withdrawal from the drugs that caused the condition. Conventional treatment for TD is unsatisfactory, so prevention is considered crucial. It is important that people requiring antipsychotic drugs be given the lowest effective dose and that treatment be discontinued as soon as it is feasible.

Product ratings for tardive dyskinesia

Science Ratings Nutritional Supplements Herbs
3Stars

Vitamin E

 
2Stars

Choline

Lecithin

Manganese

Melatonin

 
1Star

Branched-chain amino acids (BCAA)

DMAE

Evening primrose oil

Vitamin B3 (niacin or niacinamide)

Vitamin B6

Vitamin B–complex

Vitamin C

 
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Symptoms of TD include repetitive and involuntary movements (tics), most often of the facial muscles and tongue (such as lip smacking), although any muscle in the body can be affected (e.g., moving legs back and forth). Symptoms may be mild or severe and can interfere with eating and walking.

Medical options

Trihexyphenidyl (Artane, Trihexy) is prescribed to treat tardive dyskinesia.

Electroconvulsive therapy (electrical current applied to the brain) may be administered in severe cases. Healthcare providers may recommend discontinuing the use of antipsychotic drugs if possible.

Vitamins that may be helpful

Vitamin E has been found in a number of studies to reduce the severity of TD. In a double-blind trial, people with TD were randomly assigned to receive vitamin E (800 IU per day for two weeks and 1,600 IU per day thereafter) or a placebo. Vitamin E was significantly more effective than placebo in reducing involuntary movements.1 An uncontrolled study of 20 people with TD reported that 1,600 IU of vitamin E per day may be the optimal amount;2 this large amount should be supervised by a healthcare practitioner. Other studies have also found that vitamin E supplements reduce the severity of TD.3 4 5 Two studies failed to show a beneficial effect of vitamin E.6 7 However, the people in those studies had been receiving neuroleptics for at least ten years, and research has shown that vitamin E is most effective when started within the first five years of neuroleptic treatment.8 9

Choline and lecithin have both been used for people with TD. While some studies have shown a beneficial effect,10 11 12 others have reported variable improvement13 or no improvement.14 In a small, two-week, double-blind trial, people with TD were given 25 grams of lecithin twice a day (providing 35 grams of phosphatidyl choline per day), or a matching placebo. All participants experienced significant improvement of symptoms.15

Dimethylaminoethanol (DMAE) is a natural choline precursor. Although some preliminary data suggested that DMAE could decrease TD symptoms,16 most studies show that DMAE is no more effective than placebo for TD.17

One doctor has found that administering the trace mineral manganese (15 mg per day) can prevent the development of TD and that higher amounts (up to 60 mg per day) can reverse TD that has already developed.18 Other researchers have reported similar improvements with manganese.19 20

Several people have experienced an improvement in TD while taking evening primrose oil (EPO).21 In a double-blind study, however, supplementing with EPO (12 capsules per day) resulted only in a minor, clinically insignificant improvement.22

Preliminary research has linked TD to the inability of the body to metabolize the amino acid phenylalanine. Supplementing with branched-chain amino acids (BCAA), including valine, isoleucine, and leucine, could reduce excess phenylalanine in people with this disorder. In one trial, researchers examined the effects of BCAA supplementation in people with TD (from 150 mg per 2.2 pounds body weight, up to 209 mg per 2.2 pounds body weight) after breakfast and one hour before lunch and dinner for two weeks.23 The BCAA mixture included equal parts valine and isoleucine plus 33% more leucine than either of the other two amino acids. Of nine people treated, six experienced at least a 58% reduction in symptoms, and all nine had a least a 38% decrease.

During a ten-year period, doctors at the North Nassau Mental Health Center in New York treated approximately 11,000 people with schizophrenia with a megavitamin regimen that included vitamin C (up to 4 grams per day), vitamin B3—either as niacin or niacinamide—(up to 4 grams per day), vitamin B6 (up to 800 mg per day), and vitamin E (up to 1,200 IU per day). During that time, not a single new case of TD was seen, even though many of the people were taking neuroleptic drugs.24 Another psychiatrist who routinely used niacinamide, vitamin C, and vitamin B-complex over a 28-year period rarely saw TD develop in her patients.25 Further research is needed to determine which nutrients or combinations of nutrients were most important for preventing TD. The amounts of niacinamide and vitamin B6 used in this research may cause significant side effects and may require monitoring by a doctor.

In a double-blind trial, supplementation with 10 mg of melatonin each night for six weeks reduced abnormal movements by 23.8% in patients with TD, compared with 8.4% in the placebo group, a statistically significant difference.26

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

References:

1. Adler LA, Peselow E, Rotrosen J, et al. Vitamin E treatment of tardive dyskinesia. Am J Psychiatry 1993;150:1405–7.

2. Hashim S, Sajjad A. Vitamin E in the treatment of tardive dyskinesia: a preliminary study over 7 months at different amounts. Int Clin Psychopharmacol 1988;13:147–55.

3. Sajjad SHA. Vitamin E in the treatment of tardive dyskinesia: a preliminary study over 7 months at different doses. Int Clin Psychopahrmacol 1998;13:147–55.

4. Elkashef AM, Ruskin PE, Bacher N, Barrett D. Vitamin E in the treatment of tardive dyskinesia. Am J Psychiatry 990;147:505–6.

5. Lohrr JB, Cadet JL, Lohr MA. Alpha-tocopherol in tardive dyskinesia. Lancet 1987;1:913–4.

6. Shriqui CL, Bradwejn J, Annable L, Jones BD. Vitamin E in the treatment of tardive dyskinesia: a double-blind placebo-controlled study. Am J Psychiatry 1992;149:391–3.

7. Dorevitch A, Kalian M, Shlafman M, Lerner V. Treatment of long-term tardive dyskinesia with vitamin E. Biol Psychiatry 1997;41:114–6.

8. Egan MF, Hyde TH, Albers GW, et al. Treatment of tardive dyskinesia with vitamin E. Am J Psychiatry 1992;149:773–7.

9. Lohr JB, Caligiuri MP. A double-blind placebo-controlled study of vitamin E treatment of tardive dyskinesia. J Clin Psychiatry 1996;57:167–73.

10. Davis KL, Hollister LE, Barchas JD, Berger PA. Choline in tardive dyskinesia and Huntington’s disease: preliminary results from a pilot study. Life Sci 1976;19:1507–15.

11. Gelenberg AJ, Doller-Wojcik JC, Growdon JH. Choline and lecithin in the treatment of tardive dyskinesia: preliminary results from a pilot study. Am J Psychiatry 1979;136:772–6.

12. Growdon JH, Hirsch MJ, Wurtman RJ, Wiener W. Oral choline administration to patients with tardive dyskinesia. N Engl J Med 1977;297:524–7.

13. Nasrallah HA, Dunner FJ, Smith RE, et al. Variable clinical response to choline in tardive dyskinesia. Psychol Med 1984;14:697–700.

14. Anderson BG, Reker D, Ristich M, et al. Lecithin treatment of tardive dyskinesia—a progress report. Psychopharmacol Bull 1982;18:87–8.

15. Jackson IV, Nuttall EA, Perez-Cruet J. Treatment of tardive dyskinesia with lecithin. Am J Psychiatr 1979;136:1458–60.

16. Casey DE, Denney D. Dimethylaminoethanol in tardive dyskinesia. N Engl J Med 1974;291:797 [letter].

17. Soares, KV, McGrath JJ. The treatment of tardive dyskinesia–a systematic review and meta-analysis. Schizophr Res 1999;39:1–16 [review].

18. Kunin RA. Manganese in dyskinesias. Am J Psychiatry 1976;133:105.

19. Norris JP, Sams RE. More on the use of manganese in dyskinesia. Am J Psychiatry 1997;134:1448.

20. Hoffer A. Tardive dyskinesia treated with manganese. Can Med Assoc J 1977;117:859.

21. Vaddadi KS. Essential fatty acids and neuroleptic drug-associated tardive dyskinesia: preliminary clinical observations. IRCS Med Sci 1984;12:678.

22. Vaddadi KS, Courtney P, Gilleard CJ, et al. A double-blind trial of essential fatty acid supplementation in patients with tardive dyskinesia. Psychiatr Res 1989;27:313–23.

23. Richardson MA, Bevans ML, Weber JB, et al. Branched chain amino acids decrease tardive dyskinesia symptoms. Psychopharmacology 1999;143:358–64.

24. Tkacz C. A preventive measure for tardive dyskinesia. J Int Acad Prev Med 1984;8:(5)5–8.

25. Toll N. To the editor. J Orthomolec Psychiatry 1982;11:42.

26. Shamir E, Barak Y, Shalman I, et al. Melatonin treatment for tardive dyskinesia. A double-blind, placebo-controlled, crossover study. Arch Gen Psychiatry 2001;58:1049–52.

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