title: Forgotten but not gone: new developments in the understanding and treatment of tardive dyskinesia.
abstract: The broad use of atypical antipsychotics was expected to dramatically reduce the prevalence and incidence of tardive dyskinesia (TD), but data show that TD remains an important challenge due the persistent nature of its symptoms and resistance to numerous treatment modalities, including antipsychotic discontinuation. Recent insights on genetic risk factors and new concepts surrounding pathophysiology have spurred interest in the possibility of targeted treatment for TD. As will be reviewed in this article, the number of evidence-based strategies for TD treatment is small: only clonazepam, amantadine, ginkgo biloba extract, and the vesicular monoamine transporter 2 (VMAT2) inhibitor tetrabenazine have compelling data. Using new insights into the metabolism of tetrabenazine and the properties of its active metabolites, 2 modifications of tetrabenazine have been synthesized to improve the kinetic profile, and are currently involved in double-blind placebo controlled studies aimed at U.S. Food and Drug Administration (FDA) regulatory approval. The possible availability of these new agents, deuterated tetrabenazine and valbenazine, significantly widens the range of treatment choices for patients with TD. For clinicians with patients at risk for TD due to dopamine antagonist exposure, experience has shown that the problem of TD will be an ongoing issue in modern psychiatry, and that an appreciation of new developments in the pathophysiology of, risk factors for, and treatment of TD is crucial to managing this condition.
authors.affiliation: 1Department of Psyshiatry,University of California,San Diego,California,USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Meyer
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000547:Amantadine / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002998:Clonazepam / Q000627:therapeutic use; D015259:Dopamine Agents / Q000627:therapeutic use; D018492:Dopamine Antagonists / Q000009:adverse effects*; D018757:GABA Modulators / Q000627:therapeutic use; D020441:Ginkgo biloba; D006801:Humans; D010936:Plant Extracts / Q000627:therapeutic use; D012307:Risk Factors; D000071057:Tardive Dyskinesia / Q000139:chemically induced* / Q000188:drug therapy; D013747:Tetrabenazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000096983:Ginkgo Extract
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000547:Amantadine; D014150:Antipsychotic Agents; D002998:Clonazepam; D015259:Dopamine Agents; D018492:Dopamine Antagonists; D018757:GABA Modulators; D010936:Plant Extracts; D013747:Tetrabenazine; D014633:Valine; C063170:Ginkgo biloba extract; D000096983:Ginkgo Extract; C000603978:valbenazine; C000609690:deutetrabenazine
keywords: Amantadine; antipsychotic; gingko; tardive dyskinesia; tetrabenazine