How to treat tardive dyskinesia in a 31-year-old woman?

Question

Hi doctor,

My 31-year-old daughter developed tardive dyskinesia after taking antipsychotics for bipolar disorder and postpartum psychosis two years ago. The involuntary movements in her face and tongue began about six months after stopping the medications and have not improved.

She experiences constant lip-smacking and tongue protrusion, making it difficult to eat and speak. Although her psychiatrist has switched her to different mood stabilizers, the tardive dyskinesia symptoms persist. She has become increasingly self-conscious, avoiding social situations entirely.

The movements worsen with stress or fatigue. A neurologist prescribed some medications, but they interfered with her psychiatric treatment. She still occasionally breastfeeds her toddler and is concerned about the effects of any new medications.

The condition is significantly affecting her ability to work and care for her child. She is asking whether tardive dyskinesia might improve over time or if there are treatment options that would not interfere with her mental health medications.

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

I am really sorry to hear what your daughter is going through. Tardive dyskinesia (TD) can be incredibly frustrating and socially isolating, especially for someone already managing mental health challenges and caring for a young child.

It is not uncommon for TD symptoms to appear after stopping antipsychotics, sometimes even months later, and unfortunately, they can persist. In some cases, symptoms gradually improve over time, but in others, they can become long-term or even permanent, especially if they have been ongoing for this long.

It is also typical for TD to worsen with stress and fatigue. Those are well-known triggers that can amplify the movements.

Treatment of tardive dyskinesia (TD) is challenging, especially in individuals with a psychiatric history such as bipolar disorder.
VMAT2 inhibitors (vesicular monoamine transporter two inhibitors), including Tetrabenazine, Valbenazine, and Deutetrabenazine, can reduce TD symptoms but may lead to mood destabilization or sedation, which is particularly risky in bipolar disorder.
Breastfeeding limits treatment options, as these medications are not well-studied or recommended during lactation.
Multidisciplinary coordination between the psychiatrist and neurologist is essential to maintain mood stability while managing TD symptoms.
If standard options are unsuitable, non-dopaminergic agents such as low-dose Clonazepam (a Benzodiazepine) or Ginkgo biloba (a herbal supplement with modest supporting evidence) may be considered with caution.

A few general suggestions that might help:

Try to minimize stress where possible. It is not easy, but it does make a difference.
Prioritizing good sleep and regular meals can somewhat stabilize symptoms.
Avoid caffeine and other stimulants, which can worsen involuntary movements.
If she is open to it, speech therapy or occupational therapy may help her cope with the functional and social challenges of TD.
Whether the symptoms will entirely go away is hard to predict. Some people do see slow improvement over time, especially if the nervous system is given a chance to stabilize.

However, if symptoms have persisted for over a year with little change, it may be more realistic to focus on symptom management and support.

I would also gently encourage her to continue regular follow-ups with both her psychiatrist and neurologist, ideally at a center where there is collaboration between neuro and psychiatric care.

I hope this answers your query. Feel free to reach out anytime.

Thank you.