Why has my 67-year-old mother developed tardive dyskinesia?

Question

Hello doctor,

My 67-year-old mother developed tardive dyskinesia after being on Risperidone for four years for her bipolar disorder. The facial movements and tongue protrusion are getting embarrassing for her. She can not eat properly anymore and has lost 15 pounds in the last two months.

Her psychiatrist switched her to Quetiapine, but the tardive dyskinesia symptoms are not improving. She is also going through menopause, and the hot flashes combined with the involuntary movements are making her very depressed. Her estrogen levels are low, and she is asking about hormone replacement therapy.

Will HRT interact with her psychiatric medications? The tardive dyskinesia is affecting her speech, and she is becoming isolated. She worked as a teacher for 30 years and now feels too ashamed to leave the house. What treatments are available for tardive dyskinesia that would not interfere with her mental health medications?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Tardive dyskinesia (TD) after long-term Risperidone use can persist even after switching to a lower-risk drug like Quetiapine, as the brain changes are not always reversible. The mainstay of treatment now is adding a VMAT2 (vesicular monoamine transporter 2) inhibitor such as Valbenazine or Deutetrabenazine, which specifically targets the abnormal dopamine signaling that causes TD. These are generally safe to use alongside mood stabilizers and antipsychotics, though monitoring for sedation or mood changes is important.

For eating and speech problems, speech and swallow therapy can help maintain nutrition and communication. Nutritional support may be needed to prevent further weight loss.

Regarding hormone replacement therapy (HRT), there is no strong evidence of direct interaction with Quetiapine or VMAT2 inhibitors, but HRT (hormone replacement therapy) must be weighed against her cardiovascular and cancer risk factors, and discussed with her gynecologist or endocrinologist. HRT is unlikely to improve TD itself but may help her menopause symptoms and overall mood.

Given the emotional toll, integrating psychological support or therapy is important to reduce isolation and depression. Early use of VMAT2 inhibitors plus supportive therapies gives the best chance of improving quality of life without destabilizing her mental health.

I hope this information will help you.

Kindly follow up if you have any further concerns.

Thank you.