How to manage tardive dyskinesia in my 68-year-old mother?ge

Question

Hello doctor,

My mother, who is 68 years old, has developed involuntary lip-smacking and grimacing after being on Risperidone for several years for bipolar disorder. Her psychiatrist thinks it is tardive dyskinesia. She is now off Risperidone, but the symptoms persist. Can you tell me?

Is there any chance these movements will improve over time?
Are medications like Valbenazine or Deutetrabenazine effective in elderly women with comorbid hypertension and osteoporosis?
Is this condition progressive even after stopping the offending drug?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Based on your mother's symptoms, she has tardive dyskinesia (TD), which is a well-recognized side effect of long-term use of antipsychotic medications like Risperidone (an atypical antipsychotic), especially in older adults. And the involuntary lip smacking and facial grimacing your mother is experiencing are classic signs.

Unfortunately, even after discontinuing the offending drug, TD can persist, and in some cases, it can become permanent. However, some patients do experience partial improvement over time, especially if the condition is recognized and managed early.

Medications like Valbenazine (a monoamine transporter 2 inhibitor used to treat unnatural muscle movement) and Deutetrabenazine (a drug used to treat movement disorders) are both FDA (Food and Drug Administration)-approved for treating TD and have shown promising efficacy in reducing involuntary movements, including in older adults. Among the elderly, particularly women with comorbidities like hypertension and osteoporosis, these medications can still be used but require careful monitoring because both drugs can potentially affect blood pressure and cause sedation or balance issues. Close supervision is essential to reduce fall risk, especially in individuals with osteoporosis.

The course of TD can vary from case to case. It may stabilize or improve after stopping the antipsychotic, but it can also be progressive or irreversible in others. That is why early intervention with VMAT2 (vesicular monoamine transporter type 2) inhibitors like Valbenazine or Deutetrabenazine, along with regular neurologic follow-up, is important. Physical and occupational therapy may also help your mother to improve function and reduce the impact of symptoms on daily life.

I hope this information helps you.

Feel free to ask further queries.

Thank you.