Therapeutic Approaches to Tardive Dyskinesia

This episode outlines all treatment approaches available for tardive dyskinesia and how they are applied in practice. The panel highlights VMAT2 inhibitors, valbenazine and deutetrabenazine, as evidence based options supported by randomized controlled trials with favorable number needed to treat values and long term durability, though symptoms often return after washout. Switching antipsychotics, including using clozapine, is another strategy, particularly when TD is linked to high dose dopamine receptor blockade. The panel stresses that increasing an antipsychotic dose is not an appropriate treatment and may worsen outcomes. They also describe situations where withdrawal dyskinesia occurs during rapid antipsychotic changes, underscoring the need for careful tapering. Real world barriers such as cost, formulary restrictions, and the need for coordinated care lead clinicians to collaborate with neurology and pharmacy teams to evaluate movements, confirm diagnosis, and secure patient assistance for VMAT2 therapy.