I thought tardive dyskinesia is permanent?

[joshie]

Hi all, at the moment im having risperdal consta injections. my pdoc organized it so that my GP gives me the injections and i see my pdoc in between the injections. main reason why my pdoc doesnt give it is coz he is fully booked for weeks on end and plus my gp is walking distance from my house while my pdoc is not. so its easier.

now straight to the point. i had my injection yesterday and I asked my gp about "Tardive Dyskinesia". I said that if im on an antipsychotic for a REALLY long time I might get it and that its permanent even once the antipsychotic has been stopped. he said I was wrong and that if that ever happens lowering the dose or stopping it will make it go away.

while my pdoc told me yes it is permanent once it happens. i also had a chat with a pharmacist and she agreed with my GP. so what do you guys think? once you get tardive dyskinesia is it really permanent?

[Velvet Elvis]

Sometimes it is and sometimes it isn't. It can go away over time.

The odds of getting it from an atypical AP are really low though.

[notfred]

It can go away. Depends of how long you were on it and how high the dose. The catch 22 here is that AP's suppress TD so you may not know you have it. Keep in mind that we used to give really big doses of AP's, that was the norm. Lower doses have less chance to causing TD and today we tend to use more moderate to low doses of AP's. As VE said the AAP's are much better in regards to T

nf

[Aurochs]

The catch 22 here is that AP's suppress TD so you may not know you have it.

Wait, what? As far as I know, TD is a treatment-emergent side effect, not a discontinuation effect.

[Guest]

The catch 22 here is that AP's suppress TD so you may not know you have it.

Wait, what? As far as I know, TD is a treatment-emergent side effect, not a discontinuation effect.

Clozapine can suppress it in some people, I can't think of another AP that can off the top of my head though.

[Aurochs]

notfred implied that TD may exist but not be visible until the drug is discontinued. I've never heard of that happening before.

[notfred]

notfred implied that TD may exist but not be visible until the drug is discontinued. I've never heard of that happening before.

The Treatment of Tardive Dyskinesias

The administration of traditional NLs to patients with TD oftenleads to a decrease in the severity of dyskinetic movements; studies inwhich NLs were employed as treatment for TD confirmed theseobservations. Jeste and Wyatt (52) found an average improvement rate of 66.9% in 501 NL-treated patients, while the first APA Task Force Report (55) similarly found that NL treatment produced >50% improvement in 60% of TD patients.

The reduction of TD severity by typical NLs may be movementsuppression rather than a true antidyskinetic effect for the followingreasons. The decrease in TD may be temporary and may be accompanied bya simultaneous increase in parkinsonian symptoms (57).Furthermore, after NL withdrawal, a rebound increase is often observedin proportion to the TD suppression produced by the NL (42).

[Guest]

I had with risperidone very mildly, it went away on it's own.

[wondernut]

what dose are you getting if it is 25mg you are not likely to have that problem at all and yes if it is induced by risperdal consta it can go away

[notfred]

A little info about masking:

Masking TD

• Antiparkinsonism agents usually do not improve neuroleptic-induceddyskinesias. Decreasing the dose of the neuroleptic may increase themovements temporarily. Increasing the dose of the neurolepticdiminishes movements in some patients thus masking the TD.
• Althoughthe neuroleptic dose may temporarily diminish the disorder, regularincrements are needed to achieve apparent beneficial effects. Over along-term period, maintaining and increasing doses of neuroleptics tomask TD may be ineffective. However, situations may exist in whichmasking of TD by continuing and escalating neuroleptic doses may bejustified. Benefits and risks must be weighed. Neuroleptic-induced TDsare absent during sleep.

[Aurochs]

Nothing in either of those links supports your assertion that withdrawing an antipsychotic can "unmask" symptoms of TD that didn't exist before. Instead, they describe how increasing the dose of the offending drug can temporarily reduce symptoms that already exist. In fact, from your emedicine link:

Distinguish TD from acute dystonic reactions induced by medications and from neuroleptic withdrawal dyskinesias. Unlike TDs, withdrawal dyskinesias remit within a month of discontinuing neuroleptics.

[notfred]

I watched this unmasking happen quite often to a friend who had TD. This was in the 1970's-80's where "drug holidays" were popular. The AP Missy was on controlled the TD pretty well but once it was removed all hell broke loose wrt TD symptoms.

nf

[notfred]

There is quite a bit of information using the search terms "unmasking TD" here is an example:

ü SUBTYPES

o Transient TD – brief, limited only during treatment

o Withdrawal Emergent TD – described in pediatrics following discontinuation! Common for TD to appear after a reduction in dose or switch to less potent AP. Called “unmasking”. Withdrawal TD normally resolves within several weeks.

Unmasking TD

[Aurochs]

I watched this unmasking happen quite often to a friend who had TD. This was in the 1970's-80's where "drug holidays" were popular. The AP Missy was on controlled the TD pretty well but once it was removed all hell broke loose wrt TD symptoms.

Anecdata doesn't count for much of anything with me, especially when it's not even a very good case description. I have no idea what happened except that symptoms got worse when the AP was withdrawn (which, BTW, implies they were there before). And since it happened over 20 years ago, I can't really trust anyone's recollection.

Unmasking TD

This blog appears to be a collection of unsourced notes, which is hardly convincing.

[notfred]

Feel free to do a search on the terms "unmasking tardive dyskinesia". There is a lot of info out there. Apparently AD's can also unmask TD.

nf

[Aurochs]

What you're already presented me through Internet searching is enough to tell me that there's no reason to bother.

[notfred]

Ok, I'll give a better reference:

NIH

Covert TD refers to existing tardive dyskinesia that is unmasked when neuro-

leptic drug treatment is reduced or discontinued.

nf

[Aurochs]

That one was actually somewhat convincing, though it didn't really give a whole lot of information on the subject. I might start looking for case reports of this now. I have specific doubts about how this can be termed "tardive" if symptoms are clearly related to withdrawal of a drug. One wouldn't call SSRI discontinuation syndromes "tardive" even though they don't show up unless the patient has been on the drug for several months.

[Russ]

That one was actually somewhat convincing, though it didn't really give a whole lot of information on the subject. I might start looking for case reports of this now. I have specific doubts about how this can be termed "tardive" if symptoms are clearly related to withdrawal of a drug. One wouldn't call SSRI discontinuation syndromes "tardive" even though they don't show up unless the patient has been on the drug for several months.

It's sometimes referred to as Withdrawal Emergent Dyskinesia. Same symptoms as tardive, just happens after the patient reduces dosage or withdraws from the drug completely. Semantics aside, it's a real condition, look it up.