Tardive dyskinesia (TD) is a medical condition that consists of involuntary movements that are repetitive in nature. These movements may include sticking out the tongue, grimacing or making faces, and smacking or licking the lips. Rapid jerking movements or slow and writhing movements of the hands, feet, fingers, and toes may also be present.
TD is a side effect of certain types of medications known as neuroleptics.
They are primarily used as antipsychotics in the treatment of schizophrenia or bipolar disorder. They can also be prescribed for the treatment of various gastrointestinal conditions. Approximately 20% of the people who develop TD suffer serious and detrimental setbacks to their ability to function regularly. Studies have shown that the use of CBD for Tardive Dyskinesia can be a safe and viable alternative treatment.
What is Tardive Dyskinesia?
Patients suffering from tardive dyskinesia (TD) find themselves unconsciously and uncontrollably repeating various movements. These can also be referred to as “tics” in everyday English. These may include:
- Lip smacking, pursing, and/or puckering
- Excessive blinking of the eyes
- Making unusual faces, particularly grimacing
- Moving the tongue around erratically, particularly sticking it in and out of the mouth rapidly
- Rapid movements of the hands, feet, fingers, toes, and torso may also occur
These movements are by their nature jerky and unpredictable, and in severe cases, the patient’s legs may become so unstable that they become unable to walk or move around. TD is sometimes colloquially referred to as the opposite of Parkinson’s Disease. This is because patients with Parkinson’s have difficulty moving and patients with TD have difficulty not moving.
TD may appear on the surface to be a mental illness but it is actually a neurological disorder. Essentially the patient’s nervous system is going haywire and is constantly sending signals to various parts of the body to move erratically and chaotically. In more severe cases the patient may exhibit grunting and difficulty breathing. The development of tics that are almost identical to Tourette’s may also occur. The patient may also find it impossible to sit still and begin to twist and writhe their body around into unusual and even painful positions. In some cases, the condition may become permanent.
What Causes Tardive Dyskinesia?
TD is caused by the prescription of neuroleptic medications. These are primarily known as antipsychotics and were first developed and prescribed in the 1950’s. These early versions of the drug are known as “typical antipsychotics”. They bind to dopamine receptors in the brain to control symptoms of psychosis and delusional disorders. In the 1960’s and 70’s the class of “atypical antipsychotics” were developed. These bind to not only dopamine but serotonin and norepinephrine receptors in the brain. Antipsychotics are used to treat various mental illnesses, including bipolar disorder, schizophrenia, schizoaffective disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). The symptoms of TD generally appear in patients who take the drugs for chronic, and not acute, conditions. If an antipsychotic is taken for a short period of time, the likelihood of developing TD is very low. Furthermore, potent typical antipsychotics appear to cause TD more frequently.
Other drugs may also cause TD, including:
- Metoclopramide, used to treat ulcers and sores in the stomach or throat as well as gastrointestinal disorders in the stomachs of diabetics
- Prochloperazine, used to treat severe nausea and vomiting
- Certain drugs for Parkinson’s
- Drugs used to treat seizures such as phenytoin and phenobarbital
- Certain antidepressants, including trazodone, fluoxetine, and sertraline (though this is fairly rare)
The mechanism by which these various drugs cause TD is poorly understood. It is likely that it is primarily due to hypersensitivity in a dopamine receptor known as D2. There is a portion of the human brain known as the basal ganglia that control motor functions. It is inhibitory, meaning that in its base state it is inhibiting physical movement and motor functions. It requires dopamine to keep it locked in its inhibitory state. When it is unlocked from its inhibitory state, largely via a decrease in dopamine, then motor functions go haywire.
Essentially, TD is a problem of a malfunctioning nervous system sending excessive signals to D2 receptors. This depletes dopamine levels which in turn unlocks the motor cells of the basal ganglia. Furthermore, there are several risk factors which increase the likelihood that a patient may develop TD. These include:
- Being female
- Being a postmenopausal female
- Being elderly
- Being a diabetic
- Suffering from other, related mental disorders
- Genetic factors in some individuals who have naturally hypersensitive D2 receptors
- Cognitive dysfunction, including head trauma, mental retardation, drug or alcohol abuse, or dementia
- Taking antipsychotics for an extended period of time, sometimes as little as three months but generally on the order of several years
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Traditional Treatments For Tardive Dyskinesia
Treatments for TD are fairly limited. One possibility is neuroleptic drug titration. This refers to the process of adjusting the dose of the neuroleptics to maximize benefits and minimize adverse effects. This ensures that the medication still treats the disease while triggering minimal or even no side effects. There is also some research to suggest that high doses of certain vitamins, particularly Vitamin E, may be effective in preventing or treating TD. Certain antioxidants and even melatonin, a hormone that regulates sleep, are also promising treatments.
In more severe cases of TD, however, more potent medications are generally needed. These may include valbenazine, which targets the release of dopamine, tetrabenazine, whose mechanism of action is unknown, and clonidine, which regulates blood pressure. All of these medications have potentially serious side effects, including:
- Fatigue, sedation, and drowsiness
- Low blood pressure
- Dry mouth
- Rare and specific cases of severe depression and suicidal thoughts
It is clear that some of the medications used to treat to TD have simply too many side effects to be tenable treatments for many patients. This is particularly true in patients who are already a vulnerable population as they are suffering from severe psychotic disorders. There has been promising research CBD For Tardive Dyskinesia can be used as treatment without disrupting the underlying function of typical or atypical antipsychotics as well as various other medications that may cause TD. This means that a patient may continue to take their medications without developing the TD that may eventually disrupt their life.