More than Skin Deep: Examining the Full Impact of Tardive Dyskinesia

Tardive dyskinesia (TD), which affects over 500,000 people in the United States (US), is an involuntary movement disorder associated with dopamine-receptor antagonists–most commonly antipsychotic drugs. TD is characterized by abnormal, uncontrollable, and repetitive movements that are frequently observed in the orofacial region, but it can also affect the neck, trunk, and extremities, resulting in consequences well beyond physical appearance for most patients. These include profound negative impacts on physical, cognitive, and psychosocial functioning, as well as high rates of nonadherence to antipsychotic therapy and suboptimal outcomes. Because TD is often gradual in onset and cannot be reversed, clinicians who care for patients at risk must be attuned to early signs of TD and understand the full spectrum of its manifestations, potential consequences, and treatment options. Although recognition, assessment, and management of TD have improved since the 2017 FDA approval of two novel vesicular monoamine transporter 2 (VMAT-2) inhibitors (valbenazine and deutetrabenazine) for the treatment of TD, many healthcare providers remain hesitant to use them, whether because they underestimate TD’s devastating impact or do not fully understand the utility and optimal role of approved therapies. Clinicians require an understanding of the full impact of TD and the essential differences between novel VMAT-2 inhibitors to facilitate timely intervention and optimal treatment selection, with the goal of improving TD management and positively impacting patient outcomes and quality of life.