Finding Treatment Options for Tardive Dyskinesia

Desiree Matthews, PHMNP-BC, shares her personal clinical journey with treating tardive dyskinesia (TD) in her patients as a clinician who does not prescribe typical agents to treat mental health conditions. Psych Congress Network sat down with Matthews at Psych Congress Elevate 2022 in Las Vegas, Nevada, to discuss how her perspective changed when entering the field, how her relationship with anticholinergics shifted, and what treatment options are FDA approved for the treatment of tardive dyskinesia.

For more practical insights directly from the session rooms, visit the Psych Congress Elevate Newsroom. Looking forward to next summer’s meeting? Reserve your spot now for Psych Congress Elevate, taking place in Las Vegas, Nevada from June 1-4, 2023.

>>WATCH: Desiree Mathews discuss Provider Misconceptions About Tardive Dyskinesia HERE and Addressing Antipsychotic Non-Adherence in Tardive Dyskinesia HERE.

Read the transcript:

My approach to treating tardive dyskinesia really changed over time. First, as a provider, I had to recognize that tardive dyskinesia was in my patient population. I came from this education and this era where we had these newer atypical antipsychotics. We weren't really using a lot of the typical agents. The general message to us during school was, "You use the newer agents, you're not going to see tardive dyskinesia." So as a brand new clinician in community mental health, I vowed that I'll only use the second generation antipsychotics, and I won't have to deal with TD. My patients won't experience this.

Unfortunately, very early on in the first couple of months of my practice, certainly I did have people with tardive dyskinesia, and it was a bit hopeless. I really felt hopeless as a provider that I really couldn't address their TD. I had tried a lot of off-label evidence. I even used anticholinergics. And Why? Well, somebody that I trusted in school told me to use it. But unfortunately, I saw that many of these efforts at managing their tardive dyskinesia, even with referring out to neurology and a movement disorder specialist, we were really left kind of with our hands open, our hands out, and saying, "Hey, I'm sorry. But we can't really do anything for your movements." That was a really tough place as a provider because I did see people with TD, and there was nothing that I could really do.

I remember very clearly when there was a press release in an online email or newsletter saying, "The FDA is clearing a treatment for tardive dyskinesia." I actually remember it was the weekend, and I had this particular patient in mind that was really struggling. She wasn't doing her usual activity; she was embarrassed by her movement. She stopped going out shopping, going to church, and even spending time with her grandchildren and her close family because the movements were so embarrassing to her.

I was thinking, "Wow, this is going to be a game changer for a lot of my patients." [That patient] was somebody that happened to get TD from her atypical antipsychotic for adjunctive treatment for a major depressive disorder. This really switched the script that now there is treatment. I really need to be screening. I need to be talking to and educating my patients that there are treatments that we can do something about it and also certainly reconsider really the widespread use of these anticholinergic agents because just from kind of trial and error, I realize that it doesn't work. We know now from the literature and many, many guidelines now that these anticholinergics are not useful for tardive dyskinesia. In fact, they can worsen those dyskinetic movements.

So I really had that journey of the anticholinergics and trying all these different agents, and nothing really worked too. Now, I do have 2 effective treatment options and VMAT2 inhibitors to choose from, and that's certainly something I implement in my practice every day.

Desiree Matthews, PHMNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner. She received her Bachelor's of Nursing from University at Buffalo and her Master's of Nursing at Stony Brook University. She currently resides in Charlotte, NC, and practices at Monarch, a community mental health center providing telepsychiatry services to adult patients. Clinical interests include the treatment of schizophrenia, bipolar disorder, treatment-resistant unipolar depression, and drug-induced movement disorders, including tardive dyskinesia. She has provided faculty expertise and insight into the development of a clinical screener for TD called MIND-TD.