How do VMAT2 Inhibitors treat tardive dyskinesia (TD)?

Tardive Dyskinesia or TD is a movement disorder characterized by incontrollable movements of the hands, feet, face and/or torso.  The condition can develop within days or decades after the initiation of antipsychotic medication but is most closely linked with long-term use of these medicines.  Factors that may increase the risk of developing TD is older age, biological female gender, diabetes and having multiple mental health disorders.  TD can be a permanent condition and can last beyond the time that antipsychotic medication is stopped.  Symptoms of TD do not usually occur until at least 3 months into treatment with antipsychotics.  Even though TD can be irreversible, if you begin to experience any uncontrollable movements, please let your clinician know immediately so that you can be evaluated and potentially treated.

 VMAT2 inhibitors are a fairly new medication used to treat Tardive Dyskinesia or TD.  Antipsychotic medications work with a chemical in the brain called dopamine.  This chemical is thought to be responsible for the delusional thought and hallucinations that persons with psychosis experience.  When medication blocks the dopamine other brain chemicals that are controlled by dopamine become stimulated.  When an antipsychotic medication blocks too much dopamine and the other brain chemicals can cause uncontrollable body movement (Stahl, 2017).

The VMAT2 inhibitors work with dopamine in the brain to help it control the other brain chemicals.  This control over the chemicals stops uncontrollable body movements from occurring.  Two medications that have been approved to treat TD are Ingrezza (valbenazine) and Austedo (deutrabenazine).  These medications work similarly, and both have been shown to cause a significant decrease in body movements in the treatment of TD (Touma & Scarff, 2018). Improvement in AIMS scores have occurred with the use of these medications with scores lowering by 3 points on average.

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