What is a commonly used treatment option for tardive dyskinesia when symptoms persist despite dose adjustments?

• A. Switch to dextrose infusion.
• B. Consider VMAT2 inhibitors as a treatment option.
• C. Stop all medications immediately and discharge.
• D. Increase dose to maximum to suppress.

Answer: (B)

When tardive dyskinesia remains despite optimizing the antipsychotic dose, addressing the excess dopaminergic activity at the presynaptic level is a common and effective approach. VMAT2 inhibitors work by blocking vesicular monoamine transporter 2, which reduces the packaging and release of dopamine into the synapse. With less dopamine available to stimulate dopamine receptors, the abnormal, involuntary movements of tardive dyskinesia often diminish. Medications in this class, such as valbenazine and deutetrabenazine, are specifically approved for TD and have demonstrated benefit in reducing symptoms over weeks of treatment. This strategy targets the underlying mechanism more directly than simply titrating the antipsychotic dose, which can be insufficient or even counterproductive if receptor sensitivity has already increased.

Other options listed don’t address the condition effectively. Switching to a dextrose infusion has no role in TD management. Stopping all medications abruptly can lead to psychiatric destabilization and withdrawal effects. Increasing the antipsychotic dose could worsen or precipitate more movement problems, not relieve them.