Tardive Dyskinesia: Altering Current Medications to Treat Abnormal Movements

Richard Jackson, MD

Diplomate of the American Board of Psychiatry and Neurology
Adult, Adolescent and Child Psychiatry
Certification in the Subspecialty of Forensic Psychiatry

Associate Clinical Professor of Psychiatry
Wayne State University/Oakland University William Beaumont School of Medicine
Department of Psychiatry 

Assistant Clinical Adjunct Professor of Psychiatry
University of Michigan School of Medicine
Department of Psychiatry

A 66-year-old man with bipolar depression presents with lip smacking, lateral jaw movements, and problems swallowing related to his tongue movements which was evident on exam but only with activation. His mood is stable, and he is currently taking lithium, 300 mg twice a day and lurasidone, 60 mg/d.  

The patient also presents with a hand tremor, which is more severe with intentional movements but is also present at rest. He avoids eating in front of others, increasing isolation. To treat the tremors, the patient’s Lithium was tapered from 900mg/day to 300 mg daily, As a result, the patient decompensated with an increase in depressed mood. Lithium was increased back to 300mg twice a day, with a Lithium level of 0.5.