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47-Year-Old Woman with Involuntary Jaw Movements

Janice, a 47-year-old patient, has a long-standing depressive mood disorder. Her symptoms include poor sleep quality, inability to concentrate, low self-esteem, and guilt. She admitted recently to experiencing several passive suicidal ideation episodes.

She took duloxetine at 120 mg. daily for 18 months, but with little response. Ziprasidone at a dose of 80 mg. was added, but she developed akathisia, and ziprasidone was discontinued.

Aripiprazole, at 5 mg. a day was added to the duloxetine. Her MDD symptoms improved. Six months later, Janice developed involuntary lateral jaw movements.

Her aripiprazole was discontinued and replaced with buspirone at 15 mg. per day, augmenting the duloxetine. Her tardive dyskinesia symptoms improved, but her depression increased.

The patient was switched to desvenlafexine (200 mg.) monotherapy. She has experienced excellent mood control without a return of tardive dyskinesia symptoms for the past 2 years.

Why is it so critical to be vigilant for patients like Janice?

  • from Neurologist Connect 8 months 3 weeks
    Pt developed TD on antidepressants & antipsychotic meds! Best approach consider Ingrezza or Austedo as soon as symptoms occurs
    At the same time antipsychotic dose can be adjusted!
    Consider new generation psych meds like seroquel etc which has less potential for TD!
  • from Neurologist Connect 9 months
    It is imperative because the symptoms of TD can ultimately be permanent if they are not identified and treatment is changed. I see patients regularly who have relatively debilitating symptoms of TD all because their medications were not changed. Thankfully for Janice, she was able to receive the beat of both worlds. Her TD improved and her depression was well managed with other medications. Close monitoring is key in patients like Janice.
  • 9 months
    Serotonin meds can add to akathesia, especialky at higher doses or in conjunction with Atypical antipsychotics. Women are at higher risk. Should this patient relapse, Wellbutrin, Deplin or l-methylfolate supplementation, might be better options. If an atypical is used, Seroquel XR and Rexulti would have lower akathedia rates than Abilify or Ziprasidone.