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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?