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OF TARDIVE DYSKINESIA
by Walter Lemmo, ND
Vancouver, BC, Canada
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In the September 2001 issue of the American Journal of Psychiatry vitamin B6
(aka. pyridoxine) demonstrated significant benefit for the troublesome movement disorder tardive dyskinesia (TD) 1. For those people unfamiliar with this painful & crippling problem, TD is a neurological problem associated with antipsychotic or neuroleptic medications. Some abnormal movements characteristic of TD include grimacing, sticking out the tongue, smacking and sucking of the lips, and sometimes, rapid movements of the arms and legs. Recent evidence suggests that symptoms may begin as early as one month after beginning medications, affecting more than 1 in four older patients annually 2. The belief is these psychiatric medications cause some sort of change and/or damage to the brain & nervous system. Treatments are poor and involve additional medications (which also have their limitations).
In the B6 study of TD, fifteen patients with schizophrenia who met research criteria for tardive dyskinesia were randomly given treatment with either vitamin B6 or placebo for 4 weeks in a double blind cross over fashion. The patients were given 100mg of B6 daily, increasing weekly in 100 mg increments to a total of 400 mg/day by the fourth week. The study found significant improvements in various movement scores (i.e.
parkinsonism, dystonia, and dyskenetic movement) beginning in the third week (at 300 mg/day). No adverse effects were noted. It is important to mention that B6 in TD is not new. One of the first positive reports of B6 for TD was a small study published in the Journal of Clinical Psychiatry back in 1978 3. Four out of 5 patients improved using 1000-1400 mg/day. Responses were noticed within as little as 1 week of treatment (as compared to 3 weeks in the previous study); the high doses were well tolerated. Why has there been an over 20-year delay with this single vitamin and TD? Supporters of nutritional medicine have reported significant benefit not only with B6, but also with additional nutrients for TD. Kunin demonstrated dramatic results in treating TD with the mineral manganese and vitamin B3 4,5. Hawkins reported the successful prevention of TD in a total of 61,508 patients using vitamins B3, C and B6 6. These findings have yet to be explored in "mainstream" psychiatry journals. Several other nutrients such as vitamin E, lecithin,
tryptophan, & essential fatty acids have also demonstrated benefit in TD. [Note: Recommended dosages of nutrients are listed at the end of this article.]
The findings reported in the American Journal of Psychiatry are long over due for such a devastating problem. Vitamin B6 is readily available, cheap, and safe. Higher doses (>400 mg/day) may have greater advantages for TD, however in such cases I recommend the supervision from a qualified healthcare provider.
Another recent study, reported in the November 2001 issue of the Archives of General Psychiatry, examined using melatonin for TD. The study found significant improvements with 10mg/day in 22 schizophrenic patients using a 6 week double
bind,cross-over design. This study makes sense when considering the improvements noted with
tryptophan, and also when considering the connections between the pineal gland, calcifications & and TD (Archives General Psychiatry 2001;58:1049-52)
Along with B6 and melatonin, additional nutrients should be utilized for TD and also for its prevention. Nutritional medicines demonstrate lower side effect profiles and greater safety margins when compared to standard psychiatric &
neuro-active medications. In addition to supporting neurotransmitter & hormone function, nutritional intervention help protect the body & brain from damaging medications, infections, environmental exposures, and other harmful agents.
Nutrient dosages for treatment of tardive dyskinesia:
All doses are total daily recommendations. It is best to separate in divided doses for all nutrients employed
Preventing TD (Hawkins):
Vitamin B3 (niacin or niacinamide): 3000mg
Vitamin C: 3000mg
Vitamin E: 400IU
Treatment of TD with manganese/B3 (Kunin):
Between 15-60mg Mn-chelate
*begin with low dose (i.e. 5mg tid) and increase accordingly to symptoms
*may aggravate dyskinesia at high doses
*Kunin believes that about 20mg/day can also prevent TD
*Vitamin B3 is used in unresponsive cases (divided doses 500-1500mg/day)
Lecithin (phosphatidylcholine) treatment:
20 grams and greater for general cases
50 grams/day or greater for difficult cases
*extremely safe nutrient
Fairly mainstream vitamin for TD. Doses should not be less than 800IU per day and greater if it is the only nutrient employed (i.e. 1200IU-2000IU)
1. Lerner V et al. Vitamin B(6) in the treatment of tardive dyskinesia: a double-blind, placebo-controlled, crossover study. Am J Psychiatry 2001;158(9):1511-4
2. Jeste, DV et al. Incidence of tardive dyskinesia in early stages of low-dose treatment with typical neuroleptics in older patients. Am J Psychiatry 1999; 156(2):309-311
3. DeVeaugh-Geiss J, Manion L. High-dose pyridoxine in tardive dyskinesia. J Clin Psychiatry 1978;39:575-75
4. Kunin RA. Manganese and niacin in the treatment of drug-induced
dyskinesias. J Orthomolecular Psychiatry 1976;5(1):4-27
5. Hoffer, A. Tardive dyskinesia treated with manganese. CMAJ 1977;117:850
6. Hawkins DR. Successful prevention of tardive dyskinesia. J Orthomolecular Medicine 1989;4(1):35-36
Dr. Walter Lemmo, ND
330-2025 W. 42nd Avenue
Vancouver, BC V6M 2B5
Tel. (604) 788 8858
Fax. (604) 263 6381
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