Fourteen patients with TD, all but one also having
tardive akathisia, were evaluated on presynaptically acting
dopamine-depleting drugs,
reserpine, TBZ, and AMT. Initially, the drugs were evaluated individually, but later AMT was used in combination with
reserpine and with TBZ, since their different mechanisms of action allowed for increased potency when they were used in this combination. All but one patient responded to this therapeutic approach.
Parkinsonism was easily induced, however. Most patients varied during the day between mild
parkinsonism and mild
dyskinesia-
akathisia. It was difficult to have patients at the normal level between these two conditions. The addition of
carbidopa/levodopa in one patient not only relieved the side effect of
parkinsonism but may have also accelerated a remission from TD and
akathisia. Although
postural hypotension was a common adverse effect in patients receiving
reserpine, especially in combination with AMT, it did not develop in patients taking TBZ, either alone or in combination with AMT. This observation suggests that TBZ may be less effective depleting monoamines in the periphery than in the central nervous system. Since
reserpine is available commercially in the United States whereas TBZ is not,
reserpine may be the
drug of choice in treating patients with TD or
tardive akathisia. The addition of AMT will increase the potency of this form of treatment.