Tardive dyskinesia is a drug-induced neurological disorder characterized by involuntary movements of the face and body. The condition develops as a side effect of long-term use of antipsychotics and other medications that block dopamine receptors in the brain.
People who develop this movement disorder can’t control facial movements, like tics, lip-smacking, rapid blinking, and tongue thrusting.
There are currently only two medications approved by the Food and Drug Administration (FDA) available to manage tardive dyskinesia, deutetrabenazine (Austedo) and valbenazine (Ingrezza).
While medications can help manage symptoms, many people with tardive dyskinesia are interested in natural therapies as an alternative or complementary approach.
What the Research Says About Non-Traditional Approaches to Tardive Dyskinesia
In light of the limited scientific consensus in this field, we delve into the evidence surrounding a range of nontraditional therapies, such as supplements, vitamins, herbs, and lifestyle adjustments, to evaluate their efficacy and potential risks for treating tardive dyskinesia. It’s always best to consult your healthcare provider before trying a new therapy.
Tardive dyskinesia affects everyone differently and at different levels. “Each person we treat is going to be different, but there are many ways we can go about helping with symptoms,” says Baljit Khamba, a naturopathic doctor and chair of clinical sciences in the School of Naturopathic Medicine at Bastyr University San Diego.
1. Ginkgo Biloba
What It Is The herbal therapy comes from the ginkgo, one of the world’s oldest living tree species, and is often used for anxiety, depression, allergies, dementia, and other health problems. Research has shown “moderate evidence” for using ginkgo biloba extract to treat tardive dyskinesia, reports the American Academy of Neurology
Finding the Facts Containing powerful antioxidants, a meta-analysis of randomized controlled trials found a daily 240-milligram dose of ginkgo biloba extract — prepared from the tree’s fan-shaped leaves — to be an effective, safe option for improving symptoms of tardive dyskinesia in people with schizophrenia. The extract appears to combat the harmful effects of free radicals, which damage cells and are one possible cause of tardive dyskinesia.
One study was conducted on 78 male inpatients with schizophrenia and tardive dyskinesia. Researchers found that taking ginkgo biloba extract may help improve the symptoms of the movement disorder, likely due to ginkgo’s protective and regulatory effects on the nervous system.
Additionally, the study found that the effectiveness of ginkgo biloba extract may depend on the individual’s BDNF (brain-derived neurotrophic factor) genotype. BDNF is a protein that helps support the growth and survival of neurons in the brain, and ginkgo biloba may affect BDNF levels in the blood.
Key Takeaway For most people, ginkgo leaf extract appears to be safe when taken by mouth in moderate amounts, according to the National Center for Complementary and Integrative Health (NCCIH). But because it may cause side effects or interact with some conventional medications, it’s best to first talk with your healthcare practitioner.
2. Vitamin B6 (pyridoxine, pyridoxyl‐5‐phosphate [P5P])
What It Is Some studies have shown that vitamin B6, an essential nutrient for keeping the nervous and immune systems healthy, improves tardive dyskinesia symptoms. But those studies are few, with small sample sizes and short follow-up periods, and some people have developed toxicity with higher doses, even after short exposures.
Finding the Facts National Organization for Tardive Dyskinesia founder Kathleen A. Shea is one. A few hours after her first dose of vitamin B6, P5P, 200 mg, her arms started shaking uncontrollably, and she couldn’t speak or walk normally. She was able to recover fully in about a week. Still, because of Shea’s experience — and after hearing of others who’ve taken months or years to recover after adding vitamin B6 to their treatment — the organization no longer considers the vitamin a suitable supplement.
Meanwhile, a 2022 case report in the peer-reviewed Marshall Journal of Medicine adds to the literature that some patients with tardive dyskinesia won’t respond well to high-dose vitamin B6 therapy. In fact, after following a 66-year-old man with bipolar I disorder who was treated with 1200 mg of vitamin B6 daily, the authors suggested theirs was the first case suggesting an association of high-dose vitamin B6 with depression.
Key Takeaway It’s critical to get guidance when settling on dosage for B6 vitamins, emphasizes Khamba, who says people with tardive dyskinesia may be prescribed between 200 to 300 mg of vitamin B6, P5P, daily. “This is why you’ve got to work with somebody who understands dosing with natural health products,” she says.
3. Vitamin E
What It Is As for vitamin E, the antioxidant has been used to treat tardive dyskinesia because it may help protect against brain-cell damage that can be caused by long-term use of antipsychotic medication.
But “its effect is at best modest, and I usually don’t bother with it,” says Kevin J. Black, MD, a movement disorders neuropsychiatrist at Missouri’s Washington University in St. Louis.
Illustrating his point, Black points to a review of scientific literature suggesting that while small trials of limited quality suggest vitamin E may protect against deterioration of tardive dyskinesia, there’s no evidence it improves symptoms once the condition is established.
Key Takeaway Vitamin E also comes with its own toxicity risks if taken in excessive doses. To be safe, the National Institutes of Health (NIH) recommends a daily dose of up to 1,000 mg for adults (equivalent to 1,100 IUs for synthetic vitamin E and 1500 IUs for natural vitamin E).
4. Branched‐Chain Amino Acids
What It Is Branched‐chain amino acids (BCAAs) can’t be made by the body but are found as a dietary supplement sold primarily in powder form and in protein-rich foods such as meat, dairy, and legumes.
BCAAs were shown to be a successful treatment for men with both tardive dyskinesia and psychiatric disorders in a study published in the American Journal of Psychiatry. The placebo-controlled trial found that the essential amino acids reduced involuntary movements by an average of 36.5 percent.
Key Takeaway Anyone considering BCAAs should know, however, that studies have discovered a strong association between BCAAs, insulin resistance, and the development of type 2 diabetes. Other studies have associated BCAAs with a higher risk of cardiovascular disease.
5. Yi-Gan San (Yokukansan)
What It Is Yokukansan, a traditional Japanese herbal medicine, helps regulate serotonin, dopamine, and other neurotransmitters and is used for a variety of conditions, from irritability in children to aggressiveness, agitation, and hallucinations that come with dementia.
Finding the Facts For those with tardive dyskinesia, one study published in Phytotherapy Research shows a significant improvement in physical symptoms in 22 patients also diagnosed with schizophrenia.
And a research report in Brain Research Bulletin described how yokukansan reduced vacuous chewing motions in rats. Vacuous chewing motions — movements without a purpose — are common in tardive dyskinesia.
Key Takeaway Khamba is a cautious proponent of this type of supplement. “Because it does have an impact on neurotransmitters, you have to be careful when it comes to taking it alongside with other medication since it can potentially worsen tardive dyskinesia — at least until more long-term studies are done.”
6. Melatonin
What It Is As with other natural treatments, there is limited data on how melatonin — a naturally occurring hormone often taken in supplement form to promote sleep — affects tardive dyskinesia.
Finding the Facts But when used with other treatments, melatonin reduced the severity of tardive dyskinesia symptoms, according to a meta-analysis of four randomized controlled trials in 2017. That said, the amount of the reduction was low and, therefore, not clinically significant, summarized the researchers, who called for higher quality and more extensive randomized controlled trials to confirm results.
Melatonin is readily available and affordable, but because dosages range anywhere from 1 mg to 20 mg—and that range can produce very different responses for different people—it’s best to check with a healthcare professional before taking them.
Key Takeaway While the National Center for Complementary Integrative Health (NCCIH) says that short-term use appears to be safe for most people, there isn’t much information on long-term safety. “Melatonin is powerful and can be used not just on its own … but theoretically it can interact with other medications,” says Khamba.
7. Meditation and Mindfulness
What It Is “Like every movement disorder, tardive dyskinesia is worse when someone’s stressed out, so any interventions that help reduce anxiety and worries are likely to provide a modest benefit” in reducing symptoms, says Black.
A person who generally feels calm all day after meditating for a half hour likely would see fewer symptoms that same day, for example.
Finding the Facts A 2021 study published in Neurology International found that four weeks of repeated mindfulness meditation sessions stabilized oral and facial movements in a person with tardive dyskinesia.
In addition to mindfulness, light exercises such as yoga, qigong, and tai chi “bring the body into a calming state” and can relieve symptoms, says Khamba. “The more we engage in relaxation, the better we can help with some of the involuntary movements that come with tardive dyskinesia.”
Key Takeaway Ultimately, while some non-traditional therapies may show potential benefits for managing tardive dyskinesia symptoms, further research is needed to confirm their effectiveness. Individuals should continue to work with their healthcare team to manage their symptoms and consider complementary or alternative treatments if necessary.
Editorial Sources and Fact-Checking
- Zheng W, et al. Extract of Ginkgo Biloba for Tardive Dyskinesia: Meta-Analysis of Randomized Controlled Trials. Pharmacopsychiatry. 2016.
- Menghan LYU, et al. The Therapeutic Effect of Ginkgo Biloba Extract for Male Patients with Tardive Dyskinesia: The Role of Brain-Derived Neurotrophic Factor Genotypes. Chinese Journal of Behavioral Medicine and Brain Science. 2020.
- Ginkgo. National Center for Complementary and Integrative Health.
- Lerner V, et al. Vitamin B6 in the Treatment of Tardive Dyskinesia: A Double-Blind, Placebo-Controlled, Crossover Study. American Journal of Psychiatry. 2001.
- Tardive Dyskinesia: Alternative Treatments. National Organization for Tardive Dyskinesia.
- McCoy M, Schindzielorz A, Holroyd S. Treatment of Tardive Dyskinesia with High-Dose Vitamin B6 Associated with Depression. Marshall Journal of Medicine. 2022
- Soares-Weiser K, Maayan N, Bergman H. Vitamin E for Antipsychotic‐Induced Tardive Dyskinesia. Cochrane Database of Systematic Reviews. 2018.
- Vitamin E. National Institutes of Health, Office of Dietary Supplements.
- Richardson MA, et al. Efficacy of the Branched-Chain Amino Acids in the Treatment of Tardive Dyskinesia in Men. American Journal of Psychiatry. 2003.
- Mizoguchi K, Ikarashi Y. Multiple Psychopharmacological Effects of the Traditional Japanese Kampo Medicine Yokukansan, and the Brain Regions It Affects. Frontiers in Pharmacology. 2017.
- de Claires S, Steenkamp V. Use of Yokukansan (TJ-54) in the Treatment of Neurological Disorders: A Review. Phytotherapy Research. 2010.
- Sekiguchi K, et al. Ameliorative Effect of Yokukansan on Vacuous Chewing Movement in Haloperidol-Induced Rat Tardive Dyskinesia Model and Involvement of Glutamatergic System. Brain Research Bulletin. 2012.
- Sun CH, et al. Adjunctive Melatonin for Tardive Dyskinesia in Patients with Schizophrenia: A Meta-Analysis. Shanghai Archives of Psychiatry. 2017.
- Santoro MA, et al. Improvement of Tardive Dyskinesia during Mindfulness Meditation. Neurology International. 2021.