Treatment of Tardive Dyskinesia With Donepezil: A Pilot Study
J Clin Psychiatry 2001;62(10):772-775
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Tardive dyskinesia (TD) remains a
significant clinical problem for which there is no uniformly
effective treatment. Earlier trials with acetylcholine precursors
may have been disappointing because of underlying damage to
striatal cholinergic neurons in patients with TD. In contrast,
new cholinesterase inhibitors, developed for the treatment of
dementia, may improve TD by directly increasing cholinergic
Method: We conducted an 8-week open-label trial
of donepezil in the treatment of TD. Ten patients with
schizophrenia or schizoaffective disorder who received stable
doses of antipsychotics and met DSM-IV criteria for TD were
treated with donepezil, 5 to 10 mg/day, for 6 weeks after a
2-week baseline period. Changes in total Abnormal Involuntary
Movement Scale (AIMS) scores measured every 2 weeks were assessed
for significance. Patients were also assessed using the Brief
Psychiatric Rating Scale, the Mini-Mental State Examination, the
Barnes Akathisia Scale, and the Simpson-Angus Scale.
Results: Total AIMS scores decreased
significantly (p = .0009), with no changes in other measures.
Nine patients showed a positive response. Improvement was
greatest in orofacial and upper extremity movements. No
significant interactions were noted between the total AIMS scores
and age (p > .29), duration of TD (p > .38), or duration of
antipsychotic treatment (p > .14).
Conclusion: Donepezil appeared to be effective
in suppressing TD in this pilot study. However,
placebo-controlled, double-blind studies are necessary before
donepezil can be recommended as a treatment for TD.