What Do We Know About Vitamin E in Tardive Dyskinesia Treatment?

Tardive dyskinesia (TD) is a disorder that causes involuntary movements and is often caused by the use of antipsychotic medication such as neuroleptics.¹ Though anyone on these medications is at risk of developing TD, women, older patients, patients of African descent, and patients with diabetes mellitus are among those at an advanced risk.² The effects of TD can have an extremely detrimental effect on a patient’s ability to perform routine physical tasks, negatively affecting their quality of life and mental health.

Treatment of TD can be tricky, as antipsychotics cannot be abruptly stopped.. Patients may need to be weaned off first-generation antipsychotics, which have a higher risk of causing TD, before starting a second generation antipsychotic which appears to have a  lower risk.² There are treatments such as deutetrabenazine and valbenazine, which aim to decrease TD symptom frequency and severity that may benefit patients. However, prevention still remains one of the top recommended strategies for TD.³

In researching tardive dyskinesia treatment and management, one potential option that has received consideration is the use of vitamin E. Vitamin E, which can be found in nuts, seeds, vegetable oils, and leafy green vegetables, offers antioxidant activities and is involved in immune function and certain metabolic processes.⁴ Over the last several decades, a number of studies have been published examining the potential benefits of vitamin E in the treatment and management of TD. What were the findings, and what do we know?

Vitamin E and Tardive Dyskinesia

One of the earlier studies on the potential of vitamin E in treating TD was published in 1999 in the Archives of General Psychiatry, examining the results of a randomized 9-site trial where 158 patients with TD receiving neuroleptic medication received up to 2 years of vitamin E treatment.⁵ The researchers found that while vitamin E was well tolerated by patients and medication adherence was good across treatment groups, they did not find any significant effects from vitamin E compared to a placebo.

Other studies from a similar time, however, were more hopeful about vitamin E’s efficacy. A year earlier, in 1998, a study published in Biological Psychiatry featured 40 patients receiving up to 36 weeks of either vitamin E or a placebo and concluded that vitamin E had positive effects in decreasing a patient’s Abnormal Involuntary Movements Scale (AIMS) score.⁶ However, the researchers also noted that other factors, such as the duration of the patient’s TD, may have also played a role.

Studies have varied in terms of the duration of vitamin E treatment, the dose, and the number of patients in the study. A 2023 study in European Psychiatry found that 1600 IU of vitamin E daily for 90 days had a significant positive effect on patient AIMS scores, with one decreasing as much as 80%; however, only three patients with TD were examined in this study.⁷

In 2024, Cureus published a case report on a 28-year-old man with severe TD induced by antipsychotics who had not responded to traditional TD therapies.⁷ Introducing 400 IU of vitamin E daily led to a significant reduction in symptoms, and the patient’s AIMS score reduced from 24 to 4. The patient’s dosage was gradually increased to 1200 IU of vitamin E, and this, combined with tapering of additional medications, led to his AIMS score decreasing to 0 and a resolution of symptoms.

A 2019 study in the Journal of Canadian Psychiatry focused on the treatment recommendations for tardive dyskinesia claimed that while vitamin E can potentially protect against further deterioration of TD symptoms, the researchers did not find it to cause clinically important improvements in the condition.³

Tardive Dyskinesia Treatment and Management

Overall, these studies do not offer a consensus for vitamin E’s effectiveness in the treatment of TD. Vitamin E’s antioxidant properties make it healthy when taken in daily recommended allowances (15 milligrams in patients 14 or older).⁴ If vitamin E is not showing effectiveness in lessening the tardive dyskinesia symptom burden, what other options are available to patients, and how effective are they?

Patients must know to work with their health care professional to treat or manage TD and to discuss the possibility of ceasing the medication causing the TD. Deutetrabenazine and valbenazine are seen as first-line treatment options, both of which are selective vesicular monoamine transporter 2 inhibitors.⁸ Other treatment options include clonazepam and clozapine.

Ultimately, the best management is taking preventative measures if a patient is at risk of tardive dyskinesia. Smoking cessation and careful management of blood sugar levels can reduce symptom risk, and exercise can not only relieve movement symptoms but is beneficial for patient blood sugar levels as well.² Staying aware of the risk factors and the ways medications and lifestyle factors can affect them are crucial for patients for managing TD, potentially preventing it from starting or, if it does occur, to help improve the patient’s quality of life.

This article originally appeared on Psychiatry Advisor