If you've been diagnosed with tardive dyskinesia (TD), a movement disorder that develops weeks, months, or even years after starting a class of medications called dopamine antagonists, your health care team will have to make important decisions about your treatment.
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“First, you need to identify which medication is causing TD,” explains neurologist Hubert Fernandez, MD. “If your doctor determines that you can safely reduce or stop the medication, that's the best course of action. And sometimes that's feasible. If not, your specialist may prescribe a different medication, one that doesn't cause TD.”
In an ideal world, that would be the end of the story. The involuntary movements would stop. But we don't live in an ideal world. Not everyone can safely change or reduce their medication. And even for those who can, sometimes tardive dyskinesia doesn't go away. At that point, it's time to consider other options.
The U.S. Food and Drug Administration (FDA) currently has two medications approved for the treatment of tardive dyskinesia: deutetrabenazine and valbenazine. However, as with any medication for tardive dyskinesia, effectiveness varies from person to person. Some people respond well to the medication, while others may receive only partial or no benefit at all.
But Dr. Fernandez isn't giving up.
“This is when we get creative and think of natural or additional therapies we can use,” he says. He explains the research status of vitamins and supplements as treatments for TD and offers advice for experimenting safely.
Natural Treatments for Tardive Dyskinesia
As with most illnesses, an internet search will bring up a long list of vitamins and supplements that claim to reduce or eliminate the symptoms of TD. But the truth is a bit more complicated.
While the exact cause of tardive dyskinesia remains a mystery, some experts believe that dopamine antagonists intensify the production of free radicals in the brain. Antioxidants such as vitamin B6, vitamin E, and ginkgo biloba scavenge free radicals, preventing cellular damage and protecting against future oxidative stress. If you subscribe to this theory, these three supplements make sense as adjuncts to prescribed TD treatments.
But (there is always a but)…
“The cumulative evidence on these natural therapies is not that impressive,” says Dr. Fernandez. “When you put all the studies together and do a meta-analysis, what ends up happening is that they either have no effect or only a small effect.”
But, Dr. Fernandez is quick to add, “That doesn't mean these treatments don't work for everyone.” Because meta-analyses average across multiple studies, it's likely that the supplements work for some people. And you won't know if you're in that lucky group until you try them.
“The good news is that these natural remedies are generally safe when taken as directed,” he says. “The worst that can happen is that the supplement doesn't work and you've wasted your money, but the best that can happen is that the supplement actually provides the relief you need.”
Of all the natural remedies you find online, which ones are worth trying? According to Dr. Fernandez, the most promising and lowest-risk options are vitamin B6, vitamin E, and ginkgo biloba.
“I wouldn't be opposed to someone using these supplements, because they have little to lose and a lot to gain,” he continues, but he still recommends consulting with a TD specialist before trying any natural treatments, because these supplements can cause drug interactions.
Vitamin B6
Vitamin B6 (pyridoxine) is a water-soluble vitamin that plays a key role in the production and processing of neurotransmitters like serotonin and dopamine. It's also a powerful antioxidant — a double benefit for TD. In fact, a 2008 study of antipsychotic-induced TD found that participants had lower-than-average pyridoxine levels.
People who have access to enough food rarely suffer from vitamin B6 deficiency. Vitamin B6 occurs naturally in many of the foods we eat, and it is often added to foods to boost their nutritional value.
Some case studies and small clinical trials suggest that vitamin B6 may reduce symptoms, and a 2015 meta-review found that patients with schizophrenia and tardive dyskinesia may benefit from high-dose vitamin B6 therapy. However, researchers made it clear that the studies in question were small and poorly conducted, so evidence is still lacking.
So far, studies of high-dose pyridoxine therapy for TD have not reported any serious side effects. However, according to the National Institutes of Health (NIH), taking high doses of B6 over a long period of time can cause a variety of side effects, including nerve damage and even loss of control over body movements. Your healthcare provider can determine a safe dose for you and monitor you for vitamin B6 toxicity.
Vitamin E
Vitamin E is a fat-soluble compound that's packed with antioxidants. Like vitamin B6, most people who have access to nutritious foods get all the vitamin E they need. But people with TD may benefit from taking a supplement. That last sentence is key: there isn't a lot of research on the subject, and what research we have isn't conclusive.
A 2018 meta-analysis found that vitamin E may prevent further deterioration but did not improve symptoms in patients with antipsychotic-induced TD. It also noted that existing studies on the topic are small and poorly designed. Meanwhile, a more recent meta-analysis looked at 18 studies and concluded that vitamin E reduces symptoms.
As with vitamin B6, you should be careful about the dosage when taking vitamin E. A 2018 case report noted that high-dose vitamin E therapy is associated with an increased risk of certain vascular diseases and cancers. Dr. Fernandez recommends asking your healthcare provider about the risks and benefits of vitamin E therapy before adding it to your TD toolkit.
Ginkgo
Ginkgo has been part of Traditional Chinese Medicine (TCM) for thousands of years. Because it has both antioxidant and anti-inflammatory properties, it has long been used as a natural (though controversial) remedy for addressing age-related issues such as cognitive decline, degenerative eye disease, heart health, and cancer prevention.
While the science supporting the use of ginkgo for TD symptoms is consistently positive, the studies themselves leave room for improvement: for example, a 2023 study found ginkgo to be an effective and safe treatment for people with TD and psychotic or mood-related disorders, but the study had only 63 participants.
A 2016 meta-analysis from China found similarly positive results, but the authors analyzed data from only three randomized controlled trials. The researchers stated that more studies are needed before they can be confident that ginkgo is an effective and safe treatment for TD.
Ginkgo is usually safe when taken as directed, but it can have unpleasant side effects. It can also be dangerous if you are pregnant, breastfeeding (breastfeeding), taking blood thinners (anticoagulants), or have blood disorders. Before starting a ginkgo regimen, talk to your TD specialist to make sure it won't affect other medications you're taking.
How to Use Supplements Safely
Vitamin B6, vitamin E, and ginkgo are all theoretically safe, but it's important to remember that product choice matters: supplements are not regulated by the FDA, and almost anyone can manufacture them.
“You rely on the integrity and high standards of the entrepreneurs who are the manufacturers of the natural products that you take,” says Dr. Fernandez. “You don't know if a pill that's advertised as having 100 milligrams (mg) of vitamin B6 actually has 100 milligrams in it. It could have 250 mg, 50 mg, 1,000 mg, or you don't know if it's been adulterated with something else. You have to be very careful.”
This means only buying supplements that have been independently third-party tested — check to see if the product you're considering has a Certificate of Analysis (COA) stating this.
Conclusion
There is no scientific evidence that natural remedies can effectively treat or reduce the symptoms of tardive dyskinesia. The studies that do exist are disappointing. However, some people have benefited from using natural remedies. The lowest risk and most effective options are vitamin B6, vitamin E, and ginkgo biloba.
Before adding these supplements to your daily routine, be sure to consult with your healthcare provider, who will ensure that the amounts you take are safe and that the supplements won't interact with any medications you're already taking.
Remember: supplements aren't regulated by the FDA, so it's best to buy quality products that have been evaluated through third-party testing. You might not see any results at all, but at least you know the product you're putting into your body is safe.
