Tardive Dyskinesia and Ziprasidone

Mr. A was a 49-year-old man with bipolar disorder type I who suffered from continued mild to moderate chronic bipolar depression. He had been diagnosed with bipolar disorder over 12 years ago and had previously been treated with lithium, lamotrigine, carbamazepine, amitriptyline, desipramine, fluoxetine, paroxetine, citalopram, and oxcarbazepine. Mr. A also had a history of long-term treatment with traditional antipsychotics. During a 20-year period of treatment with thiothixene, Mr. A developed mild tardive dyskinesia. These symptoms disappeared when treatment was terminated and did not recur when he started to take risperidone. Mr. A took risperidone for 2 years but did not develop tardive dyskinesia.

Mr. A’s medication regimen had been stable for several months and included lithium, clonazepam, ziprasidone, citalopram, and buspirone. Four months after Mr. A started taking ziprasidone, 100 mg/day, he began to experience symptoms of tardive dyskinesia again. Mr. A had seven consistently abnormal ratings of moderate to marked severity on the Abnormal Involuntary Movement Scale (AIMS) (3) over a period of 2 months. He experienced moderate improvement in depression but continued to have symptoms of tardive dyskinesia after 7 months of treatment with ziprasidone.