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Letters to the Editor
March 1998

Marked Reduction of Tardive Dyskinesia With Olanzapine

Arch Gen Psychiatry. 1998;55(3):279-280. doi:

Tardive dyskinesia (TD) is a syndrome of involuntary hyperkinetic abnormal movements that can occur in predisposed individuals during or shortly after the cessation of long-term antipsychotic drug therapy.1 The focus of clinical work with long-term antipsychotic therapy has been to optimize the benefit-to-risk ratio of adverse events, especially TD. The risk of developing TD is believed to increase with total cumulative drug exposure. This risk, on average, is about 5% per treatment year for the first 5 to 7 years,2 decreasing slightly thereafter but reaching a staggering 68% by 20 years.3 The introduction of atypical antipsychotic medications in this decade has demonstrated therapeutic effects for patients with preexisting TD.46 Olanzapine, a new atypical antipsychotic, has recently become available in the United States. It is characterized as a selective monoaminergic antagonist with high-affinity binding to serotonin, dopamine, muscarinic, histamine, and adrenergic receptors.7 The actual risk of TD with olanzapine was examined in the extension phase of study.4 Preliminary results show a significantly lower incidence (one-third to one-fourth lower) of new TD among those patients receiving olanzapine than in those receiving the typical antipsychotic medication, haloperidol decanoate.8

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