Electroconvulsive therapy for depression and oral dyskinesia in a patient who developed parkinsonism induced by valbenazine

TL;DR

A 65-year-old woman with depression and oral dyskinesia improved after ECT when valbenazine caused parkinsonism.

Contribution

Demonstrates ECT as a potential treatment for depression and TD in patients intolerant to VMAT2 inhibitors.

Findings

ECT improved depressive symptoms and oral dyskinesia in a patient who developed DIP from valbenazine.

Valbenazine discontinuation was necessary due to DIP, but ECT provided an alternative therapeutic benefit.

This case highlights ECT's potential role in managing TD and depression when VMAT2 inhibitors are ineffective.

Abstract

Tardive dyskinesia (TD) is a movement disorder related to long‐term antipsychotic use and characterized by involuntary repetitive movements that often affect the oral and facial muscles. Although valbenazine, a vesicular monoamine transporter 2 (VMAT2) inhibitor, is an effective treatment of TD, it may induce drug‐induced parkinsonism (DIP) in some patients. Electroconvulsive therapy (ECT) improves depressive symptoms and certain movement disorders; however, its role in managing TD, particularly in patients intolerant to VMAT2 inhibitors because of DIP, remains elusive.

Herein, we describe a 65‐year‐old Japanese woman with a history of major depressive episodes and oral dyskinesia. The patient was treated with valbenazine for oral dyskinesia; however, she developed DIP, requiring valbenazine discontinuation. After the worsening of depression, the patient was hospitalized and underwent 10 sessions of modified ECT, which remarkably helped improving depressive symptoms and oral dyskinesia.

This case suggests that ECT could be a viable treatment option for managing patients with depression and oral dyskinesia who are susceptible of valbenazine‐induced parkinsonism.

Figures