Melatonin treatment for tardive dyskinesia - A double-blind, placebo-controlled, crossover study

Background: Antipsychotics remain the mainstay of drug intervention in the management of schizophrenia. However, long-term treatment with antipsychoti cs is associated with a variety of movement disorders, the most disabling o f which is tardive dyskinesia (TD), which occurs in up to 50% of patients h ospitalized with chronic schizophrenia. The pathophysiology of TD is still unclear and no definite treatment exists. Both dopamine receptor supersensi tivity and oxidative stress-induced neurotoxicity in the nigrostriatal syst em are apparently implicated. The pineal hormone melatonin is a potent anti oxidant and attenuates dopaminergic activity in the striatum and dopamine r elease from the hypothalamus. Thus, it may have a beneficial effect for bot h the treatment and prevention of TD. crossover study, we evaluated the eff icacy of 10 mg/d of melatonin for 6 weeks in 22 patients with schizophrenia and TD. The primary outcome measure was the change from baseline in Abnorm al Involuntary Movement Scale (AIMS) score. Results: The decrease (mean SD) in AIMS score was 2.45 +/- 1.92 for the melatonin and 0.77 +/- 1.11 for th e placebo treatment groups (P < .001). No adverse events or side effects we re noted. Conclusion: This is the first clinical evidence for efficacy of m elatonin in the treatment of TD. Methods: Using a double-blind, placebo-con trolled,