Which class of drugs is approved for tardive dyskinesia and decreases dopamine release?

• A. VMAT2 inhibitors decrease dopamine release and are approved for tardive dyskinesia.
• B. SSRIs increase dopamine release and treat tardive dyskinesia.
• C. Anticholinergics decrease dopamine release.
• D. MAO inhibitors have a role in tardive dyskinesia.

Answer: (A)

Decreasing dopamine release through VMAT2 inhibition is the mechanism behind treatments for tardive dyskinesia. VMAT2 transports dopamine into vesicles for release; blocking this transporter reduces vesicular dopamine, leading to less dopamine available in the synapse and reduced overstimulation of striatal D2 receptors that drive TD movements. FDA-approved VMAT2 inhibitors like valbenazine and deutetrabenazine embody this approach.

Other classes don’t fit because they don’t primarily lower dopamine release. SSRIs boost serotonin and aren’t used for tardive dyskinesia. Anticholinergics mainly affect acetylcholine balance and can help some extrapyramidal symptoms but don’t decrease dopamine release. MAO inhibitors raise monoamines, including dopamine, and aren’t a treatment for TD.