MARKED IMPROVEMENT OF TREATMENT-RESISTANT TARDIVE DYSKINESIA WITH COMBINED NAD AND GLUTATHIONE INFUSIONS: CASE REPORT

Abstract Background Tardive dyskinesia (TD) is a persistent hyperkinetic movement disorder most commonly associated with prolonged exposure to dopamine receptor antagonists. Although vesicular monoamine transporter 2 (VMAT-2) inhibitors such as valbenazine and deutetrabenazine are first-line pharmacologic options, a subset of patients exhibits inadequate response, necessitating alternative therapeutic approaches. Case presentation We describe a 21-year-old male with bipolar II disorder who developed progressive perioral and lower limb dyskinesia after four years of risperidone and lithium therapy. Symptoms worsened following abrupt risperidone discontinuation and showed no improvement with valbenazine. He was switched to deutetrabenazine XR 48 mg daily and treated with baclofen, trihexyphenidyl, and weekly infusions of nicotinamide adenine dinucleotide (NAD) and glutathione. While mild lower limb dyskinesia persisted, marked improvement in perioral dyskinetic movements and swallowing allowed him to resume an unrestricted diet. Conclusion To the best of our knowledge, this is the first reported case of refractory tardive dyskinesia showing marked improvement with combined NAD and glutathione infusions alongside adjunctive pharmacologic agents. These findings suggest a potential therapeutic role for redox-targeted interventions in treatment-resistant TD and warrant further investigation. Keywords: Tardive dyskinesia, Treatment-resistant tardive dyskinesia, Nicotinamide adenine dinucleotide, NAD+, Glutathione, Oxidative response?