Antipsychotic medications, while crucial in managing severe psychiatric disorders such as schizophrenia and bipolar disorder, are frequently associated with extrapyramidal symptoms (EPS) and tardive dyskinesia (TD). TD, characterized by repetitive, involuntary movements, especially of the face and limbs, poses a substantial clinical challenge due to its often irreversible nature. Conventional management strategies, including dose reduction and switching to atypical antipsychotics, frequently offer limited success, prompting exploration of alternative therapies. This case report highlights the effectiveness of vitamin E, a potent antioxidant, in treating a 28-year-old male with severe antipsychotic-induced EPS and TD, unresponsive to traditional therapies. The patient, who had been receiving paliperidone injections as part of his psychotic disorder treatment regimen, developed marked EPS, including muscle rigidity, a parkinsonian gait, significant motor disturbances as well as tardive dyskinesia. Despite discontinuation of paliperidone and initiation of procyclidine, propranolol, clonazepam, and omega-3 supplements, his symptoms persisted. Introduction of oral vitamin E at 400 IU daily led to a dramatic improvement, with an 80% reduction in EPS and TD symptoms within weeks. The patient's Abnormal Involuntary Movement Scale (AIMS) score decreased from 24 to 4, and his overall quality of life improved significantly. Gradual increase of vitamin E dosage to 1200 IU daily, coupled with tapering of other medications, eventually led to complete resolution of symptoms, as evidenced by an AIMS score of 0. The patient maintained symptom-free status during follow-up, with no recurrence of psychotic symptoms. This case underscores the potential role of vitamin E as a viable adjunctive treatment for TD, particularly in patients who do not respond adequately to conventional therapies. While the literature presents mixed evidence regarding vitamin E's effectiveness, this case adds to the growing body of research suggesting its benefits, especially when introduced early in the disease course. Further large-scale studies are warranted to establish the most effective treatment protocols and identify patient populations most likely to benefit from vitamin E therapy.
