Progesterone attenuates neuroleptic-induced orofacial dyskinesia via the activity of its metabolite, allopregnanolone, a positive GABA(A) modulating neurosteroid.

GABAergic hypofunction in the basal ganglia is stated as an important mechanism underlying the pathophysiology of tardive dyskinesia. In the present study we sought to establish the protective effect of progesterone in haloperidol-induced orofacial dyskinesia. Besides this we also tried to find out whether the GABA(A) facilitatory action of progesterone metabolites is responsible for the action of progesterone in attenuating the haloperidol-induced orofacial dyskinesia, an animal model of tardive dyskinesia. Chronic administration of haloperidol (1 mg/kg, i.p. 21 days) induced significant increase in hyperkinetic orofacial dyskinetic movements and oxidative damage in the brain as compared to control group. Coadministration of progesterone (5-20 mg/kg, i.p. 21 days) dose dependently prevented the hyperkinetic orofacial movements as well as oxidative damage parameters. The protective activity of progesterone was reversed by pre treatment with finasteride (50 mg/kg i.p.), a 5alpha-reductase inhibitor that blocks the metabolism of progesterone to allopregnanolone and other metabolites. Further, chronic administration of haloperidol resulted in significant decrease in dopamine levels in rat striatum homogenates and increase in catecholamine metabolite levels. Coadministration of progesterone also reversed the decrease in dopamine levels induced by chronic haloperidol treatment, an effect which was again reversed by pre treatment with finasteride. Our study provides strong evidence that the protective effect of progesterone resides in the GABAergic as well as neuroprotective activity of its metabolite allopregnanolone. These findings lend support to recognized GABA hypofunction theory of tardive dyskinesia and strongly suggest progesterone as a protective therapy in this debilitating movement disorder.