# Treatment Options for Progressive Supranuclear Palsy
PSP is a tauopathy whose course is strongly determined by neurological decline. Although no medication is available that stops the underlying disease, treatments aim to relieve symptoms and maintain functioning for as long as possible. The choice of treatment varies greatly from person to person and from phase to phase of the disease.
Medications for Movement Symptoms
The symptoms of PSP (rigidity, slowness, falling) superficially resemble Parkinson's, but respond poorly to levodopa (the first-line medication for Parkinson's). Nevertheless, the same types of medications are sometimes tried, because they offer some relief in a few cases.
**Levodopa**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Levodopa has been the standard treatment for Parkinson's for decades. In PSP it helps in approximately 20–30% of patients, but usually much less strongly than in Parkinson's itself. The substance ensures that more dopamine (a signaling molecule) becomes available in the brain. In PSP, the effect often diminishes as the disease progresses. Possible side effects include drowsiness, nausea, hallucinations and restlessness. If levodopa helps, it usually provides mild improvement in slowness and rigidity.
**Other Dopaminergic Medications (Dopamine Agonists)**
ResearchediPositive results in clinical studies, not yet standard treatment
Medications that directly activate dopamine receptors (such as bromocriptine or ropinirole) are sometimes tried as a supplement or alternative to levodopa. The evidence for effectiveness in PSP is limited. These medications can cause the same side effects as levodopa, and additionally sometimes impulse control problems (such as gambling, shopping or sexual behavior without normal inhibition).
**Amantadine**
ResearchediPositive results in clinical studies, not yet standard treatment
This antiviral medication also works on dopamine and glutamate (another signaling molecule). In several studies, amantadine showed modest improvement in rigidity and slowness in PSP patients. Side effects are generally mild and include confusion, drowsiness and sometimes fluid retention in legs and ankles.
Medications for Eye Movements and Stiffness
The characteristic fixed gaze and reduced vertical eye movements are one of the hallmarks of PSP. Medications for this are of limited effectiveness, but some are tried.
**Botulinum Toxin (Botox)**
ProveniIncluded in official guidelines, or approved by EMA or FDA
This substance is injected into the muscles around the eyes to prevent oculogyric crisis (involuntary vigorous upward eye movements) and sometimes to keep the eyes more open. The substance blocks the transmission of signals from nerve to muscle, causing the muscle to relax. Side effects are local and minor: sometimes eye dryness or swelling at the injection site. This is a supportive measure, not a cure.
**Anticholinergics (Acetylcholine-Blocking Medications)**
ResearchediPositive results in clinical studies, not yet standard treatment
Several studies suggest that medications that block certain brain signals (anticholinergics, such as benztropine) can provide some relief from rigidity. Use is more widespread in other parkinsonian syndromes. Side effects include dry mouth, constipation, memory problems and dilated pupils.
Medications for Depression and Behavioral Changes
Many PSP patients experience depression, apathy or personality changes. This can be a direct result of brain changes or a reaction to the diagnosis and disability.
**SSRIs (Selective Serotonin Reuptake Inhibitors)**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Antidepressants such as sertraline, citalopram or paroxetine were developed for depression and also work on anxiety and obsessive thoughts. They increase the availability of serotonin. In PSP they are used mainly because depression and anxiety are very common. Side effects can include nausea, sleep problems, sexual dysfunction and, with sudden discontinuation, withdrawal symptoms. Many PSP patients experience some benefit.
**Other Antidepressants**
ResearchediPositive results in clinical studies, not yet standard treatment
Tricyclic antidepressants (such as amitriptyline) or the drug bupropion are sometimes tried when SSRIs do not help. Tricyclic drugs have more anticholinergic side effects (see above). Bupropion works differently and can give some people more energy, but it also increases the risk of insomnia and tremor.
Cognitive and neuropsychiatric symptoms
Cognitive decline is central to PSP and often causes the most suffering. Specific medications for this do not exist, but some are being tried.
**Cholinesterase inhibitor (rivastigmine, donepezil)**
ResearchediPositive results in clinical studies, not yet standard treatment
These drugs increase the availability of acetylcholine in the brain. They are used more in Alzheimer's, but are also sometimes tried in PSP for memory problems. The evidence is weak. Side effects include nausea, diarrhea, and heart rhythm disorders.
Experimental and investigational treatments
Recent studies point to growing interest in immune mechanisms, iron metabolism, and tau treatment.
**Tau-targeted therapies**
ExperimentaliOngoing in study setting, outcome still unknown
PSP is a tauopathy: tau proteins accumulate in the brain. This is an important new area of research. Studies with monoclonal antibodies directed against tau (such as UCB0107, investigated in an ongoing clinical trial) test whether removing tau accumulation can slow disease progression. These drugs are still in clinical trial phases.
**Immunomodulators**
ExperimentaliOngoing in study setting, outcome still unknown
Recent research shows that immune cells and inflammation markers are important in PSP. Investigations into modulating the immune response (for example by counteracting certain inflammatory pathways) are underway, but not yet in widespread clinical use.
**Metabolic and iron-targeted interventions**
ResearchediPositive results in clinical studies, not yet standard treatment
Neuroimaging studies show abnormalities in iron metabolism in the brains of PSP patients. Investigations into iron chelation techniques and metabolic support are ongoing, but are not yet standard.
Supportive measures
Much of daily well-being depends on non-medication care.
**Speech therapy**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Speech and swallowing worsen in PSP. Speech-language pathologists can teach exercise routines that allow communication to remain possible longer and enable safer nutrition. This has no side effects and is part of multidisciplinary care.
**Physiotherapy and occupational therapy**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Specialized training in balance, walking, and daily activities helps reduce fall risk and maintain independence. This is not a cure, but it does extend quality of life.
**Psychological support**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Conversations with psychologists or psychotherapists help cope with the diagnosis, depression, and social isolation. This is part of recognized guidelines.
**Art therapy**
ResearchediPositive results in clinical studies, not yet standard treatment
Ongoing studies (including 2026) investigate whether art therapy contributes to emotional well-being in PSP. Preliminary findings are cautiously positive, but the research is not yet large enough for strong statements.
Treatment of specific problems
**Orthostasis (sudden drop in blood pressure when standing up)**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Many PSP patients have low blood pressure, especially when they stand up. This causes dizziness and falls. Prevention includes standing up slowly, drinking more fluids, and sometimes elastic stockings. Medications such as fludrocortisone or midodrine are prescribed when simple measures do not help.
**Sleep problems**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Insomnia, REM sleep behavior disorder, and sleep apnea are frequent. Sleep hygiene (fixed sleep times, dark bedroom) is the first step. Sleep pills are used cautiously because they can worsen apathy.
Comprehensive approach per phase
**Early phase:**
Diagnosis is central. Medications are optional, depending on symptoms. Supportive therapies (speech-language pathologists, physiotherapy) can begin early. Psychological support helps with processing.
**Middle phase:**
Medications for movement, depression, and sleep are started. Intensive contact with physiotherapy, speech-language pathology, and occupational therapy. Aids (walker, stair lift) are introduced.
**Late phase:**
Focus shifts to comfort, fluid intake, and nutrition (sometimes via feeding tube). Psychotropic medications can be reduced to maintain clarity. Hospital beds, care, and support for caregivers become central.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._