What Is Tardive Dyskinesia?

A side effect of neuroleptic medications

Tardive dyskinesia is a condition characterized by involuntary repetitive movements that usually involve the tongue and face. It can develop as an adverse effect of certain prescription medications, many of which are described as neuroleptics.

The movements of tardive dyskinesia may go away after neuroleptic medications are discontinued or reduced. But sometimes, the condition persists even after the causative medication is stopped. In these situations, prescription medication or interventional procedures can usually alleviate the symptoms of tardive dyskinesia.

Tardive dyskinesia can cause distress in public places
Getty Images / AntonioGuillem

Definition 

Tardive dyskinesia is not a disease. It is a medication side effect. While it is usually noticeable, it can vary in severity.

Tardive dyskinesia is characterized by rapid, recurrent movements such as:

  • Tongue protrusion 
  • Lip smacking 
  • Mouth puckering 
  • Facial grimacing 
  • Excessive bouts of eye blinking
  • Prolonged, tight eye blinking 
  • Writhing movements of the trunk or extremities

Quality of Life 

The movements that occur with tardive dyskinesia are involuntary. You can’t suppress them, and they can occur at any time. You might notice certain times when they are more likely to happen, but they can occur without a predictable pattern.

Some people who are affected by the condition have insight and are aware of its physical effects, while others are unaware or unconcerned about the symptoms. 

Tardive dyskinesia can interfere with a person’s quality of life. The movements can be distracting or may make a person feel self-conscious.

Tardive dyskinesia tends to have a more profound effect on quality of life for people who are experiencing it due to neuroleptic medication treatment for schizophrenia than it does on people who are experiencing it due to neuroleptic treatment of other disorders.

Tardive dyskinesia can cause some people to avoid being around others and can contribute to feelings of anxiety and depression. 

Stigma 

There is often a stigma associated with tardive dyskinesia. People who are aware of the effects may be aware of the stigma and the reaction of others. The stigma of tardive dyskinesia can interfere with socializing, school, maintaining a professional demeanor at work. 

If you are experiencing social or other effects of stigma due to your tardive dyskinesia, be sure to discuss your concerns with your doctor. Medication adjustment or other treatment may help alleviate your symptoms. 

Causes and Risk Factors 

Tardive dyskinesia is a side effect of certain medications that are used to treat psychiatric disorders, nausea, and gastrointestinal disorders. The condition usually develops after chronic use, and it is often dose-dependent (the higher the dose, the more likely it is to occur). But tardive dyskinesia can develop due to neuroleptic use even after very brief duration and with a low dose. 

Medications associated with tardive dyskinesia include:

  • Antipsychotics: Used to treat schizophrenia or schizoaffective disorder, they include ziprasidone, iloperidone, haloperidol, chlorprothixene, thiothixene, loxapine, asenapine, molindone, olanzapine, tiapride, sulpiride, remoxipride, thioridazine, clozapine, fluphenazine, risperidone, paliperidone, perazine, mesoridazine, levosulpiride.
  • Antidepressants and mood stabilizers: Used to treat depression and bipolar disorder, they include amoxapine, lithium, duloxetine, citalopram, quetiapine.
  • Treatment for movement disorders: These include pimozide, aripiprazole.
  • Anti-emetics and medications used for gastrointestinal symptoms: Often used to treat cancer-associated nausea, they include metoclopramide, clebopride, cinnarizine, perphenazine, amisulpride.
  • Medications used for a variety of conditions: Many of these medications have multiple uses, and they include veralipride, droperidol, flunarizine, chlorpromazine, triflupromazine, trifluoperazine, prochlorperazine.

The medications that are associated with tardive dyskinesia alter the body’s response to dopamine, a neurotransmitter. Tardive dyskinesia is associated with alterations in dopamine concentration and alterations in dopamine receptors (proteins that help mediate dopamine’s actions).

Prolonged effects of tardive dyskinesia that persist even after the medication is stopped are believed to be associated with lasting medication-induced changes in the body’s response to dopamine.

Not everyone who uses neuroleptic medications will develop tardive dyskinesia. There are some risk factors that make the side effect more likely.

Risk factors for tardive dyskinesia include:

  • A family history of tardive dyskinesia
  • A pre-existing movement disorder
  • A history of brain damage
  • Age over 50
  • Female, especially post-menopausal

It is important to know that you can develop tardive dyskinesia in response to taking the causative medications even if you don’t have any predisposing risk factors.

Treatment and Prognosis

There are a number of treatment approaches used for managing tardive dyskinesia. Your doctor may change or reduce your medication if that is possible.

As you are undergoing any adjustments in your prescription, you will need to keep track of the symptoms of the primary condition that you are being treated for, as well as changes in your tardive dyskinesia symptoms. 

Often, changing or discontinuing the causative medication relieves tardive dyskinesia. About one-third of people who have tardive dyskinesia experience complete resolution of symptoms within two years after stopping the medication that’s causing it.

But in approximately two-thirds of people, the condition persists even after the causative neuroleptic is stopped. And for many people, adequate control of the primary condition is not possible if the medication that’s causing tardive dyskinesia is stopped or reduced.

In these instances, balancing treatment for the primary condition with management of tardive dyskinesia can be a complicated process that requires careful fine-tuning of the different treatments.

Medications used for treatment for tardive dyskinesia include: 

  • Austedo (deutetrabenazine) is the first and only medication approved to treat both tardive dyskinesia and Huntington's disease chorea.
  • Ingrezza (valbenazine): FDA approved for this indication
  • Xenazine (tetrabenazine): A drug commonly used to control involuntary movements in Huntington’s disease
  • Benzodiazepines or Clozaril (clozapine)
  • Amantadine: A drug usually used in treating Parkinson’s disease

Procedures

Sometimes interventional procedures are used instead of, or in addition to, medications that are used to manage tardive dyskinesia. Interventions include botulinum toxin injection and deep brain stimulation.

Botulinum toxin is an injection that causes paralysis of the targeted muscles so they can't move involuntarily. The effect lasts for several months at a time, often requiring repeat treatment. It could be an option for you if only a few muscles are involved in your involuntary movements.

Deep brain stimulation is a process in which a targeted area of the brain is stimulated with electrical currents to prevent the involuntary movements. This requires surgical implantation of the device that can be controlled externally to achieve optimal stimulation and clinical effects.

A Word From Verywell

Tardive dyskinesia is a possible consequence of certain medications. The condition can be distressing, but it can be controlled for an effective balance between therapeutic treatment of the primary condition and minimal involuntary movements.

If you or your loved one is experiencing tardive dyskinesia as an adverse effect of medication, it is important that you speak with your doctor about it promptly. This is a well-known side effect of neuroleptics, and there are recommended ways of managing it. Timely intervention can give the best chance of effective treatment for tardive dyskinesia.

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