What to Know About Tardive Dyskinesia and COVID-19

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Tardive dyskinesia is a disabling side effect of medications most often used to treat mental health disorders. It causes involuntary and repetitive movements, usually in the tongue and face. People living with mental health conditions and associated complications like tardive dyskinesia may wonder how a COVID-19 infection might affect them differently than others.

This article will discuss the risks and complications of COVID-19 in people with tardive dyskinesia, the pandemic's effect on the diagnosis of tardive dyskinesia, and other considerations, including concerns about vaccination.

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Tardive Dyskinesia and COVID-19 Risk

Many people with chronic health conditions and those who take certain medications are concerned about how COVID-19 will affect them.

According to the Centers for Disease Control and Prevention (CDC), certain groups of people are more vulnerable to the effects of COVID-19, including people over the age of 65, and people with certain health conditions, including:

Currently, research does not suggest that having tardive dyskinesia increases a person's risk of contracting COVID-19 or becoming severely ill from the disease. However, people with mental health disorders and those who require treatment with certain medications might be at risk of becoming very sick from COVID-19.

It is common for people with mental health disorders to have other medical problems, especially substance use disorder, that can put them at risk for severe COVID-19 infection.

An analysis of more than 40,000 patients with mental health disorders showed an association between the presence of any mental illness and an increased likelihood of needing hospitalization or dying from COVID-19. This association was found in people who take antidepressants and antipsychotic medications.

Tardive dyskinesia is a reaction to medication, and it most commonly develops after taking certain antipsychotics. Therefore, people who develop tardive dyskinesia from taking these medications may have an increased risk of needing hospitalization for or dying from COVID-19.

Experts are not yet sure why certain medications increase the likelihood of hospitalization or death from COVID-19. However, some contributing factors include:

  • Comorbid (co-occurring) health conditions, like substance use disorder
  • Reduced access to mental health care during the pandemic
  • Changes in the immune system associated with certain conditions and medications

Vaccines Are Highly Recommended

Research is ongoing, but in the meantime, experts highly recommend the COVID-19 vaccine for people with mental health disorders and for those who use antipsychotics, antidepressants, and antianxiety medicine.

Complications of Tardive Dyskinesia and COVID-19

Patients with tardive dyskinesia have the same likelihood as the general population of experiencing complications or long-hauler syndrome after infection with COVID-19. There are no reports of complications specifically associated with having tardive dyskinesia and COVID-19.

Experts are glad to find that COVID-19 infection does not often lead to new-onset or worsening movement disorders like tardive dyskinesia.

After reviewing 200 papers in the literature that describe COVID-19 complications from the start of the pandemic to January 2021, experts indicated that the prevalence of new movement disorders was very low in hospitalized and mild COVID-19 cases.

The most common movement disorder cases included myoclonus (muscle jerks), ataxia (problems with coordination and balance), action or postural tremor (tremor with movement or by maintaining a special posture), and rigid akinetic syndrome (slow movement and muscle stiffness). There were no new cases of tardive dyskinesia.

1918 Influenza Pandemic to Now

Encephalitis (an infection or inflammation of the brain) was associated with the 1918 influenza pandemic, and it led to many movement disorders. In contrast to the experience from the 1918 influenza, there are very few movement disorders associated with COVID-19.

Despite this, the change in living and social situations during the COVID-19 pandemic has led to a delay in diagnosing and treating tardive dyskinesia in at-risk people.

Tardive dyskinesia is characterized by uncontrollable, abnormal, and repetitive movements of the extremities and torso, but the reaction particularly affects movements of the tongue and face. The inability to evaluate people either in person or when they are wearing face masks decreases the ability of clinicians to read facial expressions and appropriately diagnose tardive dyskinesia.

Tardive Dyskinesia Treatments and COVID-19

Treating tardive dyskinesia often means changing the dose of the medication or switching to an entirely new medication. A person should only make these types of changes in consultation with their prescribing healthcare provider. 

Classically, the medications used to treat chronic tardive dyskinesia include:

  • Klonopin (clonazepam)
  • Gocovri (amantadine)
  • Ginkgo biloba

However, two new medications have been approved by the Food and Drug Administration (FDA) for the treatment of tardive dyskinesia:

  • Ingrezza (valbenazine)
  • Austedo (deutetrabenazine)

Each treatment for tardive dyskinesia has been evaluated separately for complications related to COVID-19.

Clonazepam

Clonazepam, in the benzodiazepine class, is a sedative that treats anxiety and agitation associated with tardive dyskinesia. At higher doses, this medication can make people sleepy.

Observational studies have previously shown an increased risk of pneumonia in people who take benzodiazepines. Additionally, experts have raised concerns about respiratory impairment in people with COVID-19 who take benzodiazepines. But currently, there is no clear evidence that the use of clonazepam leads to complications related to COVID-19.

Amantadine

Amantadine is a medicine often used to treat Parkinson’s disease, but it is also used to treat movement problems associated with tardive dyskinesia. It is also an antiviral that prevents the flu.

Previous studies have indicated that amantadine is effective against severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1). Therefore, scientists have devised a clinical study of amantadine for the COVID-19 virus, SARS-CoV-2. The study began in May 2021, and it's estimated to be completed in the first half of 2022.

There are not any documented risks of taking amantadine for tardive dyskinesia if a person has COVID-19.

Gingko Biloba

The American Academy of Neurology recommends using ginkgo biloba, an herb rich in antioxidants, to help treat tardive dyskinesia in people hospitalized with schizophrenia, a chronic brain disorder associated with delusion, hallucinations, and disorganized speech and thinking processes. The herbal therapy has not been studied in other populations.

Some experts think that ginkgo biloba could provide anti-inflammatory and immune system modulation in patients with influenza and COVID-19. The leaves of ginkgo biloba contain a protein that might inhibit SARS-CoV-2 activity.

However, clinical studies have not been conducted on the use of ginkgo biloba in people with COVID-19, so it cannot be recommended as an effective treatment. There are not any documented risks of taking ginkgo biloba for tardive dyskinesia if a person has COVID-19.

Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors

Valbenazine and deutetrabenazine are part of a class of medications called vesicular monoamine transporter 2 (VMAT2) inhibitors. Both medicines were approved by the FDA in 2017 to treat tardive dyskinesia.

Tetrabenazine is in the same class of medication and is used off-label to treat tardive dyskinesia.

There is no clear evidence that using this class of medication leads to complications related to COVID-19.

How to Stay Safe

The best way to protect yourself and others is to get vaccinated for COVID-19.

People with tardive dyskinesia should stay in touch with their healthcare providers and monitor their symptoms. They should continue taking prescribed medication and discuss any changes with their prescribing provider.

Other ways to prevent infection from COVID-19 include:

  • Wearing a mask
  • Social distancing (staying 6 feet away from other people)
  • Avoiding crowds and poorly ventilated spaces
  • Washing your hands regularly
  • Covering coughs and sneezes
  • Cleaning and disinfecting surfaces
  • Monitoring for symptoms of COVID-19 such as fever, cough, shortness of breath, and body aches

A Word From Verywell

At the beginning of the COVID-19 pandemic, risk factors were still unknown. It is now known that having tardive dyskinesia does not put you at greater risk for COVID-19 infection or complications from the virus. However, if you have tardive dyskinesia, you likely have a mental health disorder that you treat with medications that may increase the likelihood of being hospitalized for COVID-19. It's not yet known if this is because of the mental health disorder and medication, or if it's related to other factors, like difficulties in accessing care.

It's essential to get vaccinated for COVID-19 to prevent the spread of the virus. Follow social distancing and hygiene guidelines to prevent contracting the infection. Stay in touch with your healthcare provider to discuss your health risks, new symptoms, and any changes to your medications.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

Frequently Asked Questions

  • How do I know if I have tardive dyskinesia?

    Tardive dyskinesia affects people who have been taking antipsychotic medications for a long time. Talk to your healthcare provider if you take these types of medications and have increased agitation, uncontrollable lip-smacking or facial grimacing, jerking movements of the arms or legs, or slow, twisting movements of the torso or neck.

  • Which medications are most likely to cause tardive dyskinesia?

    Tardive dyskinesia most often develops after long-term use of a class of medicines called antipsychotics or neuroleptics. These medications treat hallucinations, delusions, and disordered thinking. Tardive dyskinesia is more common in people who take first-generation antipsychotics like haloperidol, chlorpromazine, and fluphenazine.

    However, second-generation antipsychotics like clozapine, risperidone, and olanzapine can still cause tardive dyskinesia. Several other medication classes are associated with the disease, but to a lesser extent. Talk to your healthcare provider about your medications and whether they can lead to movement problems.

  • Is there a chance I can develop tardive dyskinesia from vaccination for COVID-19?

    The CDC highly recommends COVID-19 vaccination for all eligible people. The vaccines are safe and effective.

    The public has had concerns about side effects of COVID-19 vaccines, and some of these concerns include neurological disorders. Through July 2021, eight people reported tardive dyskinesia after vaccination with the Pfizer-BioNTech COVID-19 vaccine, four people reported the disease after receiving the Moderna vaccine, and one person reported it after receiving the Johnson & Johnson vaccine. The risk of developing this movement disorder with COVID-19 vaccination is extremely low, and the benefits of vaccination outweigh the risks.

  • Which vaccine should people with tardive dyskinesia receive?

    Public health and government officials recommend that eligible people receive the first vaccination available to them. One brand of vaccine does not pose greater risk to people with mental health disorders or tardive dyskinesia, and the approved vaccines are safe and effective.

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26 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. People with certain medical conditions. Updated August 20, 2021.

  2. Wang QQ, Kaelber DC, Xu R, Volkow ND. COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United StatesMol Psychiatry. 2021;26(1):30-39. doi:10.1038/s41380-020-00880-7

  3. Vai B, Mazza MG, Delli Colli C, et al. Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysisLancet Psychiatry. 2021;8(9):797-812. doi:10.1016/S2215-0366(21)00232-7

  4. National Institute of Neurological Disorders and Stroke. Tardive dyskinesia information page. Updated January 27, 2021.

  5. Geyer HL, Kaufman DM, Parihar RK, Mehler MF. Movement disorders in COVID-19: whither art thou? Tremor Other Hyperkinet Mov. 2020;10:25. doi:10.5334/tohm.553

  6. Brandão PRP, Grippe TC, Pereira DA, Munhoz RP, Cardoso F. New-onset movement disorders associated with COVID-19Tremor Other Hyperkinet Mov. 2021;11:26. doi:10.5334/tohm.595

  7. Laboe C, Jain A, Cardiel Sam H. Masked tardive dyskinesia in the coronavirus disease 2019 eraCureus. 2021;13(8):e16999. doi:10.7759/cureus.16999

  8. Bhidayasiri R, Fahn S, Weiner WJ, Gronseth GS, Sullivan KL, Zesiewicz TA. Evidence-based guideline: treatment of tardive syndromes: report of the guideline development subcommittee of the american academy of neurologyNeurology. 2013;81(5):463-469. doi:10.1212/WNL.0b013e31829d86b6

  9. US Food and Drug Administration. FDA approves first drug to treat tardive dyskinesia. Updated April 11, 2017.

  10. US Food and Drug Administration. Austedo drug information. Updated August 30, 2017.

  11. Sun GQ, Zhang L, Zhang LN, Wu Z, Hu DF. Benzodiazepines or related drugs and risk of pneumonia: A systematic review and meta-analysis.  Int J Geriatr Psychiatry. 2019;34(4):513-521. doi:10.1002/gps.5048

  12. Ostuzzi, G., Papola, D., Gastaldon, C. et al. Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendationsBMC Med. 2020;18(1):215. doi:10.1186/s12916-020-01685-9

  13. Parkinson's Foundation. Amantadine.

  14. Butterworth RF. Potential for the repurposing of adamantane antivirals for COVID-19Drugs R D. 2021;21(3):267-272. doi:10.1007/s40268-021-00351-6

  15. ClinicalTrials.gov. Amantadine for COVID-19 (ACT). Updated May 25, 2021.

  16. Xiong Y, Zhu GH, Wang HN, et al. Discovery of naturally occurring inhibitors against SARS-CoV-2 3CLpro from Ginkgo biloba leaves via large-scale screeningFitoterapia. 2021;152:104909. doi:10.1016/j.fitote.2021.104909

  17. Touma KTB, Scarff JR. Valbenazine and deutetrabenazine for tardive dyskinesiaInnov Clin Neurosci. 2018;15(5-6):13-16.

  18. National Institute of Diabetes and Digestive and Kidney Diseases. Vesicular monoamine transporter 2 (VMAT2) inhibitors. Updated April 2, 2019.

  19. Centers for Disease Control and Prevention. How to protect yourself & others. Updated August 13, 2021.

  20. National Organization for Rare Disorders. Tardive dyskinesia. Updated in 2018.

  21. Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM. Medication-induced tardive dyskinesia: a review and updateOchsner J. 2017;17(2):162-174.

  22. MedlinePlus. Tardive dyskinesia. Updated September 1, 2021.

  23. Centers for Disease Control and Prevention. Safety of COVID-19 vaccines. Updated September 20, 2021.

  24. eHealthMe. Pfizer BioNTech Covid Vaccine and Tardive dyskinesia - a phase IV clinical study of CDC and FDA data. Updated July 21, 2021.

  25. eHealthMe. Moderna COVID Vaccine and Tardive dyskinesia - a phase IV clinical study of CDC and FDA data. Updated July 22, 2021.

  26. eHealthMe. Johnson and Johnson Covid Vaccine and Tardive dyskinesia - a phase IV clinical study of CDC and FDA data. Updated July 23, 2021.