6 Things to Know About Tardive Dyskinesia

For some people, the use of antipsychotic medication can lead to tardive dyskinesia, a disorder that causes involuntary movements.

Tardive dyskinesia, a drug-induced movement disorder that can cause involuntary lip puckering, tongue movements, frowning, and more, can be a side effect of long-term use of antipsychotic drugs typically prescribed for conditions such as schizophrenia, schizoaffective disorder, and bipolar disorder.

Antipsychotics work in part by blocking dopamine receptors in your brain, but sometimes they have unintended consequences for sensory and motor function.

“By definition, tardive dyskinesia is an iatrogenic disorder, meaning it is due to medications,” says Joseph Jankovic, MD, a professor of neurology and the director of the Parkinson’s Disease Center and Movement Disorders Center at Baylor College of Medicine in Houston. “It doesn’t occur without exposure to these medications.”

Long-term use of first-generation or second-generation antipsychotics can lead to tardive dyskinesia, according to a review article.

First-generation antipsychotic medications pose the greatest risk, with about 30 percent of people who use them developing tardive dyskinesia, compared with 20 percent of people treated with second-generation antipsychotics. A third generation of antipsychotics is now available, but some risk remains, says Dr. Jankovic.

1. Symptoms Often Include Involuntary Mouth Movements

Tardive dyskinesia symptoms can include involuntary mouth movements that resemble chewing, puckering, smacking, or pursing the lips, which can interfere with your ability to speak or chew. Other common symptoms include rapid eye blinking and tongue thrusting.

Tardive dyskinesia can also have sensory symptoms, such as a burning sensation in the mouth, and some women experience vaginal burning, says Jankovic. Young people with tardive dyskinesia may experience tardive dystonia, which are muscle spasms that may cause involuntary head or neck movements, he says.

2. Symptoms May Not Be Obvious At First

“The onset of tardive dyskinesia is often very subtle,” says Jankovic. “It may initially be manifested by just a feeling of restlessness or the need to move the lips, jaw, or tongue.”

But some people have an immediate reaction to antipsychotic drugs, such as sudden, involuntary, or painful jaw or eye movements.

“That may last a few minutes and may spontaneously resolve,” says Jankovic. “But that often is a signal that there’s more trouble to come. If the person is exposed again to these drugs in the future, it may evolve into this persistent, possibly permanent tardive dyskinesia.”

3. Don’t Stop Taking Antipsychotics Without Your Doctor’s Supervision

If you suspect you have tardive dyskinesia, consult the doctor who prescribed your antipsychotic, says Jankovic.

Research suggests that the best screening tool for recognizing and tracking the severity of someone’s tardive dyskinesia is the Abnormal Involuntary Movement Scale.

During this simple exam, your doctor will ask a few questions and observe you while you make a few movements.

If your doctor determines you have tardive dyskinesia, they’ll help you develop a plan, which may include tapering your medication dose.

“The drug should not be stopped suddenly by the patient,” says Jankovic. “It should be done under the supervision of the physician and should be done gradually.”

4. Drugs Called VMAT2 Inhibitors May Help Relieve Tardive Dyskinesia

Stopping the medication — under your doctor’s supervision only! — is typically the first step to curbing the symptoms of tardive dyskinesia, says Jankovic.

Another type of medication, called a vesicular monoamine transporter-2 (VMAT2) inhibitor, can also be prescribed to suppress the involuntary movements. Two such drugs, deutetrabenazine (Austedo) and valbenazine (Ingrezza), have been approved by the U.S. Food and Drug Administration for the treatment of tardive dyskinesia.

5. Tardive Dyskinesia Can Take Months to Years to Subside

Your prognosis with tardive dyskinesia depends on several factors. For one, people who have taken higher doses of antipsychotics or for longer periods tend to have longer-lasting symptoms.

“Almost all patients with tardive dyskinesia have the condition for months or years. And, particularly in elderly women, it may be a persistent, permanent condition,” says Jankovic. “The sooner they bring symptoms to the attention of the physician and gradually discontinue the medication, the greater likelihood that the condition will resolve.”

6. Some People Are More Susceptible to Tardive Dyskinesia Than Others

People with certain risk factors are more likely to develop tardive dyskinesia when taking antipsychotics. According to a review, those risk factors include:

Older age
Being female
An intellectual disability or brain damage
Negative symptoms of schizophrenia
Mood disorders or cognitive symptoms in mood disorders
Certain genetic risk factors
Taking antipsychotics for a longer time
Diabetes
Smoking
Misuse of alcohol or other substances
First-generation antipsychotics
Higher doses of an antipsychotic
Early parkinsonian side effects
Taking anticholinergic drugs in addition to antipsychotics
Certain other movement disorders

Involuntary movements of tardive dyskinesia may be distressing and affect quality of life. But knowing some key facts about the condition, such as the latest treatment options and how to reduce risk factors, can help you take steps to prevent or manage the condition. And by working with your doctor to get regular assessments for tardive dyskinesia symptoms, you can potentially spot problems earlier and address them before they become more difficult to treat.

The Takeaway

Tardive dyskinesia may occur as a side effect of long-term use of antipsychotic drugs and can cause involuntary movements such as lip puckering, tongue movements, and frowning.
Educating yourself about tardive dyskinesia risk factors, symptoms, treatment, and other key facts can help you understand and manage the movement disorder better.