Tardive dyskinesia (TD) is a movement disorder that is a serious side effect of some medications, particularly neuroleptic drugs (antipsychotic drugs and tranquilizers). The classic signs of tardive dyskinesia are uncontrollable movements of the face and mouth: facial grimacing, blinking, tongue movements, lip smacking, lip pursing, puffing out the cheeks, and fish lips. These involuntary movements can be random but are often patterned, repetitive, and persistent. Other parts of the body can be affected, too: uncontrollable finger tapping, arm movements, torso movements, leg swinging, and hip swaying. In the worst cases, TD can be seriously debilitating by interfering with people’s ability to eat, drink, write, or take care of themselves. It can also affect the throat by interfering with swallowing and breathing. For most people, tardive dyskinesia does not go away quickly and can last for years or even decades. Unfortunately, TD has no cure, but treatments can help moderate the symptoms.
Tardive dyskinesia is a rare health condition that mostly affects people taking certain types of psychiatric, malaria, and anti-nausea medications.
Early signs of TD include mild involuntary movements, including blinking, facial movements, tongue movements, and sometimes uncontrollable movements in other parts of the body.
Serious symptoms of TD or tardive syndrome may require immediate medical attention. These include a sudden onset of severe movement problems, hyperkinetic movement, fever, fast heartbeat, trouble breathing, eyes frozen in a deviated position, abnormal postural positions, or movement problems that are so severe they may cause injury, damage, or death.
TD is caused by medications, primarily antipsychotics, but other drugs can cause tardive dyskinesia. You may be at risk for developing TD symptoms if you have a mental health condition, are taking medications, are female, past menopause, elderly, or African-American. Other risk factors include diabetes, HIV, substance use, brain injury, and long-term use of drugs called anticholinergics.
TD usually requires a medical diagnosis.
TD generally requires treatment. Tardive dyskinesia symptoms occasionally may go away in a few weeks or months when the medications causing the problem are stopped. Still, typically most people may have symptoms that wax and wane for years or decades.
Treatment of TD may include discontinuation of the medications causing the condition, prescription medications to improve symptoms, or in rare cases, deep brain stimulation.
Untreated TD could result in complications like discomfort, loss of daily functioning, social impairment, and breathing or swallowing difficulties.
Use coupons for TD treatments like Klonopin (clonazepam), amantadine, and Ingrezza (valbenazine) to save up to 80%.
The early signs of tardive dyskinesia are mild or even subtle involuntary movements including:
Mouth movements
Tongue movements
Face movements
Blinking
Hand or finger tapping
Leg movements
Torso movements
Arm movements
Early signs of TD are not always easy to identify. Although TD symptoms can sometimes develop suddenly, they typically come on slowly over days and weeks. At first, the involuntary movements may not be noticeable. They might first appear as tics. Because antipsychotic medications are the most common cause of TD, early involuntary movements may be mistaken for atypical behaviors related to schizophrenia, psychosis, or Tourette’s syndrome.
The symptoms of classic tardive dyskinesia involve involuntary movements of the face and mouth including:
Lip smacking
Tongue movements
Lip pursing
Mouth movements
Grimacing
Frowning
Blinking
Other common symptoms include repetitive and patterned involuntary movements of other parts of the body. Healthcare professionals often call these movements “tardive stereotype”:
Arm movements
Torso movements
Hand movements or finger tapping
Hip swaying
Leg movements
Tardive dyskinesia and tardive dystonia are both problems caused by medications that block the neurotransmitter dopamine. However, dystonia can be caused by other problems as well. Both TD and tardive dystonia may happen at the same time, but tardive dyskinesia is much more common than tardive dystonia. Both involve involuntary muscle movements, but dystonia involves random and slow spasms. This results in twisting, writhing, and turning movements, sometimes holding the person in an unnatural posture, such as their head tilting back. Dystonia can lock the eyes in a bizarre position, such as pointing straight up. Treatment of dystonia symptoms is more urgent. If dystonia involves the throat, it may become hard to swallow or breathe. Additionally, dystonia can rapidly develop into a severe, life-threatening condition called dystonic storm.
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Other movement disorders similar to TD can also be caused by dopamine receptor-blocking drugs. They may occur alone or along with tardive dyskinesia. Healthcare providers call this entire group of medication-induced neurological disorders “tardive syndrome.” Some are as common as TD, which occurs in about 20% to 30% of people taking first-generation antipsychotics. Others are rare. Other movement disorders associated with tardive syndrome include:
Restlessness (tardive akathisia—30% to 40%)
Tremor (tardive tremor or tardive parkinsonism—20%-35%)
Slow, involuntary twisting or turning postural movements (tardive dystonia—1% to 2%),
Tics (tardive tourettism—rare)
Some healthcare professionals may lump some or all of these together under “tardive dyskinesia” because they are similar and have the same cause. For instance, it’s not uncommon for some healthcare professionals to think of tardive dystonia as “severe tardive dyskinesia.”
See or talk to a doctor immediately when symptoms of tardive dyskinesia are noticed. A person who experiences TD symptoms will usually already be under the care of a psychiatrist or other mental health professional. In those cases, they should already be aware that they need to immediately report any abnormal symptoms or medication side effects to the doctor. For TD, the medication will need to be stopped. That can’t always happen immediately, so the prescriber needs to know about the symptoms as soon as possible.
Healthcare professionals primarily diagnose tardive dyskinesia. However, tests will be needed to make sure the symptoms aren’t due to another disease. The most common instruments they use to assess symptoms are the Abnormal Involuntary Movement Scale (AIMS) or the Extrapyramidal Symptom Rating Scale (ESRS). The AIMS test focuses specifically on measuring TD symptoms, but the ESRS also tests for other movement disorders, including dystonia, parkinsonism, and restlessness (akathisia).
The clinician will perform other tests to rule out other neurological disorders such as Parkinson’s disease, Tourette syndrome, or Huntington’s disease. These tests may include:
Physical exams
Blood tests
An electroencephalogram (EEG) to measure brain function
Imaging studies such as a CT scan or MRI
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Classic tardive dyskinesia is a distressing and often debilitating illness, but by itself rarely results in severe complications. Possible complications include:
Reduced quality of life
Functional impairment
Social impairment
If involuntary movements affect the throat or diaphragm, more severe complications might ensue, including:
Difficulty swallowing
Difficulty breathing
The first and most effective treatment for tardive dyskinesia is to stop taking the medication causing the problem. Sometimes, the drug can’t be safely stopped right away so the medication will be tapered gradually. With some drugs, sudden withdrawal can worsen TD symptoms, cause withdrawal, or bring back symptoms of the underlying mental health condition.
Medications that can cause tardive dyskinesia include:
Antipsychotics, particularly older antipsychotic drugs like haloperidol
Anxiety drugs
Anti-Parkinson’s drugs
Some types of antiemetics (metoclopramide, prochlorperazine, and promethazine)
Bipolar disorder drugs (lithium)
Once the drug has been stopped, symptoms of TD may remit in a few weeks, but typically last for years or decades. Healthcare professionals treat TD with symptom-reducing drugs, including:
VMAT-2 inhibitors—the drugs Ingrezza (valbenazine) and Austedo (deutetrabenazine) are usually the first-line treatments for tardive dyskinesia
Some clinicians may use deep brain stimulation (DBS) in the most severe cases, but little evidence exists that it’s effective at reducing TD symptoms.
If TD symptoms are interfering with daily functioning, physical therapy, speech therapy, and occupational therapy can help bring some control over movements, improve speaking, and help daily functioning.
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Unfortunately, tardive dyskinesia is a long-term disorder. Most people who develop TD will have symptoms that go in and out for years. Some days will be better, and some days will be worse. A few tips can help increase the number of better days:
Reduce stress—emotional arousal, stress, anxiety, and worry worsen the symptoms of TD, so learn to manage and reduce stress
Practice relaxation techniques—relaxation improves the symptoms of TD, so practice relaxation techniques such as meditation, deep breathing, and yoga
Sleep well—adequate, quality sleep improves TD symptoms during the day, so practice good sleep hygiene by going to bed at the same time each night, waking up at the same time each morning, avoiding distractions in bed, and relaxing before bedtime
Other tips that can help you cope with TD and maintain good health include:
Get support from friends and family
Join a peer support group
Be active physically as much as you can tolerate
Eat a healthy diet
Plan each day’s tasks and activities
If symptoms are making it difficult to perform everyday tasks, consider using assistive utensils, tools, and other household implements that are designed to make daily functioning easier.
Sometimes muscles twitch, jerk, or spasm without warning. That’s normal if it only happens once in a while. However, if uncontrollable movements happen regularly, it may be a sign of a serious problem. If you take any medication that may potentially cause TD, immediately get medical help if you develop tics or uncontrollable movements. Do not stop taking medicine until you’ve talked to a healthcare professional. The drug may need to be tapered slowly. Unfortunately, it needs to be stopped as quickly as possible, so talk to the prescriber or other healthcare professional immediately after noticing symptoms.
Tardive dyskinesia starts slowly, typically taking several days or weeks for full symptoms to develop.
Tardive dyskinesia symptoms ease off as a person becomes more relaxed. The symptoms usually disappear during sleep. On the other hand, according to one study, having problems sleeping at night may make TD symptoms worse during the day. Therefore, good quality sleep is very important when attempting to reduce TD symptoms.
Emotional arousal, including stress and anxiety, worsens tardive dyskinesia symptoms. Proper stress management can help ease TD symptoms.
Tardive dyskinesia, National Organization for Rare Disorders (NORD)
Tardive dyskinesia, StatPearls
Tardive dyskinesia in an emergency setting, Emergency Medicine Saint John
An update on tardive dyskinesia: from phenomenology to treatment, Tremor and other Hyperkinetic Movements
FDA-approved medications to treat tardive dyskinesia, Psychiatrist.com
Tardive dyskinesia, Cleveland Clinic
Tardive dyskinesia, National Alliance on Mental Illness (NAMI)
Treatment of movement disorder emergencies, Neurotherapeutics
Poor nighttime sleep is positively associated with dyskinesia in Parkinson’s disease patients, Parkinsonism & Related Disorders
Schizophrenia treatments and medications, SingleCare
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