Tardive dyskinesia (TD) is a brain and nervous system condition caused by certain medications, leading to involuntary and abnormal movements of the face, body, and limbs. It typically stems from using antipsychotic drugs, which block dopamine receptors involved in regulating movement and emotions. These medications are often prescribed for mental health issues like bipolar disorder, schizophrenia, and depression.
Unfortunately, most TD cases are permanent. Each year, about 5 to 7% of people taking antipsychotics develop TD, with higher rates among older adults, especially those over 55, and those on long-term antipsychotic treatments. Symptoms usually appear a month to six months after starting these medications. However, various treatments can help manage and reduce the symptoms, improving life quality while allowing continued antipsychotic use.
TD mainly causes uncontrolled movements in the jaw, face, and tongue, affecting about three-quarters of sufferers. These movements can disrupt speech, eating, and swallowing and may also extend to the arms, legs, and other body areas. Younger people tend to experience more severe limb movements, which can impact posture and balance, increasing fall risks.
The condition primarily results from long-lasting antipsychotic drug use, though factors like genetics, age, sex, and substance use can also play roles. Both first- and second-generation antipsychotics can lead to TD. Common antipsychotic examples include medications prescribed for schizophrenia, depression, and bipolar disorder. Besides antipsychotic drugs, other meds like Reglan and Stemetil, used for nausea, have been linked to TD.
Several risk factors make some individuals more prone to TD, such as older age and prolonged medication use. Women, particularly post-menopausal ones, along with Black Americans, are at higher risk. TD diagnosis involves a doctor’s observation during antipsychotic treatment, using the Abnormal Involuntary Movement Scale (AIMS) to assess and categorize the severity of movements.
Doctors aim to alleviate TD symptoms through various strategies. These may include switching or tapering off the current antipsychotic medication under medical guidance to prevent withdrawal issues. The FDA has approved Ingrezza and Austedo to treat TD by reducing dopamine release in motor control areas of the brain. These medications have shown effectiveness in reducing symptoms according to the AIMS scale.
An alternative treatment option is deep brain stimulation, a surgical procedure that involves implanting electrodes to control brain activity. Emerging research suggests it can lessen TD symptoms significantly.
Prevention of TD focuses on using the smallest effective antipsychotic dose for the shortest duration. Regular screening for TD symptoms is crucial, particularly every three months for those on long-term treatment, along with considering individual risk factors before starting antipsychotics.
TD often coexists with mental health disorders like schizophrenia and bipolar disorder and with cardio-metabolic conditions such as hypertension and diabetes, as well as higher rates of substance use disorders. While it’s not life-threatening, TD can greatly affect daily life and carry a stigma that leads to social isolation.
Fortunately, treatment can improve symptoms and quality of life. Exercise can also help manage symptoms related to balance and movement. If you or someone you care for is on antipsychotic treatment, speak with a healthcare provider about monitoring for TD symptoms.
