It is most often caused by long-term treatment with antipsychotic drugs, according to the American Academy of Neurology (PDF). Statistics are hard to come by, but a study published in the journal Neurotherapeutics estimated that approximately 700,000 people may have tardive dyskinesia. Tardive dyskinesia most commonly causes movements in the muscles of the face and mouth, though they may also occur in the trunk and extremities, says Frederick Charles Nucifora Jr., DO, PhD, a professor of psychiatry and behavioral sciences at Johns Hopkins Medicine in Baltimore. In addition to those mentioned above, movements can include chewing motions, lateral movements of the jaw, and jerky tongue movements, Dr. Nucifora says. Although tardive dyskinesia can be reversed, the condition is permanent in the majority of people, says Nucifora. NIMH states that antipsychotic drugs can also be used in combination with other medications to treat mental health conditions, such as:
Attention deficit hyperactivity disorder (ADHD)Severe depressionEating disordersPost-traumatic stress disorder (PTSD)Obsessive compulsive disorder (OCD)Generalized anxiety disorder (GAD)
Antipsychotics work by blocking dopamine receptors in the brain, according to the study in Neurotherapeutics. Dopamine is a neurotransmitter that not only helps control the part of the brain that signals reward and pleasure but also plays a big role in coordinating muscle movements. Other medications that can cause tardive dyskinesia include antidepressants, antiemetics (used for severe nausea and acid reflux), and anxiolytics (used to treat anxiety), according to a review published in 2017 in the Ochsner Journal. The severity of tardive dyskinesia varies widely from person to person. Some people may not even be aware that they’re experiencing involuntary movements, nor are they bothered by them, says Nucifora. Other people, however, may develop speech, swallowing, and even breathing problems, which can make them feel embarrassed and uncomfortable, he says. “For more severe tardive dyskinesia, people will seek help … but many people accept tardive dyskinesia as part of their illness,” Nucifora notes. Tardive dyskinesia can look and feel different in each person. As a result, there are many misconceptions about the condition — and it can be difficult to separate the myths from the facts. Learn the truth here.
Fact: The Risk of Developing Tardive Dyskinesia Increases the Longer You Take an Antipsychotic
Tardive dyskinesia primarily occurs as a side effect of long-term use of antipsychotic medications, according to the National Alliance on Mental Illness (NAMI). And, says Nucifora, higher doses of an antipsychotic can add to the likelihood of the condition. Although tardive dyskinesia can occur from short-term use, it usually doesn’t appear before the three-month mark, says Nucifora. Anhar Hassan, MBBCh, a neurologist at the Mayo Clinic in Rochester, Minnesota: “Tardive dyskinesia also rarely occurs after a single dose.” Because tardive dyskinesia is linked with long-term use of antipsychotics, NAMI recommends that people taking these medications be closely monitored and screened by their doctor.
Myth: People Who Develop Tardive Dyskinesia Should Stop Taking Their Medicine ASAP
Although you should talk to your doctor right away about any involuntary movements you’re experiencing, you shouldn’t stop taking the drug on your own, says Dr. Hassan. Halting medication without speaking to your doctor first can be risky, she says. Abruptly stopping antipsychotics can trigger a recurrence of your psychiatric symptoms or even withdrawal symptoms. And sometimes, reducing the medication can worsen the dyskinesia and make it more challenging to treat, she says. If your physician decides to change your current medication, the tardive dyskinesia may stop, says Hassan. And even if the symptoms don’t go away completely, says Nucifora, the progression of the disorder may be halted or slowed by switching drugs. The drugs suppress symptoms of tardive dyskinesia, but they do not cure it, and symptoms can recur if the drugs are stopped.
Myth: Only the ‘Older’ Antipsychotics Cause Tardive Dyskinesia
Doctors refer to different groups of antipsychotic drugs as first-generation, or typical, antipsychotics; second-generation, or atypical, antipsychotics; and third-generation antipsychotics, or dopamine receptor partial agonists. People who take first-generation antipsychotics are more likely to develop tardive dyskinesia than those who take second-generation antipsychotics, says Nucifora, but the latter class of medications can still cause it. The risk of tardive dyskinesia from third-generation antipsychotics is unknown, according to a review published in 2020 in CNS Drugs. But publications from 2015, 2017, and 2019 describe incidences of tardive dyskinesia arising from the use of third-generation antipsychotics.
Fact: Certain Risk Factors Can Increase Your Chance of Developing Tardive Dyskinesia
Although there is no medical consensus on what, exactly, causes tardive dyskinesia to occur in some people, there are several risk factors that seem to make people more likely to develop the condition. Those include older age, female sex, and longer illness duration, according to a review published in 2018 in the Journal of Neurological Sciences, as well as diabetes, smoking, and abuse of alcohol or other substances. Other risk factors for tardive dyskinesia include use of dopamine-blocking medications, stronger or older versions of dopamine-blocking medications (like haloperidol), a history of prior movement disorders during use of dopamine-blocking medications, a genetic predisposition to tardive dyskinesia, or brain developmental disorders, says Hassan. If you are taking a medication that can cause tardive dyskinesia and you have one or more of these risk factors, talk to your doctor about your concerns, says Hassan.
