Tardive Dyskinesia (TD): Symptoms, Causes, and Treatment

Tardive dyskinesia is a movement disorder that can develop if you take an antipsychotic medication and/or other types of medications. Tardive dyskinesia (TD) is a neurological syndrome that involves involuntary (out of your control) movements. “Tardive” means delayed or late, while “Dyskinesia” refers to involuntary muscle movements. It’s typically not reversible, but treatment may help manage the symptoms.

Understanding the Condition

With this condition, there’s typically a delay between when you start a medication and when you develop dyskinesia. Many people take a medication for years before developing the condition. But you can also develop TD after short-term medication use. TD after short-term medication use is more likely to happen to people over 65. Researchers estimate that at least 20% of all people who take first-generation antipsychotic medications develop tardive dyskinesia. There aren’t as many studies on the other medications that can cause the condition, so it’s difficult to estimate how frequently they result in tardive dyskinesia.

Symptoms of Tardive Dyskinesia

The symptoms of tardive dyskinesia can range from mild and barely noticeable to severe. Tardive dyskinesia causes involuntary movements of your facial muscles, tongue, neck, trunk muscles, and limbs. Healthcare providers may describe these symptoms as:

• Dystonia: uncontrollable muscle contractions.
• Myoclonus: brief, sudden muscle movement.
• Buccolingual stereotypy: repetitive movements of your mouth.
• Tics: habitual contractions of your muscles, often in your face.

Facial Involuntary Movements

Facial involuntary movements may include:

• Lip-smacking or making sucking motions with your mouth.
• Grimacing or frowning.
• Sticking your tongue out or against the inside of your cheek.
• Chewing movements.
• Puffing your cheeks.
• Rapid eye blinking (blepharospasm).

Other Involuntary Movements

Other involuntary movements may include:

• Making repetitive finger movements like you’re playing the piano.
• Thrusting or rocking your pelvis.
• Walking with a duck-like gait.
• Inability to remain physically still (akathisia).

Causes and Pathophysiology

Researchers don’t know the exact cause of tardive dyskinesia. But the main theory is that it can develop due to the use of dopamine receptor-blocking medications (dopamine antagonists). Taking antipsychotic (neuroleptic) medications is the main cause of this condition. This includes short-term and long-term use of the medications, though it’s more likely to develop after long-term use. TD can also happen after discontinuation of, a change in or reduction in medications.

Dopamine antagonists block dopamine for a long time. This may make the dopamine receptors in your brain extra sensitive, especially in your basal ganglia (a part of your brain that helps control movement). Excess dopamine (a neurotransmitter) — or extra sensitive receptors — leads to involuntary movements. In addition to dopamine, other neurotransmitter receptors may be involved in the condition, including serotonin, acetylcholine and GABA. This may explain why medications other than antipsychotics can occasionally lead to tardive dyskinesia.

Medications Linked to Tardive Dyskinesia

Tardive dyskinesia can develop due to exposure to the following medications:

• Antipsychotic medications (neuroleptics): These medications mainly treat psychosis-related conditions, like schizophrenia, and are the most common cause of TD.
• Metoclopramide: This medication can relieve GERD (chronic acid reflux) or help treat diabetes-related gastroparesis and is strongly linked to TD.
• Certain antidepressants: These help treat depression and other conditions like anxiety and obsessive-compulsive disorder.
• Rare Cases: Lithium, antiseizure medications, antihistamines (specifically hydroxyzine), and antimalarials.

Antipsychotic Risk Factors

First-generation (“typical”) antipsychotics are considered more likely to cause tardive dyskinesia than second-generation (“atypical”) antipsychotics. Examples of first-generation antipsychotics include: Chlorpromazine, Fluphenazine, Haloperidol, Perphenazine, Prochlorperazine, Thioridazine, and Trifluoperazine.

Metoclopramide Risk Factors

Risk factors for developing metoclopramide-induced TD include:

• Being 65 or older.
• Being female.
• Having diabetes.
• Taking metoclopramide for 12 or more weeks.