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 clinic at Baylor College of Medicine in Houston. “It doesn’t occur without exposure to these medications.” About 25 percent of people who use first-generation or second-generation antipsychotics long term develop tardive dyskinesia, according to a meta-analysis published in the March 2017 issue of the Journal of Clinical Psychiatry. A third generation of antipsychotics is now available, but some risk remains, says Dr. Jankovic. Before you take any new medication for the conditions listed above, therefore, have a thorough discussion with your doctor about the risks and benefits. Here’s what you should know about tardive dyskinesia. 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 — 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 Antipsychotic Medications Without Your Doctor’s Supervision
If you suspect that you have tardive dyskinesia, consult the healthcare provider who prescribed your antipsychotic medication, says Jankovic. According to a study published in the May 2018 issue of the Journal of Clinical Psychiatry, doctors can administer the Abnormal Involuntary Movement Scale (AIMS) exam, a short screening for tardive dyskinesia. During this simple test, your doctor will ask a few questions and observe you while you make a few movements. If it’s determined that you have tardive dyskinesia, your doctor will help you develop a plan, which may include tapering your dose of the medication that’s causing it. “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.” A type of medication called a vesicular monoamine transporter-2 inhibitor, or VMAT2 inhibitor, can also be prescribed to suppress the involuntary movements. Two such drugs, Austedo (deutetrabenazine) and Ingrezza (valbenazine), are approved by the U.S. Food and Drug Administration (FDA) for the treatment of tardive dyskinesia.
5. Tardive Dyskinesia Can Take Months or Years to Subside
Your prognosis with tardive dyskinesia depends on several factors. For one, people who have taken higher doses of antipsychotics or have taken them 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.” People with certain health problems, such as diabetes or a prior brain injury, may also have a harder time finding relief from tardive dyskinesia.
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 published in the June 2018 issue of the Journal of the Neurological Sciences, those risk factors include:
Being elderlyBeing femaleAn intellectual disability or brain damageNegative symptoms in schizophreniaMood disorders or cognitive symptoms in mood disordersCertain genetic risk factorsTaking antipsychotics for longer durationsDiabetesSmokingAbuse of alcohol or other substancesTaking first-generation antipsychoticsHigher doses of an antipsychoticHaving early parkinsonian side effectsTaking anticholinergic drugs in addition to antipsychotic medicationsCertain other movement disorders
