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What is tardive dyskinesia?
Tardive dyskinesia is a movement disorder caused by certain kinds of medication, including some antipsychotics and antidepressants. Tardive dyskinesia is brain damage in the sense that it’s likely caused by permanent alterations to your brain's biochemistry.
Researchers don’t know the exact biological changes that lead to tardive dyskinesia (TD), but it is associated with changes in your brain.
The changes are probably permanent modifications to your brain's dopamine system. These are typically caused by the long-term use of certain medications, like those used to treat schizophrenia.
Tardive dyskinesia is brain damage in the sense that it’s likely caused by permanent alterations to your brain's biochemistry. But there aren’t any large-scale structural changes to your brain visible with magnetic resonance imaging (MRI) or computerized tomography (CT) scans associated with TD.
Tardive dyskinesia is a movement disorder caused by certain kinds of medication, including some antipsychotics and antidepressants. It persists even after you’ve stopped taking the medication.
You have to have symptoms for at least a month after you’ve stopped taking the causal medication for your condition to be officially diagnosed as TD. You also must have been taking the causative medication for at least three months for your symptoms to be definitively linked to the drug.
What causes tardive dyskinesia?
Tardive dyskinesia is caused by certain classes of prescription drugs that modify your brain’s dopamine response system. Dopamine is a neurotransmitter — a chemical messenger that allows your brain cells to communicate with one another.
You need to be on these medications for an extended period, from months to years, before you risk developing TD. No one knows why, but it only develops in some of the people who take these drugs, while other people never do.
Substances that can lead to TD include:
- Neuroleptics — many of these are antipsychotic drugs used to treat conditions like schizophrenia and bipolar disorder.
- Antidepressants
- Gastrointestinal medications — metoclopramide and prochlorperazine are two examples.
- Lithium
- Certain antihistamines
There are two leading theories about how these drugs lead to TD. The first is that the antipsychotics — particularly older or first-generation ones — bind too tightly to certain dopamine receptors. This could cause your body to produce more receptors to compensate for the blocked ones. This then may lead to an exaggerated downstream dopamine response in the part of your brain called the striatum, which is involved in motor control.
Another theory is that some medications or interactions with medications lead to too many dangerous, reactive molecules in your brain — called free radicals. These interfere with your brain's normal functions.
We need more research to know exactly what changes happen within your brain when you develop tardive dyskinesia.
Who is more likely to get TD?
Anyone who takes a medication that can cause tardive dyskinesia is at risk of developing the condition. But some people seem to be more at risk. People who fall into higher-risk categories include:
- Those with schizophrenia who have been taking antipsychotic medications for a long time
- Women — particularly after menopause
- Black people
- Older people
- Those with a family history of TD
Your risk also increases with certain unhealthy lifestyle choices, including:
How is tardive dyskinesia diagnosed?
Tardive dyskinesia gets progressively worse over time. It can be difficult to notice in the early stages. Your doctor will need to carefully observe your condition and review your medical history to make the right diagnosis.
Some assessments can help your doctor decide how much involuntary movement occurs in your body. An example is the Abnormal Involuntary Movement Scale (AIMS).
Ideally, your doctor will evaluate you on this scale before prescribing medications like antipsychotics. This way, they’ll have a baseline for your current untreated level of involuntary movements. They should re-evaluate you, in the same way, a maximum of three months after you’ve started the medication.
What are the movements associated with TD?
The main symptom of tardive dyskinesia is uncontrollable muscle movement. Facial movements are the most common. but involuntary movement can also be present in your torso and limbs.
Symptomatic facial movements can include:
- Sticking your tongue out
- Puffing your cheeks
- Lip smacking
- Chewing movements
- Difficulty swallowing
Other movement types can be more widespread throughout your body. For example, chorea involves rapid, jerky movements in your limbs. Athetosis includes slow, writhing movements below your neck.
Tardive dystonia is a more extreme version of the condition, exhibiting distinct, uncontrolled movements of the neck and torso. These are specifically slow, twisting movements.
The movements can sometimes become even more severe when your doctor takes you off the causal medication. This is called withdrawal dyskinesia.
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How is tardive dyskinesia treated?
It’s best to catch tardive dyskinesia as soon as possible. The first step of your treatment is to stop your use of the causal medication. Your doctor might recommend a replacement depending on your underlying disorder.
Simply stopping the causal medication won’t cure your TD. At present, there isn’t a cure.
There are few agreed-upon treatments to manage the symptoms of your TD.
Clonazepam is a common replacement for many antipsychotic medications. The American Academy of Neurology also recommends trying Ginkgo biloba to relieve symptoms.
The FDA has approved a drug called valbenazine that’s supposed to specifically treat the symptoms of TD. But more research is needed to prove that the drug is as effective as early clinical trials suggest.
You may also want to try exercise as a treatment for your TD symptoms. Getting in a good workout on a regular basis can help with tremors, balance problems, and flexibility issues. It can also improve your cognitive function and reduce some of the negative symptoms of Schizophrenia.
There are many ongoing clinical trials for new drugs to treat TD. Talk to your doctor to see if any of these experimental medications are right for you.
What is your prognosis with TD?
Since there isn’t a permanent cure for tardive dyskinesia, your symptoms are likely to be long-lasting and difficult to control. Symptoms can easily last for years after you’ve stopped taking the medication that originally caused your condition.
On the other hand, TD is usually not life-threatening. The rare exception is in cases where the movements in your throat and larynx are too severe and cause further complications — like being unable to breathe.
Contact your doctor immediately if you’ve been taking an antipsychotic drug and start to notice an increase in uncontrollable muscle movements.