Antipsychotics cause certain biochemical changes in the brain and disrupt the neuronal communication of dopamine resulting in neurological symptoms, such as tardive dyskinesia.
Tardive dyskinesia is a neurological condition that results in abnormal movements (movement disorder), typically affecting the face, lips, jaw, or tongue that typically occurs after long-term use of antipsychotics (neuroleptics).
- Antipsychotics cause certain biochemical changes in a part of the brain called the striatum that may result in involuntary movements in certain parts of the body.
- These medications act by blocking the action of a brain chemical called dopamine. Dopamine is a neurotransmitter, which means it helps the nerve cells or neurons communicate with each other.
- Antipsychotics disrupt this neuronal communication that may lead to neurological symptoms such as abnormal movements (dyskinesia).
Some people may even develop tardive dyskinesia with short-term use of these medications, whereas some may not develop it.
Elderly patients are more likely to develop tardive dyskinesia. Some people may be more susceptible due to their genetic tendencies to develop this condition. Female gender, alcohol consumption, and diabetes may increase the risk of tardive dyskinesia following antipsychotic usage.
Which antipsychotics are most likely to cause tardive dyskinesia?
Older antipsychotics are more likely to cause tardive dyskinesia than newer ones. They are also called typical antipsychotics or first-generation antipsychotics and are used to treat schizophrenia.
These drugs include:
- Haloperidol
- Chlorpromazine
- Loxapine
- Fluphenazine
- Perphenazine
- Pimozide
- Prochlorperazine
- Trifluoperazine
- Thiothixene
Besides the treatment of schizophrenia, first-generation antipsychotics are used for other conditions such as anxiety (trifluoperazine and prochlorperazine), Tourette’s syndrome (pimozide), and intractable hiccups, acute intermittent porphyria, and tetanus (chlorpromazine).
Do all antipsychotics cause tardive dyskinesia?
Yes, all antipsychotics can potentially cause tardive dyskinesia; however, the risk is lower with second-generation or atypical antipsychotics such as:
- Risperidone
- Ziprasidone
- Olanzapine
- Quetiapine
- Paliperidone
- Aripiprazole
- Lurasidone
Apart from schizophrenia treatment, atypical antipsychotics may be prescribed for other conditions such as bipolar disorder (olanzapine), autism (risperidone, aripiprazole), Tourette’s syndrome (aripiprazole), and depression (lurasidone).
QUESTION
Schizophrenia is the most disabling mental illness.
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What other medications may cause tardive dyskinesia?
Besides antipsychotics, other medications may cause tardive dyskinesia, such as:
- Antiemetics such as metoclopramide and prochlorperazine
- Antidepressants such as:
- Selective serotonin reuptake inhibitors such as fluoxetine
- Tricyclic antidepressants such as amitriptyline, doxepin, and imipramine
- Monoamine oxidase inhibitors such as phenelzine
- Serotonin receptor antagonists and reuptake inhibitors such as trazodone
- Antianxiety medications such as alprazolam
- Antiseizure medications such as phenytoin and phenobarbital
- Antimalarials such as chloroquine
- Mood stabilizers such as lithium
- Anti-Parkinson medications such as levodopa
- Antihistamines such as hydroxyzine
- Stimulants such as caffeine, amphetamine, and methylphenidate
Does tardive dyskinesia go away?
Tardive dyskinesia may go away when detected and treated early. This may not happen in all cases, and some people continue to have the symptoms despite stopping the culprit medication.
In some people, symptoms may worsen with time. If symptoms of tardive dyskinesia do not go away despite stopping the medication responsible for causing it, the doctor may recommend medications to manage the symptoms. Moreover, this may be necessary in cases where stopping the medication is too risky for the affected person.
The U.S. Food and Drug Administration has approved two medications such as Ingrezza (valbenazine) and Austedo (deutetrabenazine) in 2017 for the treatment of tardive dyskinesia in adults. Other medications, typically benzodiazepines, may be given to manage the symptoms.
In resistant or severe cases, other therapeutic options such as Botox injections in the affected site or deep brain stimulation may be considered.