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5 Answers About Tardive Dyskinesia

What patients and caregivers should know about causes, prevalence, and treatment options for TD.

Medically reviewed in January 2021

Tardive dyskinesia (TD) is an involuntary movement disorder that is most typically seen in people who take medications called neuroleptics. Also known as antipsychotics, neuroleptic drugs are a standard treatment for schizophrenia, and are also sometimes used in the treatment of bipolar disorder (specifically for manic episodes), severe depression, and severe anxiety.

Here, we answer five questions to help better understand TD.

What causes TD?
While we do not have a complete understanding of the mechanisms of TD, the disorder is believed to result from alterations in brain structure and chemistry. It is not fully understood why these changes occur. It is believed that these changes lead to abnormal signaling between the brain and the rest of the nervous system, which in turn leads to involuntary and repetitive movements. These movements often occur in the face—grimacing, blinking, and chewing motions are common symptoms. These movements can also affect the limbs and torso.

How many people on antipsychotics develop TD?
Hard facts and figures about the prevalence of TD are difficult to pin down and can vary depending on the study. These variances may be due to differences in study populations or differences in the specific medications or doses being studied.

If you or a loved one is taking a neuroleptic medication, it is more important to focus on your specific situation rather than statistics. If you have a condition that requires management with an antipsychotic medication, it is important to work with a healthcare provider who is aware of TD and understands the risk. People who are prescribed neuroleptics should be monitored closely for adverse effects. There is no substitute for preventing TD in the first place and addressing symptoms as early as possible.

What healthcare providers treat TD?
While symptoms of TD may first be noticed or reported to a psychiatrist or primary care physician, people who are experiencing involuntary movements may also consult a neurologist, a movement disorder specialist, and/or an ophthalmologist. TD is not the only disorder that can cause involuntary movements, and diagnosing TD often involves eliminating the other possible causes.

Are TD symptoms permanent?
In some cases, the involuntary movements of TD can become permanent or take a long time to resolve. In other cases, symptoms are reversible. Again, it is better to focus on your own specific circumstance. If you or a loved one is experiencing symptoms of TD, work with a healthcare provider who understands the disorder and the treatment options available.

What are the treatment options for TD?
The approach to treatment will take into account numerous factors—the medication a person is taking, the condition they are taking it for, how long they have been taking the drug and at what dosage, their symptoms and the severity of those symptoms, the person’s age and overall health, and others. Treatment may involve a change in antipsychotic therapy, as well as medications and/or other therapeutic approaches to help control TD symptoms.

Sources:
Elsevier Patient Education. "Tardive Dyskinesia."
Muhammad Atif Ameer and Abdolreza Saadabadi. "Neuroleptic Medications." StatPearls, 2020.
Elyse M. Cornett, Matthew Novitch, et al. "Medication-Induced Tardive Dyskinesia: A Review and Update." The Ochsner Journal, 2017. Vol 17, No. 2.
Ziad Ali, Autumn Roque and Rif S. El-Mallakh. "A unifying theory for the pathoetiologic mechanism of tardive dyskinesia." Medical Hypotheses, 2020. Vol. 140.
Lana Frankle. "Expanding on possible mechanisms for tardive dyskinesia: A response to Ali, Roque, and Mallakh." Medical Hypotheses, 2020. Vol. 144.
John A. Gray. "Tardive Dyskinesia." Ferri's Clinical Advisor 2021.
Leo Robert. "Tardive Dyskinesia Facts and Figures." Psychiatric Times. May 30, 2019.
Amit Dhir, Traci Schilling, Victor Abler, Ravi Potluri and Benjamin Carroll. "Estimation of Epidemiology of Tardive Dyskinesia in the United States." Neurology, 2017. Vol. 88, Supp. 16.
Leslie J. Cloud, Deepti Zutshi and Stewart A. Factor. "Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder." Neurotherapeutics, 2014. Vol. 11, No. 1.
Sarayu Vasan and Ranjit K. Padhy. "Tardive Dyskinesia." StatPearls, 2020.
National Alliance on Mental Illness. "Tardive Dyskinesia."
Lucia Ricciardi, Tamara Pringsheim, et al. "Treatment Recommendations for Tardive Dyskinesia." Canadian Journal of Psychiatry, 2019. Vol. 64, No. 6.

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