What is tardive dyskinesia?
Tardive dyskinesia (TD) is a movement disorder that causes movements you do not control. It is caused by medicines that block dopamine, a chemical messenger in the brain. “Tardive” means delayed. TD usually appears after months or years of taking one of these medicines.
Medicines that can cause TD include:
- Antipsychotic medicines, used for schizophrenia, bipolar disorder, depression, and other conditions
- Some medicines for nausea and stomach problems, such as metoclopramide
These medicines are important and often very helpful. Many people who take them never develop TD. But anyone who takes them should know the signs, so TD can be found and treated early.
Do not stop your medicine on your own
If you think you have TD, do not stop or change your psychiatric medicine without talking to the doctor who prescribes it. Stopping suddenly can bring back serious symptoms, and it can sometimes make movements worse for a while. We work with your prescriber to find the safest plan.
Common symptoms
TD often affects the face and mouth, but it can affect any part of the body.
- Lip smacking, puckering, or pursing
- Tongue movements, such as pushing the tongue out or moving it inside the cheek
- Chewing movements or jaw clenching
- Grimacing or fast blinking
- Movements of the fingers, arms, legs, or feet
- Rocking, twisting, or other movements of the body
Many people do not notice these movements themselves. Family members or friends often notice them first. TD can make eating, speaking, and social situations harder. It can also first appear when a medicine dose is lowered or stopped.
How we make the diagnosis
The diagnosis is made through a careful exam by a movement disorder specialist. At your visit, we will:
- Review all of your medicines, past and present, and how long you took them
- Ask when the movements started and how they affect your daily life
- Watch your face, mouth, hands, feet, and body at rest and during simple tasks
- Use a standard rating exam to measure the movements and track them over time
- Look for other causes of similar movements, such as Huntington’s disease or other conditions
Getting the diagnosis right matters, because TD, drug-induced parkinsonism, and other movement problems caused by medicines are treated differently.
Bring a typed list of your medicines
It is crucial to bring a typed list of all antipsychotic medicines and anti-nausea medicines you received before the involuntary movements started. The list should include the name of each medicine, when it was started, and when it was stopped. It is important to note that you may have received as-needed medicines for nausea in the hospital or emergency room without being given their names.
Treatment options
Treatment is built around your movements, your mental health, and your goals.
VMAT2 inhibitors
VMAT2 inhibitors are a class of medicine approved to treat TD. They lower the amount of dopamine released in the parts of the brain that control movement. For many people, they reduce the movements, and they can usually be taken while you keep taking your psychiatric medicine. We choose and adjust the medicine with you and watch for side effects, such as sleepiness.
Regular checkups
If you take a medicine that blocks dopamine, regular checks for movement changes are a good idea, even if you feel fine. Finding TD early gives you more options.
Your medication list
Make sure you bring a typed list of medications used to treat tardive dyskinesia that failed or caused side effects. Use BPMedTracker to track your medications and print a list.
Drug-induced parkinsonism
The same medicines that can cause TD can also cause drug-induced parkinsonism. This looks like Parkinson’s disease. It can cause:
- Slowness and smaller movements
- Stiffness
- A tremor
- Shuffling steps or a stooped posture
Drug-induced parkinsonism is different from TD, and the treatments are different. Some people have both at the same time. It often gets better after the medicine is lowered or changed, but this can take months. Sometimes a DaTscan helps tell drug-induced parkinsonism apart from Parkinson’s disease.
When to see a specialist
Consider seeing a movement disorder specialist if you or a loved one takes a medicine that blocks dopamine and has:
- New movements of the mouth, tongue, face, hands, or feet
- New slowness, stiffness, tremor, or shuffling
- Movements that started after a medicine was lowered or stopped
- Movements that make eating, speaking, or daily life harder
Call 940-828-MOVE (6683) to schedule a visit. Please bring a list of all your medicines, past and present.