Tardive dyskinesia (TD) is a side effect of some dopamine receptor-blocking medications that treat psychiatric, gastrointestinal, and neurological conditions. This movement disorder makes it impossible to control certain facial or body movements.

Not everyone who takes these medicines develops tardive dyskinesia symptoms. But for those who do, the side effects can affect their quality of life.

What is the connection between dopamine and tardive dyskinesia?

Dopamine receptor-blocking medications (dopamine antagonists) are most closely linked to tardive dyskinesia.

Dopamine plays an important role in controlling:

• body movements

• brain’s reward and pleasure system 

• digestion

Nerve cells (neurons) make dopamine. Dopamine is a neurotransmitter, a chemical that sends messages between nerve cells, the brain, and the body. Dopamine receptors are proteins found in the brain and nerves that receive messages from neurotransmitters. The two work together to transmit nerve signals or messages throughout the body.

People with certain mental illnesses or other health conditions may produce too much dopamine. Dopamine antagonists attach to dopamine receptors and block dopamine. This action lowers the amount of dopamine in the body.

For unknown reasons, some people who take these medications develop abnormalities in an area of the brain called the striatum. One theory is that blocking dopamine receptors causes the brain to become overly sensitive to dopamine. When exposed to any amount of dopamine, the brain responds by making exaggerated, involuntary body movements.

Who is at risk for tardive dyskinesia?

Doctors aren’t sure why some people take a medicine and then develop tardive dyskinesia, while others never have problems.

Women, older people, and Black people are more prone to tardive dyskinesia. But the condition occurs in all genders, ages, races, and ethnicities.

These factors increase your risk:

• brain injury 

• dementia

• diabetes

• history of substance abuse

• mood disorders

• positive for human immunodeficiency virus (HIV)

What mental illnesses are linked to tardive dyskinesia?

People who take medications for certain mental health problems are more likely to develop tardive dyskinesia.

These mental illnesses include:

• anxiety and depression

• attention deficit hyperactivity disorder (ADHD)

• bipolar disorder

• eating disorders

• obsessive-compulsive disorder (OCD)

• post-traumatic stress disorder (PTSD)

• psychosis

• schizophrenia

What antipsychotic medications cause tardive dyskinesia?

Approximately 1 in 4 people who use dopamine blockers for a long time to treat mental illness develop tardive dyskinesia. Older, first-generation antipsychotics (known as neuroleptics or tranquilizers) are most likely to cause this side effect.

These medications include:

• chlorpromazine

• fluphenazine

• haloperidol

• perphenazine

Less commonly, some newer, second-generation atypical antipsychotics cause tardive dyskinesia. These medications include:

• aripiprazole

• lurasidone

• olanzapine

• paliperidone

• quetiapine

• risperidone

• ziprasidone

Certain antidepressants and ADHD medications are also linked to tardive dyskinesia. These include selective serotonin uptake inhibitors (SSRIs) like fluoxetine and sertraline.

From the community: “I’m brand new to this forum and hope to learn from others. I started taking Lorazepam for anxiety after the death of my parents. My anxiety was through the roof. So my Dr gave me this medication. I was given 1 mg of Lorazepam/Adavan (just enough to take the edge off) for a total of 16 years. After serious medical/professional help to get off ...I have developed painful ugly facial grimaces. The terrible thing is I am not aware I am making faces until my face starts hurting and I can hardly see because my eyes are partiall closed from the facial grimace. I’m thinking has developed into Tardive Dyskinesia? The extensive studying I have done on Lorazepam/ Adavan shows even short periods of time have caused TD in patients, so after 16 years of taking it I’m just sick abut this.” – Inspire member

What stomach problems are linked to tardive dyskinesia?

Medications for certain gastrointestinal disorders can lead to tardive dyskinesia. These digestive problems include:

• gastroesophageal reflux disease (GERD)

• gastroparesis (slow emptying of bowels)

• vertigo and nausea

What gastrointestinal medications cause tardive dyskinesia?

Antinausea medicines (antiemetics) treat gastrointestinal disorders like GERD (sometimes called acid reflux), gastroparesis, and nausea.

One type of antiemetic, metoclopramide, is linked to respiratory tardive dyskinesia symptoms. You may gasp or have trouble breathing.

Prochlorperazine, a medicine for vertigo and nausea, may also cause tardive dyskinesia. 

What neurological conditions are linked to tardive dyskinesia?

People who take medications for certain neurological problems may develop tardive dyskinesia. These neurological conditions include:

• dementia

• Parkinson’s disease

• seizures

What other medications cause tardive dyskinesia?

Many medications can increase your risk of tardive dyskinesia. But most people take these medications, get symptom relief, and never develop tardive dyskinesia.

Other medications linked to tardive dyskinesia include:

• anxiety medications like benzodiazepines 

• antimalarial medications like hydroxychloroquine

• monoamine oxidase inhibitors (MAOIs) like selegiline for Parkinson’s disease 

• mood stabilizers like lithium for bipolar disorder

• seizure medications like carbamazepine

Can stopping medications put an end to tardive dyskinesia?

Changing medications or medication dosage sometimes alleviates tardive dyskinesia. Your doctor will work with you to find the best treatment approach. You shouldn’t make medication changes on your own. There are medications and other treatments for tardive dyskinesia.

From the community: “I have moderate TD, which manifested itself over the period of the last year or so. The TD diagnosis was made by my neurologist and psychiatrist. It became very noticeable when I started drinking after 6 years of sobriety. That slip lasted about six months and I am now about 3 months sober. My TD symptoms include: uncontrollable tongue movements, pursing of my lips, lip licking, toes wriggling, rotating my middle finger around my thumb, tightening of my adductors, tensing up the muscles controlling my feet, eyebrow raising, and constant chewing motions. The only changes that my psych made was to add Amantadine, which has somewhat lessened the movements. It seems to be wearing off.” – Inspire member

Sources

• Drug-induced dyskinesias and dystonia: Tardive syndromes. Dystonia Medical Research Foundation.

• Tardive dyskinesia. MedlinePlus. January 2021.

• Tardive dyskinesia. Mental Health America. 

• Tardive dyskinesia. Mount Sinai. June 2020.

• Tardive dyskinesia. National Alliance on Mental Illness. March 2019.

• Mental health medications. National Institute of Mental Health. October 2016.

• Tardive dyskinesia. National Organization for Rare Disorders. 2018.

• Medication-induced tardive dyskinesia: A review and update. The Ochsner Journal. 2017.

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.