Symptoms Causes and Treatments of Tardive Dyskinesia

When managing a chronic mental illness, the right medication can change everything. Sadly, several long-term meds, in particular those prescribed for psychiatric illnesses, can bring on some unexpected and alarming side effects. The worst of which is tardive dyskinesia (TD).

If you or a loved one has recently developed strange, involuntary body movements while on psychiatric medications, you likely have many questions: What is TD? Can TD be reversed? What can be done about it? Here we will review all your TD-related concerns, including symptoms, causes, diagnosis, treatment, and self-care techniques.

What is Tardive Dyskinesia?

Tardive dyskinesia, or TD, is a neurological condition that results in involuntary and rhythmic muscle movements. “Tardive” refers to the fact that the condition usually takes months or years to occur, and “dyskinesia” refers to impaired or abnormal movement. Most of the time, it occurs in patients on specific medications for a long period.

Typically, the TD movement is concerned with the muscles of the face, mouth, and tongue. It may also be expressed as movements within the trunk or limbs of the body. A TD is an involuntary movement in that the sufferer has no voluntary control over it and is unable to cease it. While TD may be of minor nuisance value to some, it can drastically interfere with a patient’s life quality, comfort, and social life. So, MAVA Behavioral Health is also available for convenient virtual health services from the privacy of your own home.

Tardive Dyskinesia Symptoms

You might not initially notice the early symptoms of TD, as the movements are quite slight at the beginning. They do, however, have a tendency to become more noticeable as time passes. You will most commonly find:

• Fluttering and smacking of the lips
• Chewing with jaw movements from side to side
• Blinking excessively
• Grinding of teeth
• Fasciculations (twitching) of the tongue
• Quick wiggling movements of the fingers
• Repetitive foot or ankle movements
• Rocking/jerking of the hips, pelvis or torso

Tardive Dyskinesia Causes

Here are the causes of tardive dyskinesia:

• Long-term use of antipsychotic medications
• High-dose or extended treatment with neuroleptic drugs
• Older age increasing sensitivity to side effects
• Female gender as a higher risk factor in some cases
• History of psychiatric or mood disorders
• Underlying diabetes or metabolic conditions
• Changes in brain dopamine receptor sensitivity
• Genetic and lifestyle factors contributing to risk

The Dopamine Connection

This happens because these medicines interfere with dopamine, a substance in our brain that governs our moods, our thinking processes and our movements. Our brains change over time and, with the use of these medicines, the reduced level of dopamine is tolerated, and they get less responsive to the medicine.

This can lead to movements that the person can’t control – movements like jerks and twitches, known as Tardive Dyskinesia (TD). Some patients have even found these movements persisting even when they discontinue the medication and their brain trying to renormalize itself to some extent. For some, these movements can even last permanently. Fortunately, there are ways of avoiding the problem, such as by identifying and treating TD at the earliest stage.

High-Risk Medications

Here are the categories of drugs and conditions that can contribute to TD, broken down simply for a blog:

1. First-Generation Antipsychotics (Also Called Typical)

These are some older medications, including haloperidol, fluphenazine, and chlorpromazine. Even though these aren’t as commonly prescribed nowadays, they are the type with the highest risk of causing TD.

2. Second-Generation Antipsychotics (Also Called Atypical )

The medications prescribed more often these days – think risperidone, olanzapine, and aripiprazole – usually carry a lower risk. However, it’s still possible for them to cause TD.

3. Gastrointestinal Medications

And while antipsychotics are a common culprit, TD isn’t always their fault! Any drug that blocks dopamine, even when taken to manage issues like acid reflux or gastroparesis, can cause TD.

Test for Tardive Dyskinesia: How is it Diagnosed?

Unfortunately, you can’t just do a simple blood test or brain scan in the lab and diagnose tardive dyskinesia. The diagnosis is made solely on clinical presentation, based on a physical exam and history, done by a neurologist or psychiatrist.

The AIMS Assessment

If you need to check and monitor for TD, there isn’t a better test than the AIMS scale. The AIMS scale is a doctor giving you a checkup while at rest and while performing certain movements, then rating the severity of involuntary movements in all parts of the body.

Face, mouth, chest, arms, and legs. Doctors say it’s important to stay one step ahead and take the AIMS scale every 3-6 months while being on the long-term antipsychotic medication.
Also, so the cause isn’t anything else, other neurological checks will be done to rule out Parkinson’s, Huntington’s, tremors, etc.

Tardive Dyskinesia Treatments

If you’re diagnosed with TD, your doctor will prepare a treatment plan specifically for you. There are two main objectives that the doctor hopes to achieve through this treatment plan: to reduce movements and stabilize mental health illness.

• Dose Reduction: Reducing the dose of antipsychotic medication prescribed while keeping the illness stabilized.
• Medication Switching: Switching from a first-generation antipsychotic to a second-generation atypical antipsychotic (such as clozapine), which has an improved risk profile.

Medication for Tardive Dyskinesia

Over the past few years, a new, highly effective FDA-approved medication that specifically targets tardive dyskinesia was developed.

These medications are from a class of drugs that are known as VMAT2 inhibitors (Vesicular Monoamine Transporter 2 inhibitors), which are used to reduce the level of dopamine released into movement-regulating portions of the brain to help lessen involuntary muscle contractions.

• Valbenazine: A once-daily oral medication management proven to improve tardive dyskinesia and well-tolerated by most patients.
• Deutetrabenazine: A medication taken twice daily that controls dopamine targetingly, thereby giving smooth movement control without involuntary movements.

Your doctor will assess your health status and current medications and prescribe the proper VMAT2 inhibitor for you.

How to Reverse Tardive Dyskinesia

Many patients often ask, Is there a cure for tardive dyskinesia, or is it reversible?

• In cases where it is caught early enough and medication has been safely titrated down or swapped, symptoms may slowly diminish or eventually disappear entirely.
• If left for several years, the neurological changes may become irreversible. Even if the case is unable to be fully reversed, newer VMAT2 inhibitor medications along with other therapies are incredibly effective at treating symptom severity.

Tardive Dyskinesia Self-Care and Living with the Condition

Daily challenges for someone experiencing tardive dyskinesia often include emotional and physical struggles. There are some lifestyle modifications and self-care practices that can be put in place to increase physical comfort, reduce stress, and enhance self-esteem.

Physical Self-Care Strategies

• Prioritize sufficient sleep: Lack of sleep amplifies involuntary movements. Get into a regular sleeping routine and optimize your sleeping environment.
• Participate in physical activity: Low-impact activities such as walking, swimming, or yoga are great for improving coordination and flexibility of the muscles.
• Practice mindful eating: Eat soft food in smaller bites and ensure you stay hydrated if chewing is difficult due to movement of the mouth.
  

Emotional and Mental Wellness

• Control Your Stress: When people get stressed, there’s a rush of dopamine, which causes more prominent TD movements. Try some daily relaxation techniques like breathing exercises, meditation, or progressive muscle relaxation.
• Get Social Support: Support communities and educational advocacy groups can help you find others going through the same things. By comparing experiences, you can avoid feelings of loneliness and self-consciousness with TD.

Final Thoughts

Taking good care of your mind and emotions are key factors in creating a well-balanced and enjoyable life. Having access to services from caring, competent professional caregivers can greatly improve your life and those of people around you who are experiencing stress, anxiety, depression, and behavioral health issues. Helping professions like MAVA Behavioral Health are there to provide individualized, evidence-based treatment with a gentle, healing touch. Asking for help isn’t a sign of weakness; it is a sign of strength and a key factor in recovery and resilience.

Everyone has access to healthy coping mechanisms and community support to learn better emotional management, improve life quality, and achieve long-term stability today and always. Reducing stigmas surrounding mental health through education and conversation gives more individuals access to the help they need. Thus, behavioral health care creates healthier individuals, families, and communities today, always.

FAQs

1. How long does it take to develop TD?

In most cases, TD will occur after months to years of taking antipsychotic medications regularly. However, in susceptible individuals, especially in the elderly, TD can occur in just a few weeks of taking the medication.

2. Can the use of vitamins or natural supplements be effective in managing TD?

There is some research that suggests that large amounts of either vitamin E or vitamin B6 can be somewhat effective in ameliorating mild TD because of the antioxidant effects they provide. However, they are not nearly as effective as medication, and one should consult a doctor before starting a course of any vitamin or supplement.

3. Is TD painful?

The movements themselves are generally an annoyance to the individual with TD, as are the embarrassing side effects, but they are not painful. However, with severe instances of TD, such as biting the tongue consistently, clenching the jaw until it hurts, or extreme twisting.

4. How do TD and Parkinsonism differ?

Both are dopamine-related movement disorders, but they look very different. Parkinsonism involves rigid muscles, a resting tremor, and slowed movements.

5. Will switching to a newer antipsychotic fix my TD?

Switching to a second-generation (atypical) antipsychotic often lowers the severity of TD symptoms over time because these drugs block dopamine less intensely. However, it does not guarantee immediate reversal, and the change must be managed carefully by a psychiatrist.