Treating Tardive Dyskinesia

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Antipsychotic Medication: What Caregivers Need to Know

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According to some estimates, up to 3.5% of the population of the United States experiences psychosis at some point in their lives. The term psychosis describes a group of medical conditions affecting the brain, resulting in symptoms such as visual or auditory hallucinations, delusions, strange or bizarre thinking, and abnormal behaviors or emotions. Psychosis can be present in several conditions, such as schizophrenia, bipolar disorder, and even depression.

It isn’t easy living with a condition that causes psychosis. However, there are several antipsychotic drugs on the market today to help people manage symptoms so they can live as normally as possible. If you know someone taking antipsychotic drugs, it’s important to know how they work and what side effects to watch out for. Some serious side effects, like tardive dyskinesia (TD)–a movement disorder involving involuntary, repetitive movements–should be reported to a doctor immediately.

How Antipsychotic Drugs Work

Many conditions causing psychosis have been shown to result from increased dopamine activity inside the brain. Dopamine is a neurotransmitter that plays a role in how humans feel pleasure and other emotions, and it helps manage the brain’s reward system.

Generally, antipsychotic drugs are divided into two classes: conventional and second-generation antipsychotics–also referred to as atypical antipsychotics. Conventional antipsychotics work by blocking dopamine receptors in the brain. This means dopamine is less effective which, in turn, lessens symptoms such as hallucinations or delusions. This category of antipsychotics includes haloperidol (Haldol), chlorpromazine (Thorazine), and mesoridazine (Serentil).

Most antipsychotic medications prescribed in the U.S. are second-generation drugs—these medications also block dopamine, but they do it more selectively than conventional antipsychotics, meaning they bind to fewer dopamine receptors and target serotonin, a different receptor. For many people, this means they’re much more effective. Also, second-generation antipsychotic medications are typically less likely to cause side effects, including tardive dyskinesia. Examples of second-generation antipsychotics include aripiprazole (Abilify), clozapine (Clozaril), and quetiapine (Seroquel).

Antipsychotic Side Effects

Side effects are possible depending on the type of antipsychotic drug a person takes. Antipsychotic side effects may include problems like:

  • Blurred vision
  • Constipation, nausea, or vomiting
  • Dizziness, drowsiness, or dulled thinking
  • Low blood pressure
  • Metabolic syndrome
  • Sedation
  • Seizures
  • Uncontrolled muscle movement
  • Weight gain

Side effects like these are more likely to occur with conventional antipsychotics, but keep in mind they may occur even with second-generation drugs.

Understanding Tardive Dyskinesia

Caregivers of people with psychiatric conditions like schizophrenia, bipolar disorder, and depression should know that continued, long-term use of antipsychotic medications can cause tardive dyskinesia. Even people who take antipsychotics for shorter periods of time are at risk. If you’re caring for someone with tardive dyskinesia, you may notice the person can’t control some of their movements. They may pucker or smack their lips repeatedly, or they may seem to have no control over the movement of their arms and legs.

Tardive dyskinesia is more likely to occur the longer someone takes an antipsychotic medication. Other factors which may increase the likelihood of this condition include:

  • Being age 55 or older
  • Being a woman
  • Having other medical disorders, such as diabetes, mood disorders, or dementia
  • Having a history of alcohol or drug abuse

In a small number of cases, tardive dyskinesia symptoms are severe and disturbing. Unfortunately, for some people these symptoms won’t go away even with treatment.

However, there are treatments available to help others manage these symptoms. In some cases, tardive dyskinesia may go away simply by stopping or changing the medication being used–although it’s important to note these drugs should never be stopped “cold turkey” or without a doctor’s guidance. Other people benefit from drugs that help reduce tardive dyskinesia symptoms, such as drugs called vesicular monoamine transporter 2 (VMAT2) inhibitors like valbenazine (Ingrezza) and deutetrabenazine (Austedo), and even botulinum toxin (Botox) injections.

Following Up With a Doctor

Regular visits with a psychiatrist are the best way to help avoid problems like tardive dyskinesia. These visits give doctors a chance to check in with the person taking antipsychotic drugs to determine how well the drugs are working and whether or not they’re causing any troubling side effects.

Caregivers of people who take antipsychotic medications should also be familiar with potential side effects to watch out for. Since, for some, tardive dyskinesia symptoms won’t go away, any unusual or problematic symptoms should be reported to the patient’s doctor immediately.

Caring for someone taking antipsychotic medications can be challenging, but it’s possible to help the person live as normally as possible through effective symptom management. If you’re concerned about a friend or loved one who is taking antipsychotic drugs, it’s best to contact their doctor for advice.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 3
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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