Understanding Tardive Dyskinesia: A Medication Side Effect

Understanding Tardive Dyskinesia: A Medication Side Effect

Tardive dyskinesia is a disorder characterized by involuntary, repetitive body movements, often of the face and mouth. It is most commonly caused by long-term use of certain antipsychotic medications used to treat mental health conditions like schizophrenia and bipolar disorder. Learning about tardive dyskinesia can help those taking psychiatric medications identify warning signs and get appropriate treatment.

What Medications Can Cause Tardive Dyskinesia?

The medications most frequently associated with tardive dyskinesia include:

• First-generation antipsychotics like haloperidol (Haldol) and fluphenazine
• Second-generation atypical antipsychotics like risperidone (Risperdal) and olanzapine (Zyprexa)
• Metoclopramide (Reglan) - used to treat gastroesophageal reflux and nausea
• Antidepressants like amitriptyline, imipramine and nortriptyline

The risk seems highest with first-generation antipsychotics and metoclopramide. However, second-generation antipsychotics can also cause tardive dyskinesia, especially with long-term use.

Who is at Risk for Developing Tardive Dyskinesia?

Factors that increase tardive dyskinesia risk include:

• Older age
• Taking antipsychotic medications for an extended time
• High doses of antipsychotic medication
• Preexisting movement disorders
• Diabetes
• Alcohol abuse or smoking

Women seem to be at greater risk than men. The elderly are also more susceptible due to age-related changes in the brain and body's ability to process medications.

Symptoms of Tardive Dyskinesia

The main symptom is involuntary body movements, such as:

• Grimacing
• Tongue protrusion
• Puckering or smacking the lips
• Rapid eye blinking
• Chewing movements
• Twitching of the fingers or toes

These movements are typically repetitive and rhythmic. In severe cases, walking and speech can become affected. Symptoms usually develop gradually after months or years of medication use.

Diagnosing and Treating Tardive Dyskinesia

Diagnosing and properly treating tardive dyskinesia involves input from healthcare providers to manage medication and mitigate symptoms.

Getting a Diagnosis

To diagnose tardive dyskinesia, a doctor evaluates symptoms and medication history. No lab test can confirm it, but blood tests help rule out other conditions. Brain imaging scans can also be done to visualize any abnormalities.

The doctor may have the patient perform repetitive movements to see if symptoms improve briefly - a characteristic of tardive dyskinesia. Reviewing videos to observe body movements can also aid diagnosis.

Discontinuing Medications

If medications are causing tardive dyskinesia, a doctor may advise discontinuing the offending drug. However, this requires carefully weighing risks vs. benefits:

• Stopping antipsychotics can worsen psychiatric symptoms
• But continued use may exacerbate tardive dyskinesia

If antipsychotics are still needed, switching to a different one may be tried. Slowly lowering dosages can also minimize withdrawal effects.

Medications for Symptoms

Medications that may help manage tardive dyskinesia include:

• Ginkgo biloba - An herbal supplement that may reduce symptoms
• Clonazepam (Klonopin) - A benzodiazepine that can decrease abnormal movements
• Anticholinergics like diphenhydramine (Benadryl)
• Amantadine - Reduces glutamate and increases dopamine
• Tetrabenazine (Xenazine) - The only FDA approved tardive dyskinesia treatment

However, these medications also carry risks like sedation, cognitive impairment, or other side effects. Their long-term efficacy is also variable.

Botulinum Toxin Injections

Injecting small amounts of Botox directly into affected muscles can provide temporary relief from focal tardive dyskinesia symptoms. Repeated injections every 3-4 months may be needed.

Deep Brain Stimulation

For severe, unresponsive tardive dyskinesia, deep brain stimulation may be an option. This involves surgically implanting electrodes in the brain to modulate problematic signal patterns. However, this last-resort treatment carries significant risks.

Living with Tardive Dyskinesia

Those experiencing tardive dyskinesia can take steps to cope with symptoms and improve quality of life despite the challenges of this condition.

Educating Family and Friends

Explaining tardive dyskinesia to loved ones enables them to understand it is not within the person's control. Support and acceptance from family and friends is very helpful in coping.

Avoiding Triggers

Stress, fatigue, caffeine, alcohol and cold medicines can exacerbate symptoms. Avoiding triggers, when possible, prevents worsening movements.

Relaxation Techniques

While emotional states do not cause tardive dyskinesia, stress and anxiety can worsen movements. Relaxation practices like deep breathing, meditation, yoga, or Tai Chi can help induce calmness.

Low-Impact Exercise

Gentle exercises like walking, swimming, stretching, and light resistance training promote overall wellbeing. But overexertion can trigger symptoms, so moderation is key.

Proper Nutrition

Eating a balanced, nutritious diet supports good health. Key nutrients that may help reduce symptoms include vitamin E, vitamin B6, zinc, and magnesium.

Joining Support Groups

Support groups for people with movement disorders provide community, valuable coping strategies, and new treatment ideas. Consult a doctor about reputable groups.

Preventing Antipsychotic-Induced Tardive Dyskinesia

While medication-induced tardive dyskinesia cannot always be avoided, certain precautions can lower the risk.

Choosing Safer Medications

Second-generation atypical antipsychotics have a lower tardive dyskinesia risk than first-generation drugs, so starting with those is preferable when medication is needed.

Using Lowest Effective Dosage

Higher doses increase tardive dyskinesia likelihood, so doctors aim for the lowest dosage that manages symptoms effectively.

Monitoring Medication Impacts

Routine follow-up appointments allow evaluation of medication tolerance and early detection of any side effects.

Prescribing Supplemental Medications

Adding medications like benzodiazepines or mood stabilizers allows lower antipsychotic dosing. This lowers tardive dyskinesia risk.

Periodic Drug Holidays

Scheduled antipsychotic breaks under medical supervision gives the brain "reset periods" and decreases the chances of side effects.

Seeking Non-Pharmacological Therapies

Psychotherapy, social skills training, and other non-drug approaches may allow medication avoidance or minimization in certain cases.

The Outlook for Tardive Dyskinesia Patients

While there is no cure for tardive dyskinesia, the prognosis depends greatly on individual factors. Mild cases sometimes improve slowly after stopping medications. Severe, longstanding cases are less likely to resolve. With treatment and lifestyle adaptations, many can manage symptoms satisfactorily.

Close medical monitoring and patient education are key for early detection and prompt treatment. While further research is still needed, newer therapies provide hope for better management of this challenging condition moving forward.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.