Tardive dyskinesia: questions when changing medications

Tardive dyskinesia is a condition that causes involuntary movements. These can include movements that affect the face, such as chewing motions, excessive blinking, sticking out the tongue, and frowning. It can also include movements that affect other parts of the body—TD can cause a person to involuntary tap their feet, wiggle their fingers, and move their arms, legs, torso, or neck.

What causes tardive dyskinesia?

TD occurs as a side effect of medications called neuroleptics. Also known as antipsychotic medications, neuroleptics are drugs that act on the brain. More specifically, neuroleptics act on neurotransmitters. Neurotransmitters are substances released by nerve cells that send a signal to other nerve cells. They are sometimes described as “chemical messengers.”

A fairly well-known neurotransmitter is dopamine. Dopamine is released in response to experiences that are pleasurable or rewarding (though it plays a role in many different functions). Most neuroleptic medications act on dopamine receptors in the brain (though newer medications work through other mechanisms).

Neuroleptic medications are used in the treatment and management of psychiatric conditions. These medications are the main treatment for schizophrenia, a mental health condition that causes psychosis. Psychosis is a collection of symptoms that occur when the mind loses contact with reality, affecting a person’s ability to distinguish what is real and what is not.

Neuroleptics are also prescribed in the treatment of bipolar disorder, major depression, and other psychiatric conditions.

Can non-neuroleptic medications cause tardive dyskinesia?

In addition to neuroleptics, TD can be caused by certain other medications. This includes anti-seizure medications, anti-Parkinson medications, antidepressants, and some medications used to treat a stomach disorder called gastroparesis.

Questions when starting or changing a medication

Most people with TD will be living with schizophrenia or another psychiatric condition, and they will need to continue to manage that condition with neuroleptic medications.

Treatment for TD can involve changing the type of neuroleptic a person is taking, changing the dosage, and/or taking additional medications that help reduce and control symptoms of TD. Changes to medications must always be made under the guidance of a healthcare provider.

People with TD and associated conditions are also encouraged to take an active role in their healthcare and treatment decisions. With that in mind, the following list of questions can be helpful when changing medications or starting a new medication:

• What is the name of the medication I am being prescribed?
• What dosage am I being prescribed?
• How does this medication work? What are the goals of taking this medication?
• How is the medication taken and how often will I need to take it?
• How will we know if the medication is working? What happens if this medication does not work?
• What are the potential side effects of taking this medication? Is there a risk of serious side effects?
• How can I expect to feel when taking this medication?
• Is there anything I need to avoid while taking this medication?
• Who can I talk to if I have concerns about the cost of this medication
• Can this medication interact with other medications I am currently taking? Keep a list of all medications you take, including prescriptions, over-the-counter medications, and supplements (including herbal supplements).