What Are the Leading Causes of Tardive Dyskinesia?

Lisa VitaliseLast Updated Sep 15, 2020 12:15:42 PM ET
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The neurological syndrome known as tardive dyskinesia is caused by the long-term use of medications used for psychiatric treatment (neuroleptic drugs). The term "tardive" means delayed, and "dyskinesia" refers to unusual movement. Therefore, "tardive dyskinesia," a term coined in 1964, refers to the period between the initial use of the harmful drug and the onset of involuntary muscle movements.

The types of repetitive and involuntary movements related to tardive dyskinesia include grimacing, rapid eye blinking, tongue protrusion, lip smacking, puckering or pursing the lips and repetitive chewing. Tardive dyskinesia (TD) is most likely to affect patients with schizophrenia, bipolar disorder or schizoaffective disorder. These patients are generally treated with antipsychotic medications for long periods.

Tardive dyskinesia also occasionally manifests in other patients. Those with fetal alcohol syndrome, developmental disabilities and other brain disorders are susceptible to the development of TD, despite receiving only one dose of the causative agent. Here’s a look at some of the leading causes of TD.

Antidepressant Drugs

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Antidepressants include a variety of drugs used to treat depression and other mental health disorders. They are designed to alter the chemicals (neurotransmitters) that influence mood and emotions in the brain and are among the most widely used medications. Some common antidepressant drugs associated with TD include fluoxetine, amitriptyline, sertraline, phenelzine and trazodone.

Some people with moderate to severe depression agree that therapy, self-help strategies and regular exercise work almost as well or even better than medication at decreasing their symptoms, and these methods don’t result in side effects. Moreover, if you choose to take antidepressant drugs, you should also pursue therapy and diet changes that can help you address the underlying issues contributing to your depression.

Antiseizure or Anticonvulsant Drugs

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According to the World Health Organization, approximately 70% of people dealing with epilepsy can live without seizures with the proper diagnosis and treatment. However, as there isn't a cure for seizure disorders, most people need to continue taking anticonvulsant drugs as an extra precaution. Phenobarbital, carbamazepine and phenytoin are some of the leading anticonvulsant drugs associated with tardive dyskinesia.

It's essential to have a seizure diary for tracking your seizures, as it helps monitor your treatment efficacy. You could also use it to document any medications you missed, side effects, ailments and doctor's appointments. Most antiseizure drugs require routine checkups of your blood pressure and simple blood analysis.

Antiparkinson Drugs

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Antiparkinson agents are used to treat Parkinson's disease symptoms, among other related disorders. These drugs operate on the dopaminergic system in the striatum and basal ganglia. Generally, they are centrally located and are muscarinic antagonists. Levodopa, amantadine and dopamine agonists are the most common antiparkinson drugs that cause tardive dyskinesia.

The major side effect related to high doses of levodopa is an increased likelihood of schizophrenia-like episodes, possibly due to the resulting dopamine synthesis. Furthermore, the use of levodopa to combat Parkinson's disease is not the revolutionary treatment it was once believed to be, but it is a useful step that modifies the disorder's symptoms.

Metoclopramide

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According to one Food and Drug Administration (FDA) analysis of the utilization of patterns, approximately 20% of patients who used metoclopramide for gastroesophageal reflux disease (GERD) took it longer than three months. The risk of developing TD increased with longer medication periods and the total overall dosage. For this reason, treatment with metoclopramide for more than the prescribed 12 weeks is discouraged, except in extreme instances where the therapeutic gain is believed to outweigh the chances of developing TD.

Metoclopramide itself can suppress TD symptoms, ultimately masking the underlying disease process. Hence, the drug shouldn't be used for the symptomatic monitoring of TD. Apart from tardive dyskinesia and GERD, metoclopramide is also used in the treatment of stomach problems like gastroparesis.

Older Antipsychotics Drugs

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Various neuroleptics are also considered to be major tranquilizers and are used to treat mental health issues. Examples of such drugs include chlorpromazine, fluphenazine, haloperidol, perphenazine, prochlorperazine, thioridazine and trifluoperazine. The longer you take these medicines, the higher the chances are of developing TD. Patients who use older versions of antipsychotics drugs (first generation) are more likely to develop TD versus patients who take newer medications.