Signs and Symptoms of Tardive Dyskinesia

Tardive dyskinesia is a movement disorder that affects the nervous system, causing symptoms like abnormal and involuntary movements in the face, limbs, and throughout the whole body. The involuntary movements include jerking hand movements, neck twisting, gait changes, and eye blinking, among many others.

Tardive dyskinesia is caused by antipsychotic medications used to treat mental health conditions like schizophrenia, depression, and bipolar disorder. Antipsychotic medications work by blocking receptors that receive dopamine, a chemical signal in the brain that controls emotion, behavior, and movement. Tardive dyskinesia affects approximately 5-7% of people who use antipsychotic medications.

Symptoms of tardive dyskinesia typically begin gradually and worsen over time. It is possible to experience symptoms just a few months after the start of antipsychotic medication treatment. These involuntary movements can affect day-to-day activities, which can significantly impact your quality of life.

Symptoms of tardive dyskinesia can be reversed if they are diagnosed early and antipsychotic medication treatment is stopped or adjusted. In some cases, symptoms can continue and may not be reversed even if you have stopped taking the medication. Luckily, there are treatment options to help treat tardive dyskinesia symptoms, which can improve your quality of life and allow for continued use of antipsychotic medication.

Symptom Types

The involuntary movement symptoms caused by tardive dyskinesia can be divided up into three major categories: involuntary facial movements, involuntary limb and body movements, and other rare muscle and motor movements. These symptoms can affect any person who is using antipsychotic medications for a long period of time.

Symptoms are worsened with prolonged medication use and usually affect older adults. These types of involuntary movements can happen independently of each other or all at the same time.

Involuntary Facial Movements

Involuntary facial movements involve all aspects of the face, including, mouth, eyes, cheeks, and tongue. Approximately 75% of people with tardive dyskinesia experience involuntary facial movements. Some examples of involuntary facial movement symptoms include:

• Facial grimacing involving lower facial muscles
• Protruding and twisting tongue movements
• Puckering and/or smacking lips repeatedly
• Moving the corners of your mouth back and forth
• Bulging cheeks
• Repetitive chewing movements
• Jaw swinging
• Eye blinking and grimacing
• Blepharospasms (eye twitching)

These facial symptoms are also known as oro-bucco-lingual symptoms. Because these involuntary movements affect the mouth, sometimes people with tardive dyskinesia can experience difficulty speaking, eating, and swallowing. If they become serious, these facial movements can also lead to mouth pain and jaw issues. 

Involuntary Limb and Torso Movements

Involuntary limb and torso movement symptoms are more commonly seen in younger people with tardive dyskinesia. These symptoms affect the whole body and can result in issues with posture, gait (the way you walk), and overall mobility. Some examples of involuntary limb and body movements caused by tardive dyskinesia include:

• Jerking hand and leg movements
• Spreading fingers and “piano-playing”-like finger movements
• Foot tapping
• Shoulder shrugging or a stiff neck
• Rocking and swaying movements
• Sudden hip rotations and thrusting
• Rigid foot and leg postures

Involuntary movement symptoms that affect the legs can result in instability while walking, which increases your risk of falling. These involuntary limb and body movements can also cause non-life-threatening irregular breathing.

Other Rare Involuntary Muscle and Motor Movements

These symptoms are rare and varied and usually involve muscle contractions and/or repeated movements. Some examples include dystonia and akathisia.

Dystonia is a sustained and uncontrollable muscle contraction. These contractions often result in twisting, repetitive motions, and having limbs become stuck in abnormal positions. Akathisia is known as general limb restlessness. Examples of akathisia include repeated leg crossing, constantly shifting weight from one foot to another, and stepping in place.

These symptoms usually affect people with tardive dyskinesia younger than 40 years old. They usually coexist with one another and can worsen limb, body, and facial symptoms. 

Symptoms in Children

Studies suggest that children are at a lower risk of developing tardive dyskinesia than adults. The few studies that have looked at tardive dyskinesia reveal that symptoms are usually mild and are mostly confined to choreiform neck movements (also called chorea)—jerking and writhing movements in the neck.

Symptoms in Men/Women

There is no difference in the type of tardive dyskinesia symptoms that affect men/women. However, there are some studies that suggest that women are at a higher risk of developing tardive dyskinesia than men.

According to a 2017 review, postmenopausal women might be at a higher risk of developing tardive dyskinesia. This may be due to some yet-to-be-understood interactions between dopamine and estrogen, the primary reproductive hormone in people assigned female at birth. 

While women might be more susceptible to developing tardive dyskinesia symptoms, men seem to develop symptoms earlier. A 2023 review states that, on average, men present symptoms at a lower age (34 years) than women (44 years).

More studies need to be performed to fully understand sex-based differences in tardive dyskinesia symptoms.

When to Contact a Healthcare Provider

Tardive dyskinesia symptoms can start happening as early as 6 weeks after beginning antipsychotic medications. Therefore, you should contact your medical provider immediately if you start presenting with some of the most common symptoms of tardive dyskinesia soon after taking antipsychotic medications. These symptoms include:

• Facial grimacing involving lower facial muscles
• Finger piano playing-like movements
• Rocking or thrusting of the hips
• Jaw swinging
• Repetitive chewing
• Rapid eye blinking
• Tongue thrusting
• Restlessness
  

A Quick Review

Tardive dyskinesia is a condition caused by antipsychotic medications which results in abnormal and uncontrollable movements in the face, torso, and limbs. Common symptoms include facial grimacing, abnormal finger movements, jaw swinging, rapid eye blinking, among many others.

Symptoms can start our gradually and worsen over time. Symptoms can start as early as 6 weeks after taking antipsychotic medications for the first time and symptoms are typically worse for those who have used antipsychotic medications for long periods of time. While symptoms in men and women are the same, women seem to be at a higher risk of developing symptoms, while men on average experience symptoms earlier while women.

If you or a loved one is experiencing involuntary movements soon after taking antipsychotic medications, contact your healthcare provider for an evaluation and a potential change in medication regimen.