Tardive dyskinesia (TD)

Explains what tardive dyskinesia is, what causes it and what you can do to manage it.

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What causes TD?

Tardive dyskinesia (TD) is an unwanted side effect of medication, most commonly antipsychotic drugs. These drugs may be part of your treatment if you have a diagnosis of:

Some other drugs used for treating physical conditions like gut problems or nausea (feeling sick) can also cause TD as a side effect. If you’d like to know more about this, you can speak to your GP or pharmacist.

I had a year-long psychosis as a teenager [...] Treating the psychosis was utterly prioritised – the side effects [of the medication] were not properly explained to me or my family as far as I can remember.

What are the risk factors?

Anyone taking antipsychotics drugs is at risk of developing TD. All drugs affect people differently; there's no way to tell in advance whether you'll get a particular side effect or not. But the following may affect your risk:

  • Which antipsychotic you take.
    • Older (first generation) antipsychotics are particularly associated with causing TD.
    • Newer (second generation) antipsychotics were developed with the intention of causing less severe movement problems as side effects, including Parkinsonism and TD. Although these newer drugs are less likely to cause TD than older antipsychotics, they can still cause TD – especially if you take them at high doses for a long time.
  • How long you've been taking it for. The longer you're on medication, the greater the risk that you might develop TD.
  • What dose you're on. The higher your dose, the greater the risk that you might develop TD.
  • Other factors. Some research suggests that the risk might also be greater if you're:
    • an older person
    • a person of African descent

TD is most common if:

  • You've been taking a moderate to high dose of antipsychotics for periods of six months to two years or more.
  • You take your medication as a depot injection (a slow-release formulation given as an injection).

TD rarely occurs if you have been taking a low dose for less than six months, although there have been a few reports of people getting TD after taking low doses for a relatively short period.

Stopping and starting antipsychotics may also contribute to the risk of TD persisting once it has developed.

(For more information about older and newer antipsychotics, side effects and what to know before starting medication, see our pages on psychiatric medication and antipsychotics.)

I firstly experienced finger and small muscle twitches and spasms which gradually got worse.

Parkinson’s symptoms and anti-Parkinsons drugs

Antipsychotics (particularly the older drugs) can also cause other side effects that affect your movement, such as:

  • symptoms that mimic Parkinson’s disease, such as shaking, stiffness, shuffling walk and restless legs
  • akathisia (extreme restlessness)

If you develop either of these side effects, you are more likely to develop TD. You are also likely to be offered anti-Parkinson’s drugs to help control these symptoms. However, anti-Parkinsons drugs themselves are also associated with the development of TD.

Anti-Parkinsons drugs aren't given out routinely; you should only be offered them if you've already developed Parkinsonism as a side effect of your antipsychotic medication, and the symptoms are very troublesome.

(For more information on anti-Parkinson's drugs and their side effects, see our page on anti-Parkinsons drugs, or visit Parkinson's UK.)

This information was published in October 2015. We will revise it in 2018.

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