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Tardive dyskinesia (TD)

Find information on what tardive dyskinesia is, what causes it and what you can do to manage it.

What causes tardive dyskinesia?

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

TD can also be a side effect of other drugs used for treating physical conditions.

It is thought that TD develops because of the way these medications change levels of the chemical dopamine in your brain.

Risk factors in developing tardive dyskinesia

Anyone taking antipsychotic drugs is at risk of developing TD. It's listed as a common or very common side effect for antipsychotic medication. All drugs affect people differently, so it's not possible to tell whether you will get a particular side effect. But the main risk factors are:

  • How long you have been taking antipsychotic medication. The longer you are on medication, the greater the risk that you might develop TD.
  • What dose you are on. Taking a higher dose makes developing TD more likely.
  • Which antipsychotic you take. Older antipsychotics – known as first-generation – are particularly associated with causing TD. Newer antipsychotics – known as second-generation – were developed with the aim of reducing side effects like TD, but can still cause it. Although medical professionals think newer drugs are less likely to cause TD, the difference is still unclear.

Once you have TD, stopping and starting antipsychotics can also increase the risk of it becoming more severe. It's very important to talk to a doctor before deciding to come off medication. It is also possible to develop TD after you stop taking medication.

Some research suggests that you may be more likely to develop TD if you:

  • are over the age of 50
  • are female
  • are post-menopause
  • are Black
  • have a drug or alcohol addiction
  • have diabetes
  • have a learning disability
  • have a brain injury.

The risk may be greater if more than one of these applies to you.

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

Parkinson's symptoms and drugs

Antipsychotics – particularly older, first-generation ones – can also cause other side effects that affect your movement. For example:

  • symptoms that mimic Parkinson's disease, such as shaking, stiffness, slow movements and restless legs – also called Parkinsonism
  • akathisia, which means extreme restlessness.

If you develop either of these side effects, you may be more likely to develop TD. You're also likely to be offered anti-Parkinson's drugs to help control these symptoms.

However, anti-Parkinson's drugs themselves are also associated with the development of TD.

You should only be offered anti-Parkinson's drugs if:

  • you have already developed Parkinsonism as a side effect of your antipsychotic medication
  • the symptoms are very troublesome.

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

This information was published in December 2021. We will revise it in 2024.

References and bibliography available on request.

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