Tardive Dyskinesia

Written by Keri Wiginton, Alicia Racelis, PhD
Medically Reviewed by Brunilda Nazario, MD on November 06, 2025
17 min read

Tardive dyskinesia (TD) is an involuntary movement condition, meaning you can't control your movements. "Tardive" means late, and "dyskinesia" means uncontrolled movements. 

It's often a side effect of medication that blocks dopamine. That's a brain chemical that helps your nerves and body function.  

“Tardive dyskinesia is really an umbrella term for a number of involuntary movements that affect the face, mouth, trunk, or other muscles in the body,” says Aderonke Pederson, MD, assistant professor of psychiatry at Harvard Medical School and Massachusetts General Hospital. “Sometimes it can be very subtle when it starts.” 

Because TD can take months or even years to appear, it’s sometimes hard to diagnose. When it does, you may have stiff or jerky movements in your face or body. You might blink often, stick out your tongue, or move your arms or legs without meaning to. 

TD is most often linked to certain antipsychotic or antiemetic medicines. Antipsychotics treat mental health conditions  such as schizophrenia or bipolar disorder. Antiemetics prevent nausea and vomiting.  

Not everyone who takes these medications will get tardive dyskinesia. But if it happens, TD can sometimes last even after stopping the drug. That’s why it’s important to tell your doctor right away if you notice new or uncontrollable movements after starting a drug or changing the dose. 

Your doctor can help find out what’s causing the movements and adjust your treatment safely. They may lower your dose, switch you to another medication, or add a drug to help manage TD symptoms. 

“The hope is always to catch those side effects and address them early because we have alternative options to medications," Pederson says. 

Tardive dyskinesia can be different for everyone. It's a complex health condition causing stiff, uncontrolled, repeated movement. TD can affect the muscles in your face (orofacial dyskinesia) or your arms and legs (dyskinesia of the limbs). 

Orofacial dyskinesia or oro-bucco-lingual dyskinesia. These are uncontrolled movements in your face — namely your lips, jaw, or tongue. 

The muscles in your face might cause you to:  

  • Stick out your tongue without trying 
  • Blink your eyes fast or twitch 
  • Chew, smack, or pucker your lips
  • Puff out your cheeks 
  • Frown
  • Grunt

Dyskinesia of the limbs. It can affect your arms, legs, fingers, and toes. TD can cause your muscles to:  

  • Wiggle your fingers, sometimes called "piano-playing" 
  • Tap your feet 
  • Flap your arms 
  • Cross your legs repeatedly 
  • Shrug your shoulders 
  • Twist or stretch your neck 
  • Thrust out your pelvis 
  • Sway from side to side 

These movements can be fast or slow. You may find it hard to work and stay active. 

Some antipsychotic medicine can cause your TD. These medications treat schizophrenia, bipolar disorder, and other brain conditions. Doctors also call them neuroleptic medicines. They lower or calm your nerve function. 

Because these medicines can block dopamine, your nerve cells may not talk to each other as well. Nerve cells help you move your muscles. So if dopamine drops too low, your movements can be jerky or out of control.  

Symptoms may not show up for three months or more after taking these medications. But there have been rare cases of TD after a single dose. 

Older versions of antipsychotics are more likely to cause this issue than newer (second generation) ones. Some studies find the same risk from both types, though.  

Antipsychotic medications that can cause TD include:  

  • Fluphenazine 
  • Haloperidol (Haldol) 
  • Olanzapine (Zyprexa) 
  • Risperidone (Risperdal) 

The longer you take these medicines, the higher your chances of getting TD.  

Some medicines that treat nausea, reflux, and other stomach problems (antiemetics) can also cause TD. You might notice symptoms after three months or more. Some of these medicines include:  

  • Metoclopramide (Reglan) 
  • Prochlorperazine (Compazine) 

Risk factors for tardive dyskinesia

Research is ongoing, but some genetic factors can also raise your risk for TD. And you're more likely to get it if you:  

  • Are a woman, especially if you've gone through menopause 
  • Are over 40 years old, and the risk gets higher after age 65 
  • Have other medical conditions such as dementia, diabetes, or intellectual disability 
  • Have a mental health condition such as schizophrenia or bipolar disorder 
  • Are a Black American 
  • Have a history of substance or alcohol abuse 

The longer you take a dopamine-blocking medication, such as an antipsychotic, the higher your risk of developing TD.

 

 

 

TD can be hard to diagnose. Symptoms might not appear for months or years after you take the medicine. Or you might first notice the movements after you’ve already stopped the medicine. The timing can make it hard to know which medicine caused your symptoms. 

“Tardive dyskinesia is a clinical diagnosis. There isn’t one test or scan that tells us you have it,” Pederson says. “We have to rule out other neurological problems first, like Hungtington’s or stroke, and base it on observations, patient history, and medication history.” 

Abnormal Involuntary Movement Scale (AIMS). If you take medicine for mental health conditions, your doctor should check you for TD symptoms at least once a year. After reviewing your medical history, they can give you a physical exam called the Abnormal Involuntary Movement Scale. The AIMS helps them rate any abnormal movements.  

They can also do tests to see if you have another medical condition that may cause your movements, like:  

To rule out these conditions, you may get:  

  • Neurological exams to check your thinking, muscle tone, and coordination 
  • Blood tests 
  • Imaging scans of your brain, such as a CT or MRI scan

Clinician's Tardive Inventory (CTI) and Tardive Dyskinesia Impact Scale (TDIS). Research is ongoing, but the CTI looks at how your eyes, legs, and arms move. It works out how often involuntary movements happen and asks about other parts of your body, too. The test also asks you how TD affects your social and daily activity.  

The TDIS lets you answer questions about TD. You'll likely talk about your social, physical, and emotional health. These tests help your doctor figure out the best treatment for your TD.  

The goal of treatment is to manage symptoms and prevent them from getting worse. When you start something new, ask about possible side effects and how to spot them early. The benefits of your medicine should always outweigh its risks.

If you notice new or worsening movements, let your doctor know. But don't stop taking your medicine on your own. “Self-tapering a medication could be dangerous,” Pederson says. 

Your doctor can help you safely adjust your treatment plan. They may:

Adjust your dose. Sometimes lowering your dose can help lessen TD symptoms. Follow your doctor’s instructions carefully, since changes may take several weeks to show improvement. Your symptoms may get worse before they get better, and your doctor might briefly adjust your medicine again before lowering it. 

“The conversation of do we lower the dose or stop the medication is usually where we start,” Pederson says. “What is the minimal necessary dose to treat your condition where we're not going to cause side effects unnecessarily?”

Switch your medication. If your doctor thinks a certain drug is causing TD, they might change you to a  different one. Some newer medications are less likely to cause involuntary movements. Whatever you take, your doctor will monitor your progress closely and watch for early signs of TD.

“If you’re on Haldol and your symptoms are well-controlled, can we switch you to a second-generation medication?” Pederson says. “They can cause target dyskinesia, but less so than the first-generation class of antipsychotics.” 

Add another medication. If TD symptoms continue, your doctor may prescribe a medication specifically designed to treat them. These include a group of drugs called VMAT2 inhibitors. These medicines help calm involuntary movements by lowering extra dopamine activity in the brain. 

Common VMAT2 inhibitors used to treat TD include:   

  • Deutetrabenazine (Austedo) 
  • Valbenazine (Ingrezza) 

Your doctor may also use an off-label medicine called tetrabenazine (Xenazine). It’s an older VMA2 inhibitor that works in a similar way. 

These medications can sometimes cause drowsiness and, in some people, may affect mood. If you have Huntington's disease, for example, deutetrabenazine may boost your odds of depression. 

Try targeted treatments. If you have tardive dyskinesia in only one part of your body, your doctor might suggest botulinum toxin (Botox) shots. These help relax muscles and reduce twitching by blocking nerve signals in the affected area. 

Consider brain stimulation. If your TD symptoms are constant, your doctor might also suggest deep brain stimulation (DBS). DBS can help Parkinson's and may also help ease TD symptoms. If other TD treatments aren't working, ask your doctor about advanced options like DBS.

Taking supplements. There's no proof that natural remedies can treat your symptoms, but some might help with movements. 

They include:  

Talk to your doctor before you take any supplements for your symptoms. 

 

 

Usually, tardive dyskinesia is a long-term medical condition. But your TD symptoms can go into remission, meaning your symptoms might go away. If you're taking an antipsychotic or antiemetic medication, watch for TD signs.  

“It’s possible that even when you lower the dose or stop the medication, TD might not go away,” Pederson says. “That’s why early detection and follow-up are so important.” 

Tell your doctor right away if you notice any uncontrolled movements. Early diagnosis gives you the best chance for treatment and remission. Your doctor can help you decide on the best treatment option.

It can be hard to take in everything about tardive dyskinesia (TD) at once. Having questions ready can help you get the answers you need. If doctor visits feel overwhelming, bring a family member or friend. They can take notes or listen for details you might miss. 

Understanding your condition:

  • What caused my TD?
  • Could another health problem or medication be contributing to my movements?
  • Can my symptoms improve if I stop or change my medication?
  • How long will it take to see improvement?

Managing treatment and follow-up:

  • What treatment options are available for me?
  • What side effects should I expect from treatment?
  • Do I need to stay on this dose indefinitely?
  • Should we adjust my medication as I get older?
  • If I’ve been on this medicine for years, should we recheck for side effects?
  • What symptoms should I look out for after starting or changing a dose?
  • Could I benefit from seeing a movement disorder specialist?

Daily life and support:

  • Will TD affect my ability to drive, work, or do everyday activities?
  • What can help if my movements don’t fully go away?
  • Are there lifestyle changes that might help with symptoms?
  • If I don’t see a psychiatrist often, who can help me monitor TD?
  • Are there therapists or support groups that can help me cope emotionally?

If you’re being treated for schizophrenia, depression, bipolar disorder, or another condition, ask how your care team will balance both your mental and physical health needs. 

Tardive dyskinesia may get missed or mislabeled by regular doctors. Because it can overlap with other movement disorders or health conditions, it helps to see a provider who knows what to look for. 

Use these tips to find the right care: 

See a specialist. Start with the doctor who manages your meds. Ask how familiar they are with TD. If the answer is “not very,” ask for a referral to a psychiatrist or neurologist who treats movement disorders. These experts can confirm your diagnosis, rule out other causes, and help fine-tune your treatment plan. 

Look for specialty centers. Large academic hospitals and movement-disorder clinics often have teams that include psychiatrists, neurologists, and pharmacists. These centers stay current on the latest TD treatments and can coordinate care. 

Ask about collaboration. TD care works best when all your doctors talk to each other, especially your psychiatry and neurology teams. They should regularly share notes on medication choices, side-effect management, and symptom tracking. 

Use trusted directories. Groups like the American Psychiatric Association, American Academy of Neurology, Dystonia Foundation, National Organization for Tardive Dyskinesia, and the International Parkinson and Movement Disorder Society can help you find qualified providers.

Meet virtually. Even one visit with a specialist can help confirm your diagnosis and shape your treatment plan. If you don’t have a center near you, ask if telehealth is an option. 

 

 

Tardive dyskinesia can affect different parts of the body and may cause physical, social, and emotional challenges. Even mild problems can affect your quality of life. 

“We don’t think about our pinky until it gets hit or our little toe until we stub it. And then it’s like, wow, this is really annoying and psychologically impactful," Pederson says. “So the effects of TD is something we certainly take very seriously and worry about.”  

Possible complications may include: 

Movement and balance changes. TD can affect how you walk, stand, or move your arms. Severe cases can raise your risk for falls or hip injuries.

Speech problems. Movements of the face, lips, or tongue can make speech harder to understand or less natural. 

Breathing or swallowing issues. Involuntary movements involving throat or chest muscles can cause choking, coughing, or, in rare cases, pneumonia.

Fine-motor problems. Trouble controlling your hands or fingers can make it harder to write, button clothes, or use small objects.

Leg weakness or stiffness. Reduced strength or flexibility can make walking or climbing stairs more difficult.

Cognitive effects. You may have a harder time with memory, focus, or visual tasks compared to those without TD.

Quality-of-life changes. Symptoms may affect work, relationships, or confidence. You may withdraw socially or feel self-conscious.

More serious health risks. Studies suggest people with TD have a slightly higher risk of infections like pneumonia or sepsis, especially as movement symptoms progress.

Daily habits can make a real difference in how you feel. Try these tips:

  • Track your symptoms and share changes with your doctor
  • Stay active with movements that feel safe and comfortable
  • Use deep breathing or mindfulness to relax
  • Keep a daily routine
  • Eat balanced meals and stay hydrated
  • Limit alcohol and nicotine
  • Get enough rest each night

If you have trouble falling or staying asleep, let your doctor know. They can help you build better sleep habits or refer you to a sleep specialist if you need more support.   

If your movements make daily tasks harder, ask for a referral to a physical, occupational, or speech therapist. These specialists can improve your movement, balance, and communication skills.

Pederson says doctors don’t always bring up this kind of practical support early on. But she encourages everyone to ask about ongoing help, not just medicine changes. 

If you’ve been diagnosed with tardive dyskinesia, you’ll have a “risk-benefit-alternative” discussion with your doctor. That means you’ll talk through the pros and cons for your treatment plan, including whether to stay on your current medication, adjust the dose, or explore other options. 

If you have a condition like schizophrenia, bipolar disorder, or severe depression, your doctor will go over the importance of treatment. In some cases, it may not be safe to stop or lower medication right away. 

During a manic or psychotic episode, for example, your care team may need to increase or continue an antipsychotic medication to stabilize symptoms. The priority is always safety, both for you and the people around you. 

“If someone is having a [mental health] emergency, we’re thinking, how do we get this under control as soon as possible?” Pederson says. 

Once your condition is stable, that’s when longer-term conversations about managing side effects like TD begin. You and your care team will go over questions like: 

  • What’s the lowest effective dose?
  • Could another medication work just as well with fewer risks?
  • What physical or emotional changes should I keep track of between visits? 
  • How soon do I tell you when I notice new movement symptoms?

Your doctor will balance mental health needs while lowering your odds of TD. Each follow-up visit is a chance to ask questions, share updates, and make sure your treatment still feels right for you.  

 

 

Tardive dyskinesia can be unpredictable. For some people, symptoms start mild and stay that way. For others, they may slowly become more noticeable or affect new areas of the body. TD can also appear right away or long after starting a medication. 

“There’s no set timeline for when tardive dyskinesia might emerge,” Pederson says. “It can happen two years later, five years later, or even 10 years later.” 

Sometimes the first signs of change are small, like an eye twitch or muscle flutter. But these early movements are easy to mistake for stress or anxiety, Pederson says, which can make the connection to medication easy to miss.  

If you take an antipsychotic or another dopamine-blocking drug, tell your doctor about any new or unusual movements. Even subtle changes matter. 

As you get older, your risk of TD goes up. That’s why regular check-ins are key, even if you’ve been on a medication for years. “Continue to ask, ‘Is this the right dose for me? Am I noticing side effects? Should I make adjustments?’” Pederson says. 

She adds that follow-ups are especially important if you have limited access to care or long gaps between appointments. Checking in regularly, ideally at least once a year, helps your care team spot early signs of TD, adjust your medication safely, and keep you feeling your best.

Many groups offer information, community, and practical help for people living with tardive dyskinesia, such as: 

  • National Organization for Tardive Dyskinesia 
  • Mental Health America National Alliance on Mental Illness (NAMI) 
  • Depression and Bipolar Support Alliance (DBSA) 
  • International Parkinson and Movement Disorder Society
  • National Organization for Rare Disorders (NORD)

Ask your doctor if there’s a social worker or patient navigator on your care team. They can point you toward other resources, including support groups in your area. 

 

 

 

Tardive dyskinesia can take a toll on your mood and confidence. You may feel self-conscious or start pulling back from activities or other people. “It’s hard to function in society with constant movements that people ask, ‘Why are you moving your body like that?’” Pederson says. 

But you don’t have to carry that emotional weight on your own. Here are some ways to support your well-being while you manage TD: 

Be honest with your doctor. Let your care team know how you feel emotionally, not just physically. They can review your treatment plan, explore other medication choices, or connect you with the right kind of help. 

Find community. Whether in-person or online, share your feelings with others who know what you’re going through. Talking to people who “get” it can help you feel seen and less alone. 

Ask about therapy. Cognitive behavioral therapy (CBT) or mindfulness-based stress reduction (MBSR) may help ease anxiety and may even improve TD symptoms. A mental health professional familiar with movement disorders can teach coping skills tailored to your needs.

Talk openly with friends and family. Explain that your movements are out of your control. If you feel comfortable, tell them it’s a medication side effect or bring them to appointments. Helping loved ones understand TD can make daily life easier and help you feel more supported.

Stay connected. You don’t need to push yourself into outings that feel uncomfortable. Find low-pressure ways to spend time with people who make you feel safe. Maybe coffee with a friend, a walk with family, or a small get-together at home. 

Try relaxation and grounding skills. Mindfulness practices like guided imagery, journaling, breathwork, or yoga can calm your body and ease stress. 

Be kind to yourself. Self-compassion can lower stress and help you cope better with chronic conditions. Try speaking to yourself the way you would to someone you care about. 

Family and friends play a big role in daily support for those with tardive dyskinesia, and doctors can learn a lot from loved ones. You might be the first to notice small changes, like new movements or trouble swallowing or breathing. Your input can help catch problems early and keep your loved one safe. 

You might not mind helping, but caregiving can take a toll on your own health and well-being. Some experts even call caregivers “invisible patients” because their needs often go unnoticed. Taking care of yourself isn’t selfish. It helps you show up fully for the person you love. 

Here are some ways to help both of you:

  • Learn the symptoms of TD and how treatments can help. 
  • Go to appointments to help keep treatment on track.
  • Help your loved one stay active and connected.
  • Take breaks and protect your own well-being.
  • Find your own support groups for advice and emotional backup.

Talk with your doctor or a counselor if you need extra support. Groups such as the National Organization for Tardive Dyskinesia or Caregiver Action Network can also help.  

Tardive dyskinesia (TD) is a condition that causes uncontrolled movements, often in your face, arms, legs, or torso. Symptoms can range from subtle to severe. It’s most often caused by certain medications, such as antipsychotics that block dopamine in the brain.

While most people who take these drugs don’t get TD, it can happen to anyone who uses dopamine-blocking medicines for a long time. Symptoms can be long-lasting, even when you stop taking medication. That’s why early diagnosis and treatment matters.

Work with a psychiatrist or movement disorder specialist who understands TD. They can adjust medications, track symptoms, and help you find a plan that controls both your mental health and movement symptoms. 

How to reverse tardive dyskinesia

Although potentially permanent, you can do some things to help prevent or lower your chances for tardive dyskinesia. Monitor your symptoms for early diagnosis. Watch out for any uncontrollable movements and tell your doctor right away. Your doctor can help identify the cause of your TD symptoms. With treatment, TD symptoms can go into remission (a period without symptoms).  

Is tardive dyskinesia permanent?  

Tardive dyskinesia is potentially a permanent condition. But early diagnosis and treatment can mean remission. Remission is when your TD symptoms go away or lessen. Your doctor can help you decide on the best treatment for your TD.  

What kind of doctor treats tardive dyskinesia?   

Most movement disorder specialists are doctors who treat brain problems. This can include a neurologist (a doctor who treats your brain, spinal cord, and nerves) or a psychiatrist (who specializes in mental health).

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