Tardive dyskinesia (TD) is a neurological movement disorder characterized by involuntary, repetitive movements, often affecting the face, tongue, lips, and sometimes other parts of the body. These movements can include grimacing, lip-smacking, tongue thrusting, blinking, and uncontrolled limb movements. TD typically develops after long-term use of certain medications, especially antipsychotics used to treat psychiatric disorders such as schizophrenia and bipolar disorder. The word "tardive" means delayed, highlighting that symptoms often appear after months or years of exposure to the causative medication.

Causes and Risk Factors

TD occurs mainly due to prolonged exposure to dopamine-blocking medications, such as first-generation (typical) antipsychotics like haloperidol and fluphenazine. Second-generation (atypical) antipsychotics, such as risperidone and olanzapine, also carry a risk but generally at lower rates. Other drugs that may cause TD include certain antiemetics (like metoclopramide) and some antidepressants.

Risk factors that increase the likelihood of developing TD include:

  • Duration and dose of dopamine-blocking medication use

  • Older age, especially above 40 years

  • Female gender, particularly post-menopausal women

  • History of mood disorders or neurological illnesses

  • Genetic predisposition and certain ethnic backgrounds

Symptoms to Watch For

Symptoms often start subtly and may initially go unnoticed. Common signs include:

  • Facial grimacing and repetitive blinking

  • Lip-smacking, puckering, or pursing

  • Tongue movements such as thrusting or protruding

  • Rapid eye blinking

  • Involuntary movements of the limbs, fingers, or trunk

These involuntary movements can interfere with daily life activities, speech, eating, and social interactions, causing significant distress.

Diagnosing Tardive Dyskinesia

Diagnosis primarily depends on clinical observation of symptoms in a patient with a history of using dopamine-blocking drugs. Doctors use various scales, such as the Abnormal Involuntary Movement Scale (AIMS), to rate the severity of movement symptoms. It’s essential to rule out other causes of involuntary movements before confirming TD.

Treatment Options for Tardive Dyskinesia

While stopping the offending medication can sometimes reduce symptoms, this is not always possible due to the underlying psychiatric or neurological condition requiring treatment. Therefore, managing TD involves a multifaceted approach.

Medication Management

If TD symptoms develop, physicians may first evaluate the necessity of continuing the responsible medication. They might switch to a newer antipsychotic with a lower risk profile or adjust the dose cautiously.

Focus on Austedo (Deutetrabenazine)

Austedo (generic name: deutetrabenazine) is an FDA-approved oral medication specifically indicated for treating involuntary movements caused by tardive dyskinesia. It works by modulating dopamine activity in the brain, which is believed to reduce the abnormal nerve signaling causing involuntary muscle movements.

How Austedo Works:

Austedo is a vesicular monoamine transporter 2 (VMAT2) inhibitor. VMAT2 regulates the packaging of neurotransmitters—particularly dopamine—into nerve endings. By reducing dopamine release, Austedo helps alleviate the excessive movement signals responsible for TD symptoms.

Benefits of Austedo:

  • Proven to significantly decrease involuntary movements

  • Generally well-tolerated with a favorable side effect profile

  • Flexible dosing tailored to patient response

  • Improves quality of life by reducing social embarrassment and improving motor control

Dosage and Administration:


Austedo is typically started at a low dose and gradually increased based on patient tolerance and clinical response. It is usually taken twice daily with or without food. Regular follow-up with a healthcare provider is essential to monitor benefits and any side effects.

Potential Side Effects:

While considered safe, some patients may experience side effects such as:

  • Fatigue or drowsiness

  • Insomnia or sleep disturbances

  • Depression or mood changes (requiring close monitoring)

  • Diarrhea or gastrointestinal discomfort

Other Treatment Approaches

Besides Austedo, another VMAT2 inhibitor called Valbenazine (Ingrezza) is also approved for TD. Some clinicians may use off-label treatments such as tetrabenazine, benzodiazepines, or botulinum toxin injections to target specific symptoms, especially if limited to certain muscle groups.

For severe, treatment-resistant cases, deep brain stimulation (DBS)—a surgical procedure involving electrical stimulation of specific brain areas—has shown promise in reducing TD symptoms, though it is generally considered when other treatments fail.

Lifestyle and Supportive Care

Managing tardive dyskinesia isn’t only about medicines. Patients are encouraged to maintain overall neurological and physical health by:

  • Avoiding substances like alcohol and illicit drugs

  • Following prescribed medication regimens carefully without abrupt discontinuation

  • Seeking counseling or support groups to cope with social and emotional impacts

  • Practicing stress-reduction techniques, since anxiety can worsen symptoms

Living with Tardive Dyskinesia: What Patients Should Know

TD can be a challenging and sometimes persistent condition, but the landscape of treatment options has significantly improved. Early detection and prompt management offer the best chances of reducing symptom severity and preserving quality of life.

If you or a loved one is on long-term antipsychotic or dopamine-blocking medications, regular monitoring for TD symptoms is vital. Open communication with your healthcare provider about any new involuntary movements can lead to timely intervention.

Thanks to medications like Austedo, many patients experience meaningful relief from the troubling symptoms of TD, enabling them to regain confidence and function better in everyday life.