Table of ContentsView AllTable of ContentsTardive Dyskinesia and AkathisiaSymptomsCausesDiagnosisTreatmentPreventionFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Tardive Dyskinesia and Akathisia
Symptoms
Causes
Diagnosis
Treatment
Prevention
Frequently Asked Questions
Tardive dyskinesiaandakathisiaare movement disorders that occur asside effects of certain medications, especially medications that are used to treat psychiatric disorders.
If you are having new involuntary movements or a sense of restlessness, it’s important that you make an appointment to see your neurologist or psychiatrist so you can work together to plan a management strategy that’s right for you.
This article will discuss the similarities and differences in the symptoms, causes, diagnosis, and treatment of tardive dyskinesia and akathisia.
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What Are Tardive Dyskinesia and Akathisia?
Tardive dyskinesia and akathisia are medication side effects. These conditions have some similarities, but they also have differences.
In some medical literature, tardive dyskinesia has been defined as a type of akathisia. And there is also a condition called tardive akathisia.
There are some consistent features that distinguish these two movement disorders, such as:
You can have both tardive dyskinesia and akathisia, and sometimes one side effect begins months before the other.
What Symptoms Occur with Akathisia and Tardive Dyskinesia?
Akathisia and tardive dyskinesia can develop within days of starting a causative medication, or the symptoms can begin after you have been taking the medication for months or years.
The symptoms of akathisia and tardive dyskinesia can resemble those of other movement disorders or psychological conditions.
Most people who have akathisia are aware of the symptoms.Sometimes people who have tardive dyskinesia are aware of the symptoms, but they are not as distressing as the symptoms of akathisia.
Tardive Dyskinesia
Tardive dyskinesia can involve slow and unusual movements. For example, your mouth may pucker or twist, you might make writhing finger movements, or you may stick out your tongue or tightly shut your eyes.
The movements can resemble tics such as those experienced with the neurological disorderTourette’s syndrome. Generally, the motor effects of tics with Tourette’s syndrome occur fast and can be jerky, while the movements of tardive dyskinesia are slower, winding, or smooth.
Akathisia
Akathisia usually involves a sense of internal restlessness. It feels distressing, and the movements do not relieve the feelings of distress. Some people who have akathisia can experience severe unease as a result of this condition, and it is associated with thoughts of suicide.
What Causes Akathisia and Tardive Dyskinesia?
Akathisia and tardive dyskinesia are considered medication side effects. Sometimes psychomotor agitation can occur due to severe metabolic changes,delirium(altered mental function), or head trauma, and this has been defined as akathisia in some instances.
Akathisia and tardive dyskinesia usually occur due to exposure to dopamine blocking agents.Dopamineis a neurotransmitter that aids in many functions of the brain and the body, including movement, motivation, and more.
Different movement disorders can occur when medications that release or involve dopamine affect areas of the brain that control physical movement. The disruption that occurs can lead to side effects of tardive dyskinesia, akathisia, orParkinsonism(medication-induced symptoms of Parkinson’s disease).
Sometimes medications used to treat mood disorders or gastrointestinal disorders can cause akathisia or tardive dyskinesia.
It isn’t possible to predict whether a person will have one or more of these side effects, how severe the motor side effects will be, or how long they will last.
Medication Side EffectsIf you are taking a medication that can cause akathisia or tardive dyskinesia, this side effect will be listed on the medication package. These conditions were described as long ago as the early 1900s when antipsychotics (medications that controlpsychosis, in which a person loses touch with reality and may have delusions or hallucinations) began to be widely prescribed.
Medication Side Effects
If you are taking a medication that can cause akathisia or tardive dyskinesia, this side effect will be listed on the medication package. These conditions were described as long ago as the early 1900s when antipsychotics (medications that controlpsychosis, in which a person loses touch with reality and may have delusions or hallucinations) began to be widely prescribed.
How Are Akathisia and Tardive Dyskinesia Diagnosed?
If you are taking medications that can cause tardive dyskinesia or akathisia, your healthcare provider will ask you about these symptoms when you go for your regular medical visits or therapy sessions. They will also observe you for signs of the movements during your visit.
There are no laboratory or imaging tests that can verify these conditions. Your healthcare provider will rely on your medical history and physical examination to diagnose your condition.
Your healthcare provider will use your medical history and physical examination to differentiate between these movement disorders, which is important because they respond differently to treatment.
For example, anticholinergic treatment can worsen tardive dyskinesia, may have a moderately beneficial effect on akathisia, and may help improve symptoms of Parkinsonism.
If you have akathisia or tardive dyskinesia, your healthcare provider will usually document your symptom frequency, which areas of the body are affected, and how severe the symptoms are. Some providers may use a rating scale to quantify your symptoms and to be able to objectively follow the progression or improvement over time.
Examples of rating scales:
Can You Treat Akathisia and Tardive Dyskinesia?
There are different ways of managing tardive dyskinesia and akathisia. Interventions include replacing the causative medication or reducing the dose, or taking prescription medication that’s used to treat the movement problems.
Medications approved for the treatment of tardive dyskinesia includeAustedo(deutetrabenazine) andIngrezza(valbenazine), which are reversible VMAT2 inhibitors that have an effect on dopamine action.
Sometimes, medications are prescribed off-label to treat the symptoms of tardive dyskinesia or akathisia. Off-label means they have not been approved for treating the condition in question but are approved to treat other conditions.
Examples of off-label treatments include:
If you experience any signs of akathisia or tardive dyskinesia, it’s important to discuss the management plan with your healthcare provider rather than trying to manage it on your own.
The underlying conditions that the medications are used to treat can have serious consequences, and these side effects can be distressing for some people, especially if they are not adequately managed.
How Can I Prevent Akathisia and Tardive Dyskinesia?
Generally, it’s best to use antipsychotic medications and other medications that can cause tardive dyskinesia or akathisia at the lowest effective dose. You may be prescribed a low starting dose with a gradually scheduled increase over time.
If you start to experience side effects before the target dose is reached or at a dose that is not effective for controlling your symptoms, your psychiatrist might switch you to a different medication. Maintaining communication is an important part of preventing tardive dyskinesia and akathisia.
Early Signs of Tardive Dyskinesia
How Talk to Your Healthcare Provider
Ask your psychiatrist or pharmacist about the potential side effects of the medications that you are taking. Make sure you call your healthcare provider or make an appointment if you begin to experience signs of side effects.
Summary
Tardive dyskinesia and akathisia are movement disorders that can develop as medication side effects. These side effects have been recognized for as long as antipsychotic medications have been in use. They can also occur due to other medications used to treat gastrointestinal disorders or mood disorders.
Tardive dyskinesia usually involves involuntary repetitive movements of the face, mouth, fingers, or arms. Akathisia is an internal sense of restlessness, which may result in movement such as rocking back and forth or excessive pacing. They can occur alone or together, and they might not begin at the same time when they occur together.
Treatment can involve a combination of adjusting the causative medication, therapy to help cope with the condition, and medication to help reduce the symptoms.
A Word From Verywell
Akathisia and tardive dyskinesia can be difficult to cope with if you or a loved one has been diagnosed with either of these conditions, it can take time for treatment to be effective. In the meantime, it can help to reach out to a therapist to get support and to discuss your concerns and the feelings that you are having about your movement problems.
What Medications Cause Tardive Dyskinesia?
Frequently Asked QuestionsDyskinesias are involuntary motor movements. There are many types, including those that occur as a result of taking antipsychotic medications or medications that are used to treat Parkinson’s disease.Learn MoreTypes of DyskinesiaAkathisia is estimated to affect approximately 15%–35% of people who use antipsychotic medications.Akathisia can’t specifically turn into tardive dyskinesia. If you have akathisia as a side effect of medication and you don’t have tardive dyskinesia, it is possible that you could develop tardive dyskinesia at a later time.Each of these conditions occurs due to biochemical medication effects, but they don’t cause each other.Yes, antipsychotics are safe and effective. These medications can have side effects, though, including movement disorders. If you experience side effects while taking antipsychotics or any other medication, talk to your healthcare provider about it.Do not make any changes in your antipsychotics in the meantime, because this could result in a return or worsening of serious psychiatric symptoms.
Dyskinesias are involuntary motor movements. There are many types, including those that occur as a result of taking antipsychotic medications or medications that are used to treat Parkinson’s disease.Learn MoreTypes of Dyskinesia
Dyskinesias are involuntary motor movements. There are many types, including those that occur as a result of taking antipsychotic medications or medications that are used to treat Parkinson’s disease.
Learn MoreTypes of Dyskinesia
Akathisia is estimated to affect approximately 15%–35% of people who use antipsychotic medications.
Akathisia can’t specifically turn into tardive dyskinesia. If you have akathisia as a side effect of medication and you don’t have tardive dyskinesia, it is possible that you could develop tardive dyskinesia at a later time.Each of these conditions occurs due to biochemical medication effects, but they don’t cause each other.
Akathisia can’t specifically turn into tardive dyskinesia. If you have akathisia as a side effect of medication and you don’t have tardive dyskinesia, it is possible that you could develop tardive dyskinesia at a later time.
Each of these conditions occurs due to biochemical medication effects, but they don’t cause each other.
Yes, antipsychotics are safe and effective. These medications can have side effects, though, including movement disorders. If you experience side effects while taking antipsychotics or any other medication, talk to your healthcare provider about it.Do not make any changes in your antipsychotics in the meantime, because this could result in a return or worsening of serious psychiatric symptoms.
Yes, antipsychotics are safe and effective. These medications can have side effects, though, including movement disorders. If you experience side effects while taking antipsychotics or any other medication, talk to your healthcare provider about it.
Do not make any changes in your antipsychotics in the meantime, because this could result in a return or worsening of serious psychiatric symptoms.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA.Characteristics of patients experiencing extrapyramidal symptoms or other movement disorders related to dopamine receptor blocking agent therapy.J Clin Psychopharmacol.2019;39(4):336-343. doi:10.1097/JCP.0000000000001061Tachere RO, Modirrousta M.Beyond anxiety and agitation: A clinical approach to akathisia.Aust Fam Physician. 2017;46(5):296-298. PMID: 28472575.Correll CU, Citrome L.Measurement-based diagnosis and treatment for tardive dyskinesia.J Clin Psychiatry.2021;82(5):NU20016AH2C. doi:10.4088/JCP.NU20016AH2CBrisch R, Saniotis A, Wolf R, et al.The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: old fashioned, but still in vogue.Front Psychiatry. 2014;5:47. doi:10.3389/fpsyt.2014.00047National Institute on Aging.Parkinson’s disease.Hauser RA, Meyer JM, Factor SA, Comella CL, Tanner CM, Xavier RM, Caroff SN, Lundt L.Differentiating tardive dyskinesia: a video-based review of antipsychotic-induced movement disorders in clinical practice.CNS Spectr.2020 Nov 20:1-10. doi:10.1017/S109285292000200XPringsheim T, Gardner D, Addington D, et al.The assessment and treatment of antipsychotic-induced akathisia.Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288Stacy M, Sajatovic M, Kane JM, Cutler AJ, Liang GS, O’Brien CF, Correll CU.Abnormal involuntary movement scale in tardive dyskinesia: Minimal clinically important difference.Mov Disord. 2019;34(8):1203-1209. doi:10.1002/mds.27769Project Teach.Barnes akathisia rating scale.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA.Characteristics of patients experiencing extrapyramidal symptoms or other movement disorders related to dopamine receptor blocking agent therapy.J Clin Psychopharmacol.2019;39(4):336-343. doi:10.1097/JCP.0000000000001061Tachere RO, Modirrousta M.Beyond anxiety and agitation: A clinical approach to akathisia.Aust Fam Physician. 2017;46(5):296-298. PMID: 28472575.Correll CU, Citrome L.Measurement-based diagnosis and treatment for tardive dyskinesia.J Clin Psychiatry.2021;82(5):NU20016AH2C. doi:10.4088/JCP.NU20016AH2CBrisch R, Saniotis A, Wolf R, et al.The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: old fashioned, but still in vogue.Front Psychiatry. 2014;5:47. doi:10.3389/fpsyt.2014.00047National Institute on Aging.Parkinson’s disease.Hauser RA, Meyer JM, Factor SA, Comella CL, Tanner CM, Xavier RM, Caroff SN, Lundt L.Differentiating tardive dyskinesia: a video-based review of antipsychotic-induced movement disorders in clinical practice.CNS Spectr.2020 Nov 20:1-10. doi:10.1017/S109285292000200XPringsheim T, Gardner D, Addington D, et al.The assessment and treatment of antipsychotic-induced akathisia.Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288Stacy M, Sajatovic M, Kane JM, Cutler AJ, Liang GS, O’Brien CF, Correll CU.Abnormal involuntary movement scale in tardive dyskinesia: Minimal clinically important difference.Mov Disord. 2019;34(8):1203-1209. doi:10.1002/mds.27769Project Teach.Barnes akathisia rating scale.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA.Characteristics of patients experiencing extrapyramidal symptoms or other movement disorders related to dopamine receptor blocking agent therapy.J Clin Psychopharmacol.2019;39(4):336-343. doi:10.1097/JCP.0000000000001061Tachere RO, Modirrousta M.Beyond anxiety and agitation: A clinical approach to akathisia.Aust Fam Physician. 2017;46(5):296-298. PMID: 28472575.Correll CU, Citrome L.Measurement-based diagnosis and treatment for tardive dyskinesia.J Clin Psychiatry.2021;82(5):NU20016AH2C. doi:10.4088/JCP.NU20016AH2CBrisch R, Saniotis A, Wolf R, et al.The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: old fashioned, but still in vogue.Front Psychiatry. 2014;5:47. doi:10.3389/fpsyt.2014.00047National Institute on Aging.Parkinson’s disease.Hauser RA, Meyer JM, Factor SA, Comella CL, Tanner CM, Xavier RM, Caroff SN, Lundt L.Differentiating tardive dyskinesia: a video-based review of antipsychotic-induced movement disorders in clinical practice.CNS Spectr.2020 Nov 20:1-10. doi:10.1017/S109285292000200XPringsheim T, Gardner D, Addington D, et al.The assessment and treatment of antipsychotic-induced akathisia.Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288Stacy M, Sajatovic M, Kane JM, Cutler AJ, Liang GS, O’Brien CF, Correll CU.Abnormal involuntary movement scale in tardive dyskinesia: Minimal clinically important difference.Mov Disord. 2019;34(8):1203-1209. doi:10.1002/mds.27769Project Teach.Barnes akathisia rating scale.
Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA.Characteristics of patients experiencing extrapyramidal symptoms or other movement disorders related to dopamine receptor blocking agent therapy.J Clin Psychopharmacol.2019;39(4):336-343. doi:10.1097/JCP.0000000000001061
Tachere RO, Modirrousta M.Beyond anxiety and agitation: A clinical approach to akathisia.Aust Fam Physician. 2017;46(5):296-298. PMID: 28472575.
Correll CU, Citrome L.Measurement-based diagnosis and treatment for tardive dyskinesia.J Clin Psychiatry.2021;82(5):NU20016AH2C. doi:10.4088/JCP.NU20016AH2C
Brisch R, Saniotis A, Wolf R, et al.The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: old fashioned, but still in vogue.Front Psychiatry. 2014;5:47. doi:10.3389/fpsyt.2014.00047
National Institute on Aging.Parkinson’s disease.
Hauser RA, Meyer JM, Factor SA, Comella CL, Tanner CM, Xavier RM, Caroff SN, Lundt L.Differentiating tardive dyskinesia: a video-based review of antipsychotic-induced movement disorders in clinical practice.CNS Spectr.2020 Nov 20:1-10. doi:10.1017/S109285292000200X
Pringsheim T, Gardner D, Addington D, et al.The assessment and treatment of antipsychotic-induced akathisia.Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288
Stacy M, Sajatovic M, Kane JM, Cutler AJ, Liang GS, O’Brien CF, Correll CU.Abnormal involuntary movement scale in tardive dyskinesia: Minimal clinically important difference.Mov Disord. 2019;34(8):1203-1209. doi:10.1002/mds.27769
Project Teach.Barnes akathisia rating scale.
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