How to manage tardive dyskinesia due to antipsychotic meds?

Question

Hello doctor,

I am 23 years old and have developed involuntary facial and jaw movements after taking Risperidone for around 8 months for anxiety and sleep issues. A neurologist diagnosed tardive dyskinesia. How does a 23-year-old manage tardive dyskinesia caused by antipsychotic medication?

My magnetic resonance imaging (MRI) was normal, but my Abnormal Involuntary Movement Scale (AIMS) score was high.

Will stopping risperidone reverse this, or is the damage permanent?
Are newer medications safer to prevent worsening?

I am worried that this will affect my confidence and social life in the long term. People have started noticing the movements and asking uncomfortable questions. Even chewing food or talking in public now makes me very self-conscious and anxious.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

The condition being experienced is called tardive dyskinesia (TD), which can occur after long-term use of medications such as Risperidone. Even at a young age, this condition can develop because the brain’s dopamine system becomes over-sensitive after prolonged blocking by the drug.

The movements described, including facial, jaw, chewing-like, or tongue movements, are typical features of TD. The fact that the magnetic resonance imaging (MRI) is normal is reassuring, as this condition is related to a functional chemical imbalance rather than structural brain damage.

The most important step is to review or discontinue Risperidone under medical supervision. In some individuals, especially younger patients, symptoms may gradually improve over several months after reducing or stopping the medication. However, recovery can be slow, and in some cases, the movements may persist partially. Therefore, it is not always permanent, but it does require patience and monitoring.

There are treatment options available that can help reduce these movements. Medications such as vesicular monoamine transporter 2 (VMAT-2) inhibitors, including Tetrabenazine, Deutetrabenazine, or Valbenazine, can significantly help in controlling symptoms. Some neurologists may also prescribe Clonazepam or supportive therapies such as ginkgo biloba, depending on the severity.

If treatment for anxiety or sleep issues is still required, doctors may switch to safer alternatives with a lower risk of TD. These may include newer antipsychotics such as Quetiapine or Clozapine, or even non-antipsychotic medications, depending on the condition. The aim is to prevent worsening of movements while continuing to manage the underlying symptoms.

Emotionally, these concerns are completely understandable. TD can affect confidence and social interactions. However, this condition is manageable, and many individuals experience significant improvement with appropriate treatment. In addition, others often notice these movements less than perceived internally.

Stress reduction is important, as anxiety can temporarily worsen the movements. Avoiding excessive focus on the symptoms may also help. With proper medical care and time, there is a good possibility of improvement, especially at a younger age.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.