I am 58. How do I manage uncontrollable facial movements?

Question

Hello doctor,

I am a 58-year-old man who has been taking antipsychotic medication for bipolar disorder for over 10 years. Recently, I have developed uncontrollable movements in my face and mouth. My tongue darts out involuntarily, I make chewing motions even when I am not eating, and my lips pucker and smack in ways I cannot control. These movements are getting worse and happening more frequently, making me self-conscious in social situations and affecting my speech.

My psychiatrist mentioned that this might be tardive dyskinesia caused by long-term medication use. I am worried about these movements becoming permanent. Are there treatments that can help? Should I stop taking my psychiatric medication, even though it has been controlling my mood symptoms well?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Tardive dyskinesia (TD) is a movement disorder that can develop after long-term use of antipsychotic medications, and the symptoms you describe, tongue darting, lip smacking, and chewing movements, are classic features.

It occurs because these medications, while very effective at stabilizing mood and controlling symptoms of bipolar disorder, block dopamine receptors in the brain over many years, leading to changes in how the nervous system regulates movement.

The concern about TD becoming permanent is real, especially if the movements persist for months or worsen over time, but the condition is sometimes reversible or at least manageable. Importantly, you should not stop your psychiatric medication on your own, as that could trigger severe mood destabilization.

Instead, talk with your psychiatrist about balancing the need for mood stabilization with the management of TD. Options include adjusting the dose, switching to a different antipsychotic with a lower risk of TD (such as Quetiapine or Clozapine), or adding a medication specifically approved for TD, such as Valbenazine or Deutetrabenazine, which can significantly reduce involuntary movements in many patients. Supportive strategies like physical therapy, speech therapy, and stress reduction can also help improve control and coping.

The key step is close coordination with your psychiatrist, because the goal is to maintain your mental health stability while reducing the impact of these troubling movements.

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

Thank you.