Is lip-smacking after Risperidone due to tardive dyskinesia?

Question

Hello doctor,

My 42-year-old husband developed lip smacking and involuntary hand movements after long-term use of Risperidone for bipolar disorder. His brain MRI was normal. His psychiatrist advised reducing the medication dose, but the symptoms have continued.

Could this be tardive dyskinesia, and are treatments such as Valbenazine effective in reversing these symptoms, or is the condition likely to be permanent?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I understand how concerning it can be to see your husband develop lip smacking and involuntary hand movements, especially after taking medication for many years and not seeing improvement even after reducing the dose.

From your description, his symptoms may be consistent with tardive dyskinesia (TD). This is a condition that causes uncontrolled, repetitive movements, often affecting the mouth, lips, tongue, face, or hands. It can sometimes happen after long-term use of medicines like Risperidone, which are used to treat conditions such as bipolar disorder (a mental health condition that causes unusual shifts in mood, energy, and activity levels, including episodes of emotional highs (mania) and lows (depression)).

A normal MRI brain is reassuring and does not rule out TD. An MRI or magnetic resonance imaging looks for structural changes in the brain, such as stroke, tumors, or injury. In TD, the issue is usually related to changes in how brain chemicals (especially dopamine) affect movement control, rather than visible damage on scans.

Sometimes, reducing or stopping the medicine causing TD may help improve symptoms. However, if the movements have been present for a long time, they can continue or become long-lasting in some people.

Treatment options that may be discussed with his psychiatrist include:

VMAT-2(vesicular monoamine transporter 2)inhibitors such as Valbenazine or Deutetrabenazine help regulate brain chemicals involved in movement and can reduce involuntary movements in many patients with TD.
Switching to another antipsychotic medicine with lower TD risk, such as Quetiapine or Clozapine, if his mental health condition remains stable and the doctor feels it is appropriate.
Supportive measures, including managing stress and improving sleep, are necessary because anxiety, tiredness, and emotional stress can sometimes make abnormal movements more noticeable.

Early treatment generally offers a better chance of symptom improvement, so discussing medicines like Valbenazine with his psychiatrist sooner rather than later would be reasonable.

These treatments usually do not interfere significantly with mood stabilization (keeping bipolar symptoms controlled) when used under proper medical supervision.

While complete reversal cannot always be guaranteed, many people experience meaningful improvement and better daily functioning with the right treatment plan.

I hope this helps.

Please revert in case of further queries.

Thank you.