Tardive Dyskinesia and Akathisia

Tardive dyskinesia is involuntary, repetitive movements of muscles. Akathisia is a feeling of restlessness. People with akathisia cannot sit still.

Tardive dyskinesia and akathisia are often caused by antipsychotic drugs or related drugs. Certain antidepressants (tricyclic antidepressants) can cause tardive dyskinesia.

Symptoms

In tardive dyskinesia, the muscles of the face are affected most often. Typically, people grimace, chew, stick their tongue out, and pucker or smack their lips. The muscles of the arms, legs, or trunk may also be affected. People with the disorder may rock back and forth or rotate their ankles. They may march in place. Their fingers may seem to be playing an invisible guitar or piano.

People with akathisia feel restless and anxious when they are not moving. They may repeatedly stroke parts of their body or pick at their clothes. They may cross and uncross arms and legs, pace, or march in place. They may moan, groan, or shout.

Diagnosis and Treatment

Diagnosis is based on symptoms and a history of taking an antipsychotic, a related drug, or a tricyclic antidepressant for a long time.

Treatment begins with discontinuing the drug or lowering the dose if possible. Sometimes a different drug can be substituted. After the drug is discontinued, symptoms may lessen, sometimes after worsening temporarily. But they may persist.

If the drug that may be causing tardive dyskinesia or akathisia cannot be discontinued, certain other drugs may help. They include benzodiazepines (a type of sedative), opioids (narcotics), and reserpine or propranolol (a beta-blocker, a type of drug used to treat high blood pressure).