Fast Five Quiz: How Much Do You Know About Tardive Dyskinesia?

Matthew Swan, MD; James Robert Brasic, MD, MPH


April 22, 2022

Long-term use of first-generation (typical) antipsychotic drugs (dopamine 2 [D2]–receptor antagonists) carries the highest risk for TD. Classes of first-generation antipsychotic medications include the following:

  • Butyrophenones (eg, haloperidol)

  • Diphenylbutylpiperidines (eg, pimozide)

  • Indolones (eg, molindone)

  • Phenothiazines (eg, chlorpromazine)

  • Thioxanthenes (eg, thiothixene)

Although second-generation (atypical) antipsychotic drugs (D2 serotonin receptor antagonists or D2-receptor partial agonists) can also cause TD, the risk of developing TD from these newer antipsychotics is thought to be significantly lower than the risk conferred by typical antipsychotic drugs. Common atypical antipsychotic medications include:

  • Amisulpride

  • Olanzapine

  • Paliperidone

  • Quetiapine

  • Risperidone

Regardless of the antipsychotic drug type, experts recommend prescribing the lowest effective dose for the shortest duration possible for primary prevention of TD.

The overall prevalence of TD among patients receiving neuroleptic therapy has been estimated at 20%-50%, though consensus has not been reached regarding epidemiology. TD can develop in younger patients, but older patients are particularly susceptible. The risk of developing TD is higher in women than men.

Although SSRIs and TCAs have been associated with TD, the risk of developing TD is much lower with these agents than with typical and atypical antipsychotic drugs.

Learn more about the etiology of TD.


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