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

Matthew Swan, MD


April 30, 2019

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 significantly lower than from typical antipsychotic drugs (32.4% TD occurrence with typical antipsychotic drugs vs 13.1% TD occurrence with atypical antipsychotic drugs.) Common atypical antipsychotic medications include:

  • Amisulpride

  • Olanzapine

  • Paliperidone

  • Quetiapine

  • Risperidone

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

The overall global mean prevalence for TD is 25.3% among patients receiving neuroleptic therapy. Older patients are particularly susceptible to TD, with 29% affected after 3 months of therapy, compared with 5.9% of patients aged 7-21 years. 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.

For more on the etiology of TD, read here.


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