What to Know About Tardive Dyskinesia and COVID-19

Tardive dyskinesia is a disabling side effect of medications most often used to treat mental health disorders. It causes involuntary and repetitive movements, usually in the tongue and face. People living with mental health conditions and associated complications like tardive dyskinesia may wonder how a COVID-19 infection might affect them differently than others.

This article will discuss the risks and complications of COVID-19 in people with tardive dyskinesia, the pandemic's effect on the diagnosis of tardive dyskinesia, and other considerations, including concerns about vaccination.

Tardive Dyskinesia and COVID-19 Risk

Many people with chronic health conditions and those who take certain medications are concerned about how COVID-19 will affect them.

According to the Centers for Disease Control and Prevention (CDC), certain groups of people are more vulnerable to the effects of COVID-19, including people over the age of 65, and people with certain health conditions, including:

• Cancer
• Chronic kidney disease
• Chronic lung diseases (such as asthma, COPD, cystic fibrosis)
• Weakened immune system
• Dementia
• Diabetes (type 1 or type 2)
• Heart conditions (e.g. hypertension, coronary artery disease, heart failure)
• Obesity
• Substance use disorder

Currently, research does not suggest that having tardive dyskinesia increases a person's risk of contracting COVID-19 or becoming severely ill from the disease. However, people with mental health disorders and those who require treatment with certain medications might be at risk of becoming very sick from COVID-19.

It is common for people with mental health disorders to have other medical problems, especially substance use disorder, that can put them at risk for severe COVID-19 infection.

An analysis of more than 40,000 patients with mental health disorders showed an association between the presence of any mental illness and an increased likelihood of needing hospitalization or dying from COVID-19. This association was found in people who take antidepressants and antipsychotic medications.

Tardive dyskinesia is a reaction to medication, and it most commonly develops after taking certain antipsychotics. Therefore, people who develop tardive dyskinesia from taking these medications may have an increased risk of needing hospitalization for or dying from COVID-19.

Experts are not yet sure why certain medications increase the likelihood of hospitalization or death from COVID-19. However, some contributing factors include:

• Comorbid (co-occurring) health conditions, like substance use disorder
• Reduced access to mental health care during the pandemic
• Changes in the immune system associated with certain conditions and medications

Complications of Tardive Dyskinesia and COVID-19

Patients with tardive dyskinesia have the same likelihood as the general population of experiencing complications or long COVID after infection with COVID-19. There are no reports of complications specifically associated with having tardive dyskinesia and COVID-19.

Experts are glad to find that COVID-19 infection does not often lead to new-onset or worsening movement disorders like tardive dyskinesia.

After reviewing 200 papers in the literature that describe COVID-19 complications from the start of the pandemic to January 2021, experts indicated that the prevalence of new movement disorders was very low in hospitalized and mild COVID-19 cases.

The most common movement disorder cases included myoclonus (muscle jerks), ataxia (problems with coordination and balance), action or postural tremor (tremor with movement or by maintaining a special posture), and rigid akinetic syndrome (slow movement and muscle stiffness). There were no new cases of tardive dyskinesia.

Despite this, the change in living and social situations during the COVID-19 pandemic has led to a delay in diagnosing and treating tardive dyskinesia in at-risk people.

Tardive dyskinesia is characterized by uncontrollable, abnormal, and repetitive movements of the extremities and torso, but the reaction particularly affects movements of the tongue and face. The inability to evaluate people either in person or when they are wearing face masks decreases the ability of clinicians to read facial expressions and appropriately diagnose tardive dyskinesia.

Tardive Dyskinesia Treatments and COVID-19

Treating tardive dyskinesia often means changing the dose of the medication or switching to an entirely new medication. A person should only make these types of changes in consultation with their prescribing healthcare provider. 

Classically, the medications used to treat chronic tardive dyskinesia include:

• Klonopin (clonazepam)
• Gocovri (amantadine)
• Ginkgo biloba

However, two new medications have been approved by the Food and Drug Administration (FDA) for the treatment of tardive dyskinesia:

• Ingrezza (valbenazine)
• Austedo (deutetrabenazine)

Each treatment for tardive dyskinesia has been evaluated separately for complications related to COVID-19.

Clonazepam

Clonazepam, in the benzodiazepine class, is a sedative that treats anxiety and agitation associated with tardive dyskinesia. At higher doses, this medication can make people sleepy.

Observational studies have previously shown an increased risk of pneumonia in people who take benzodiazepines. Additionally, experts have raised concerns about respiratory impairment in people with COVID-19 who take benzodiazepines. But currently, there is no clear evidence that the use of clonazepam leads to complications related to COVID-19.

Amantadine

Amantadine is a medicine often used to treat Parkinson’s disease, but it is also used to treat movement problems associated with tardive dyskinesia. It is also an antiviral that prevents the flu.

Previous studies have indicated that amantadine is effective against severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1). Therefore, scientists have devised a clinical study of amantadine for the COVID-19 virus, SARS-CoV-2. The study began in May 2021, and it's estimated to be completed in the first half of 2022.

There are not any documented risks of taking amantadine for tardive dyskinesia if a person has COVID-19.

Gingko Biloba

The American Academy of Neurology recommends using ginkgo biloba, an herb rich in antioxidants, to help treat tardive dyskinesia in people hospitalized with schizophrenia, a chronic brain disorder associated with delusion, hallucinations, and disorganized speech and thinking processes. The herbal therapy has not been studied in other populations.

Some experts think that ginkgo biloba could provide anti-inflammatory and immune system modulation in patients with influenza and COVID-19. The leaves of ginkgo biloba contain a protein that might inhibit SARS-CoV-2 activity.

However, clinical studies have not been conducted on the use of ginkgo biloba in people with COVID-19, so it cannot be recommended as an effective treatment. There are not any documented risks of taking ginkgo biloba for tardive dyskinesia if a person has COVID-19.

Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors

Valbenazine and deutetrabenazine are part of a class of medications called vesicular monoamine transporter 2 (VMAT2) inhibitors. Both medicines were approved by the FDA in 2017 to treat tardive dyskinesia.

Tetrabenazine is in the same class of medication and is used off-label to treat tardive dyskinesia.

There is no clear evidence that using this class of medication leads to complications related to COVID-19.

How to Stay Safe

The best way to protect yourself and others is to get vaccinated for COVID-19.

People with tardive dyskinesia should stay in touch with their healthcare providers and monitor their symptoms. They should continue taking prescribed medication and discuss any changes with their prescribing provider.

Other ways to prevent infection from COVID-19 include:

• Wearing a mask
• Social distancing (staying 6 feet away from other people)
• Avoiding crowds and poorly ventilated spaces
• Washing your hands regularly
• Covering coughs and sneezes
• Cleaning and disinfecting surfaces
• Monitoring for symptoms of COVID-19 such as fever, cough, shortness of breath, and body aches
  

A Word From Verywell

At the beginning of the COVID-19 pandemic, risk factors were still unknown. It is now known that having tardive dyskinesia does not put you at greater risk for COVID-19 infection or complications from the virus. However, if you have tardive dyskinesia, you likely have a mental health disorder that you treat with medications that may increase the likelihood of being hospitalized for COVID-19. It's not yet known if this is because of the mental health disorder and medication, or if it's related to other factors, like difficulties in accessing care.

It's essential to get vaccinated for COVID-19 to prevent the spread of the virus. Follow social distancing and hygiene guidelines to prevent contracting the infection. Stay in touch with your healthcare provider to discuss your health risks, new symptoms, and any changes to your medications.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.