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TD Care Is Evolving: Here’s What That Means for Clinicians

Desiree Matthews
AUGUST 14, 2026

Tardive dyskinesia (TD) remains a common long-term consequence of prolonged exposure to dopamine receptor-blocking agents, particularly antipsychotics. 1,2 Although it may emerge after months or years of continued exposure, what makes TD different from many other antipsychotic adverse effects is that it is often considered persistent and, in many cases, effectively irreversible, with symptoms that may continue even after the medication is reduced or discontinued. 2 Despite advances in psychopharmacology and the availability of newer antipsychotic treatments, TD remains clinically relevant. In a large meta-analysis, the overall prevalence of TD among antipsychotic-treated patients was 25.3%, meaning roughly 1 in 4 exposed patients may have TD.3 What was once thought of as a relatively uncommon adverse effect of antipsychotics is now better understood to be a frequent and meaningful risk of treatment that warrants routine assessment in everyday practice. 

This shift in understanding has also mirrored a change in my own clinical practice. Earlier in my training and early years in practice, I did not screen for TD nearly as consistently as I do now. Part of that reflected the broader clinical culture at the time. Before 2017, there were no FDA-approved treatments for TD in the United States, so practice was aimed at identification rather than meaningful intervention. Most of my clients required chronic treatment with antipsychotics and there were no other treatment options available to even potentially prevent the risk of TD developing. We do the good with the bad so to speak.  

My training also shaped how I thought about what TD “looked like.” The image that stayed with me was the severe end of the spectrum: an older patient with schizophrenia after prolonged treatment with a typical antipsychotic, with generalized movements involving the face, trunk, and body. It was so severe she was unable to stand or sit down without obvious movements that could easily be seen by anyone. That became my internal benchmark for TD. I could immediately recognize how severe, painful, and functionally disruptive that presentation might be. What I was less prepared to appreciate were the many patients whose TD would fall into the mild-to-moderate range that I suspect that looking back, I completely missed.  

At that time, I also had the assumption that if a patient was not volunteering concerns about movements, then the movements must not be particularly bothersome. But over time, after discussing movements with patients and family, I was wrong in most cases. Patients may normalize symptoms, minimize them, feel embarrassed to mention them, or assume nothing can be done if they or their loved ones had noticed.  

My perspective shifted in a more meaningful way when one patient described what TD had been like for her. She had struggled for years with major depressive disorder and eventually found relief with an FDA-approved adjunctive second-generation antipsychotic. But along the way, she developed TD that went undiagnosed for several years. When she finally described it, she did not frame it as “mild”—even though I “barely” noticed it. She described it as embarrassing, frightening, and painful. She felt like she was losing control of her body. Her family noticed the movements and pointed them out. She became more reluctant to leave the house because of the involuntary movements in her lips, tongue, and fingers. That conversation changed how I thought about TD. It reminded me that movements that may appear mild or moderate on our physical exams can still carry substantial emotional, social, and functional burden for the person living with them as well as their family. 

That, in many ways, reflects how the broader clinical conversation around TD has evolved. In the past, assessment focused largely on whether abnormal movements were present and how severe they appeared on examination. The Abnormal Involuntary Movement Scale (AIMS) remains a practical and important tool for detection and longitudinal monitoring.4 However, TD care is evolving beyond simply rating movement severity because we now better appreciate the full burden the condition can place on both patients and caregivers. TD is not simply a movement disorder. It can affect speech, eating, social confidence, emotional well-being, work functioning, and even a patient’s willingness to continue taking needed psychiatric medication. 5-7 

Consensus work published over the past several years has emphasized that TD should be assessed across social, physical, psychological, and vocational domains, not just by counting or grading movements. 5 The development of tools such as the Impact-TD Scale reflects the importance of capturing the broader functional effects of TD that may otherwise be missed during a brief movement exam. 5 Another important advancement is the Tardive Dyskinesia Impact Scale (TDIS), a validated patient-reported outcome measure designed to assess how TD affects daily functioning over the prior 7 days. Developed with input from patients and caregivers and written in patient-friendly language, the TDIS represents a meaningful step toward understanding TD from the patient’s point of view rather than solely through clinician observation. 7  

Treatment has evolved as well. Prior to 2017, clinicians in the United States had little in the way of FDA-approved treatment options for TD. The approvals of deutetrabenazine and valbenazine represented an important turning point, offering effective and generally well-tolerated oral medication for adults living with TD that can be added to many existing psychiatric and medical treatment regimens, including antipsychotics. Since those initial approvals, treatment options have continued to evolve. Deutetrabenazine, which was originally administered twice daily, is now also available in a once-daily XR formulation that can be taken with or without food. 10 Valbenazine has also expanded with an additional dosing strength and a sprinkle formulation, which may be particularly useful for individuals who have difficulty swallowing capsules. 11  

A major clinical question remains whether treating TD improves more than visible movements alone. Newer data suggest that reductions in movement severity may also be accompanied by improvement in patient-reported burden, disability, and health-related quality of life. 12,13 In the phase 4 KINECT-PRO study, valbenazine treatment was associated with significant reductions from baseline in both TDIS and AIMS total scores, as well as improvement in self-reported health-related quality of life and disability measures, including the EQ-VAS and the Sheehan Disability Scale. 12 These findings help address an important question clinicians often face in practice: when motor symptoms improve, can the distress, impairment, and day-to-day burden associated with TD improve as well? 

KINECT-PRO adds useful evidence, but it does not mean that every patient will experience the same degree of benefit or that improvement in movements will always translate into broad functional recovery. Still, it supports a more clinically meaningful treatment conversation. The question is no longer just, “Are the movements better?” It is also, “Is the patient functioning better, feeling less impaired, and experiencing less daily burden?” 

A similar theme is beginning to emerge from real-world observational data with deutetrabenazine. In an interim cohort from the ongoing IMPACT-TD Registry, adults treated with deutetrabenazine or deutetrabenazine XR showed improvement in AIMS total motor scores after 3 months, along with patient-reported improvement in several life areas affected by TD. According to Teva’s 2025 announcement summarizing the registry cohort, up to 77% of participants reported improvement in domains such as speech and communication, eating, psychosocial impact, activities of daily living, and sleep or pain. 13 These are encouraging interim findings that again suggest that reducing motor symptoms may translate into improvement in the areas of life that patients often care about most. 

This evolution in TD care is not just about new scales or newer formulations. It reflects a broader shift toward care that is more functional, more patient-centered, and more clinically useful. The AIMS still has an important role, but it should not be the whole conversation. For clinicians, this data suggests  that TD should be screened for consistently, assessed thoughtfully, and treated with goals that extend beyond visible motor change alone. The field now has better understanding to ask better questions, and emerging evidence suggests that improvements in movement severity may, in some patients, align with improvements in quality of life and functioning. TD care is no longer just about documenting movements. It is about understanding what those movements cost patients in real life and responding in a way that is equally real. 

 

References: 

  1. Waln, O, Jankovic Ju. An update on tardive dyskinesia: from phenomenology to treatment. Tremor Other Hyperkinetic Mov. 2013, Jul 12.  

  1. Zutshi D, Cloud LJ, Factor SA. Tardive syndromes are rarely reversible after discontinuing dopamine receptor blocking agents: experience from a university-based movement disorder clinic. Tremor Other Hyperkinet. 2014;4:266. 

  1. Carbon M, Hsieh CH, Kane JM, Correll CU. Tardive Dyskinesia Prevalence in the Period of Second-Generation Antipsychotic Use: A Meta-Analysis. J Clin Psychiatry. 2017;78(3):e264-e278. 

  1. Lane RD, Glazer WM, Hansen TE, Berman WH, Kramer SI. Assessment of tardive dyskinesia using the Abnormal Involuntary Movement Scale. J Nerv Ment Dis. 1985 ;173(6):353-357. 

  1. Jackson R, Brams MN, Citrome L, Hoberg AR, Isaacson SH, Kane JM, Kumar R. Assessment of the Impact of Tardive Dyskinesia in Clinical Practice: Consensus Panel Recommendations. Neuropsychiatr Dis Treat. 2021;17:1589-1597. 

  1. Jackson R, Brams MN, Carlozzi NE, Citrome L, Fritz NE, Hoberg AR, Isaacson SH, Kane JM, Kumar R. Impact-Tardive Dyskinesia (Impact-TD) Scale: A Clinical Tool to Assess the Impact of Tardive Dyskinesia. J Clin Psychiatry. 2022;84(1):22cs14563. 

  1. Farber RH, Stull DE, Witherspoon B, Evans CJ, Yonan C, Bron M, Dhanda R, Jen E, Brien CO'. The Tardive Dyskinesia Impact Scale (TDIS), a novel patient-reported outcome measure in tardive dyskinesia: development and psychometric validation. J Patient Rep Outcomes. 2024;8(1):2. 

  1. Jain R, Ayyagari R, Goldschmidt D, Zhou M, Finkbeiner S, Leo S. Impact of Tardive Dyskinesia on Physical, Psychological, Social, and Professional Domains of Patient Lives: A Survey of Patients in the United States. J Clin Psychiatry. 2023;84(3):22m14694.  

  1. Jain R, Ayyagari R, Goldschmidt D, Zhou M, Finkbeiner S, Leo S. Impact of tardive dyskinesia on patients and caregivers: a survey of caregivers in the United States. J Patient Rep Outcomes. 2023;7(1):122.  

  1. INGREZZA (valbenazine) and INGREZZA SPRINKLE (valbenazine). Prescribing information. Neurocrine Biosciences. ;2025. Accessed April 20, 2026. https://pi.neurocrine.com/ingrezza/INGREZZA-Full-Prescribing-Information.pdf 

  1. AUSTEDO XR (deutetrabenazine) and AUSTEDO (deutetrabenazine). Prescribing information. Teva Pharmaceuticals USA, Inc.;2025. Accessed April 20, 2026. https://www.austedohcp.com/globalassets/austedo/prescribing-information.pdf 

  1. Neurocrine Biosciences, Inc. (2025, June 2). Neurocrine Biosciences presents patient-reported outcomes from KINECT-PRO™ study demonstrating INGREZZA® (valbenazine) capsules improved functionality and quality of life in patients with tardive dyskinesia. PR Newswire. Accessed April 20, 2026. https://www.prnewswire.com/news-releases/neurocrine-biosciences-presents-patient-reported-outcomes-from-kinect-pro-study-demonstrating-ingrezza-valbenazine-capsules-improved-functionality-and-quality-of-life-in-patients-with-tardive-dyskinesia-302469889.html 

  1. Teva Pharmaceutical Industries Ltd. (2025, November 7). AUSTEDO® (deutetrabenazine) tablets and AUSTEDO XR® (deutetrabenazine) extended-release tablets demonstrate positive real-world impact, with patients reporting improvement in involuntary movements and activities of daily living. Accessed April 20, 2026. https://ir.tevapharm.com/news-and-events/press-releases/press-release-details/2025/AUSTEDO-deutetrabenazine-tablets-and-AUSTEDO-XR-deutetrabenazine-extended-release-tablets-Demonstrate-Positive-Real-world-Impact-with-Patients-Reporting-Improvement-in-Involuntary-Movements-and-Activities-of-Daily-Living/default.aspx