They are more commonly caused by typical antipsychotics, but can and do occur with any type of antipsychotic. Antidepressants and other medications can sometimes cause extrapyramidal side effects as well. This article discusses the symptoms and causes of extrapyramidal side effects (EPS). It also covers how these effects are treated as well as some of the other side effects you may experience while taking antipsychotic medication.
Extrapyramidal Symptoms
Extrapyramidal function refers to motor control and coordination, including being able to avoid making movements we don’t want to make. Extrapyramidal side effects from medications are serious and may include:
Akathisia
Akathisia is a feeling of restlessness that makes it hard to sit down or hold still. Symptoms include tapping your fingers, rocking, and crossing and uncrossing your legs. Research suggests that this side effect occurs in 5% to 36% of people who take antipsychotics.
Dystonia
Dystonia is when muscles involuntarily contract and contort. This can lead to painful positions or movements. It is also potentially dangerous if it affects the muscles of the throat. Symptoms of dystonia usually start within 48 hours of taking an antipsychotic. Dystonia can be treated with medications including drugs that are used to treat Parkinson’s disease. Lowering the dose of the antipsychotic medication may also be helpful. Certain risk factors make it more likely that dystonia will occur. These include younger age, male sex, having experienced dystonia in the past, and recent cocaine use.
Parkinsonism
Parkinsonism means having the same symptoms as someone with Parkinson’s disease, but the symptoms are caused by medications, not by the disease. These symptoms may include tremors, slower thought processes, slower movements, rigid muscles, difficulty speaking, and facial stiffness. Such symptoms often begin gradually after you start taking your medication and may be worse if you are taking a higher dosage of antipsychotic medication. These symptoms will eventually fade on their own, but your doctor may also recommend lowering your medication dosage or switching to a different type of antipsychotic drug. Research has found that among people who experienced parkinsonism, 3.3 cases per 100,000 were associated with drug-induced causes. Typical antipsychotics were the most common cause. These symptoms were more common in women and the risk of experiencing parkinsonism increases with age.
Tardive Dyskinesia
Tardive dyskinesia is characterized by uncontrollable facial movements such as sucking, chewing, lip-smacking, sticking the tongue out, or blinking repeatedly. There are two different subtypes of tardive dyskinesia.
Tardive dystonia, which is a more severe and persistent form of dystonia that often affects the neck and torso.Persistent akathisia, which involves rocking and movements of the arms and legs. Such symptoms are longer-lasting and present for at least one month or more after taking the same medication and dose.
The risk of this side effect may vary depending on the type of medication you are taking. Increased use of second-generation antipsychotics is believed to have reduced the incidence of tardive dyskinesia. However, some estimates suggest that approximately 15% to 20% of people who take antipsychotics develop tardive dyskinesia.
Neuroleptic Malignant Syndrome
Neuroleptic malignant syndrome is a condition that affects the nervous system that can occur as a reaction to antipsychotic drugs. It leads to symptoms such as muscle stiffness and high fever. It is rare and potentially life-threatening, occurring in less than one per 1000 people who take antipsychotic medications. While serious, it can be treated with medication.
Diagnosis of EPS
The diagnosis of extrapyramidal symptoms often takes place when family members begin to notice that someone taking antipsychotic drugs is having difficulties. For this reason, it is important that loved ones are aware of the potential for these effects and know what to watch out for. If you are being evaluated for EPS, your doctor may want to speak to your family members about the type of symptoms they have observed. Your healthcare provider may also use a scale to help evaluate the symptoms you are experiencing and their severity. These include the Extrapyramidal Symptoms Rating Scale (ESRS) and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS).
Causes of Extrapyramidal Side Effects
Antipsychotic medications work by blocking the actions of dopamine. Extrapyramidal effects are the result of this dopamine blockage or depletion in the basal ganglia. Dopamine is a neurotransmitter that is known for its role in mood and addiction. It also plays a part in medical conditions such as schizophrenia. Excessive dopamine activity is believed to play a part in schizophrenia, resulting in symptoms such as disordered thinking. By blocking the action of dopamine, antipsychotics are able to help relieve symptoms of psychotic disorders. Typical antipsychotics are the first generation of antipsychotics and are more likely to have extrapyramidal side effects. They include:
Compazine (prochlorperazine) Haldol (haloperidol) Inapsine (droperidol) Loxitane (loxapine) Mellaril (thioridazine) Navane (thiothixene) Orap (pimozide) Prolixin (fluphenazine) Stelazine (trifluoperazine) Thorazine (chlorpromazine) Trilafon (perphenazine)
Treatment for Extrapyramidal Side Effects
Treatment of these symptoms depends upon the medication that induced them and which symptoms you have. Benzodiazepines are sometimes prescribed to help counteract extrapyramidal side effects, as are anti-parkinsonism drugs called anticholinergics. Antipsychotics block dopamine, which is what causes the extrapyramidal side effects in the first place. Anticholinergics increase dopamine so it becomes leveled out in your system.
Atypical Antipsychotics
Atypical antipsychotics are the newer second-generation of antipsychotics. If you are experiencing extrapyramidal side effects on one of the older, typical antipsychotics, your doctor may switch you to one of these. Atypical antipsychotics include:
Abilify (aripiprazole)Clozaril (clozapine)Fanapt (iloperidone)Geodon (ziprasidone)Invega (paliperidone)Risperdal (risperidone)Saphris (asenapine)Seroquel (quetiapine)Zyprexa (olanzapine)
Other Side Effects
Antipsychotic medications can produce other side effects as well. You should always talk to your doctor about these potential side effects and be aware of what you should do if you experience any serious side effects from your medication.
Typical Antipsychotics
Beyond extrapyramidal side effects, these are the most common side effects of typical antipsychotics:
Blurred visionDiarrhea or constipationDifficulty sleepingDrowsiness and feeling sleepyDry mouthFeeling agitatedFeeling like your mind has slowed downHeartburnHypotension, which is when your blood pressure suddenly dropsMenstrual abnormalitiesSexual difficultiesUpset stomachVomiting
These effects may go away in time, but if they don’t or you find them bothersome, contact your doctor.
Atypical Antipsychotics
Other than extrapyramidal side effects, these are the most common side effects of atypical antipsychotics:
ConstipationDifficulty sleepingDizzinessDroolingDrowsinessFaster heartbeatHeadacheHigher body temperatureProblems urinatingRashStuffy nose or a runny nose
These effects may go away in time. If they don’t, or they get worse, talk about your options with your doctor.
Should You Discontinue Your Medication?
If you do experience extrapyramidal symptoms, you might wonder if you should stop taking your medication. Start by talking with a doctor. Often the only way to address extrapyramidal effects is to try different drugs, to try lower doses of the medication, or to switch to another medication. Depending on what type of antipsychotic drug you are taking, your doctor may also prescribe other medications to help treat the extrapyramidal side effects. Determining whether you continue your medication is often a process of weighing the benefits of the drug and the risks of no longer taking it against the severity and effects of your extrapyramidal symptoms. You may choose to live and cope with some side effects rather than risk losing the benefits of the medication. This is a decision that you should only make by talking to your doctor. If your extrapyramidal symptoms are severe, you may work with your doctor to find another treatment option that will work for you.
A Word From Verywell
Discontinuing medication without consulting your doctor can lead to complications and side effects. If you are experiencing any troubling side effects from your medication, consult your doctor to discuss the next steps. Your doctor can recommend options that can treat and reduce extrapyramidal symptoms.
