Bipolar Disorder Treatment Extrapyramidal Side Effects From Medication By Marcia Purse Updated on April 10, 2024 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Amy Morin, LCSW Print Photodisc / Getty Images Table of Contents View All Table of Contents Symptoms Diagnosis Causes Treatment Other Side Effects Discontinuing Medication Frequently Asked Questions Trending Videos Close this video player Extrapyramidal side effects are a group of movement-related symptoms that can occur when taking certain drugs and can include involuntary muscle contractions, stiff muscles, and tremors. These effects are more commonly associated with antipsychotic medications but can also occur with other types of medications and some illegal drugs. If you're concerned about extrapyramidal side effects in yourself or someone you love, it is helpful to learn the symptoms to watch for and what causes them to occur. We also discuss how these effects can be treated, along with some of the other side effects that may be experienced when taking antipsychotic medications. Extrapyramidal Side Effects or Symptoms The extrapyramidal system is responsible for regulating involuntary movements, like when our foot kicks up after tapping below the knee. Some medications can affect this system's function, leading to a variety of extrapyramidal side effects or symptoms. Here are several to watch for. Akathisia Akathisia is a feeling of restlessness that makes it hard to sit down or hold still. Research suggests that this side effect occurs in roughly 19.5% of people who take antipsychotics, but can vary between 3.5% and 57% depending on the medication prescribed. Akathisia symptoms generally involve movements that occur below the hips. This can include pacing, marching in place, rocking while standing, and crossing and uncrossing your legs. Dystonia With dystonia, muscles involuntarily contract and contort. This can lead to painful positions or movements and is potentially dangerous if it affects the muscles of the throat. Between 1.4% and 15.3% of individuals taking second-generation antipsychotics experience this extrapyramidal symptom. Dystonia usually starts within 96 hours of taking an antipsychotic drug. Certain risk factors may make it more likely that these contractions or contortions occur. They include being younger, being male, experiencing dystonia in the past, and recent cocaine use. Dystonia can be treated with medications, including drugs used to treat Parkinson's disease. Lowering the dose of the antipsychotic medication may also be helpful. Parkinsonism Parkinsonism involves having Parkinson's disease symptoms but is caused by medications and not the disease. Drug-induced parkinsonism symptoms can include tremors, rigid muscles, slow movement and speed, and postural reflex impairment. These extrapyramidal symptoms often appear gradually after starting a medication and may be worse when taking a higher dose. They do eventually fade on their own, but may also be reduced by lowering the medication dosage or switching to a different type of antipsychotic drug. Research has found that 3.3 per 100,000 cases of parkinsonism are induced by drugs, with typical antipsychotics being the most common cause. Additionally, these symptoms are more common in women and the risk of experiencing them 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 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, tends to be longer-lasting, and is present for at least one month or more after taking the same medication and dose. This extrapyramidal symptom does not appear until taking the medication for at least six months and may continue even after treatment. 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 this category of effects. Neuroleptic Malignant Syndrome Neuroleptic malignant syndrome is a condition that affects the nervous system and can occur as a reaction to antipsychotic drugs. It leads to symptoms such as muscle stiffness and high fever. This syndrome is rare and potentially life-threatening, occurring in less than one per 1000 people who take antipsychotic medications. Although serious, it can be treated with medication. Recap Extrapyramidal effects impact coordination and motor control. Some of these effects include akathisia, dystonia, parkinsonism, tardive dyskinesia, and neuroleptic malignant syndrome. Diagnosis of EPS The diagnosis of extrapyramidal symptoms (EPS) often takes place after family members begin to notice that the person 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 care provider may want to speak to family members about the type of symptoms they have observed. They may also use a scale to help evaluate the symptoms you are experiencing and their severity. Two scales used to help diagnose extrapyramidal symptoms include: Extrapyramidal Symptoms Rating Scale (ESRS) Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) Causes of Extrapyramidal Side Effects Antipsychotic medications work by blocking the actions of the neurotransmitter dopamine. Extrapyramidal effects are the result of this dopamine blockage or depletion in the basal ganglia. Dopamine is known for its role in mood and addiction. Excessive dopamine activity is believed to play a part in schizophrenia development. By blocking the action of dopamine, antipsychotics can help relieve symptoms of psychotic disorders. Typical antipsychotics are the first generation of antipsychotics and 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) Recap Extrapyramidal side effects are caused by the dopamine-blocking actions of antipsychotic medications. Typical antipsychotics, also known as first-generation antipsychotics, most commonly produce these effects. Treatment for Extrapyramidal Side Effects Treatment of these extrapyramidal symptoms depends upon the medication that induced them and the symptoms experienced. Benzodiazepine drugs are sometimes prescribed to help counteract extrapyramidal side effects. So are anti-parkinsonism drugs called anticholinergics, which increase dopamine. Your physician may also try decreasing your dose or switching your medication altogether to one that has been shown to have fewer extrapyramidal side effects. Alternative medications include atypical antipsychotics. Atypical Antipsychotics Atypical antipsychotics are a newer second-generation of antipsychotics. If you are experiencing extrapyramidal side effects on one of the older, typical antipsychotics, your physician 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) Recap Extrapyramidal side effects can be treated with medication, but lowering the dosage of your medication or switching to a different antipsychotic medication can also be helpful. Other Antipsychotic Side Effects Antipsychotic medications can produce other side effects as well. Always talk to your care provider 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, the most common side effects of typical antipsychotics include: Blurred vision Drowsiness and feeling sleepy, or trouble sleeping Dry mouth Feeling agitated Feeling like your mind has slowed down Gastrointestinal issues (heartburn, upset stomach, vomiting, diarrhea, and constipation) Hypotension, which is when your blood pressure suddenly drops Menstrual abnormalities Sexual difficulties These effects may go away in time, but if they don't or you find them bothersome, contact your physician. Atypical Antipsychotics Other than extrapyramidal side effects, the most common side effects of atypical antipsychotics include: Blood sugar issues (diabetes) Drowsiness Increased cholesterol levels Lower sex drive Seizures Sensitivity to the sun Weight gain These effects may go away in time. If they don't or they get worse, talk about your options with your care provider. Recap Antipsychotics can also produce a range of other side effects beyond extrapyramidal side effects. Should You Discontinue Your Medication? If you experience extrapyramidal symptoms, you might wonder if you should stop taking your medication. Start by talking with a physician. They may lower your dose or switch you to another medication. Depending on what type of antipsychotic you are taking, they may also prescribe other medications to help treat the extrapyramidal side effects. Determining whether to 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 lose the benefits of the medication. This decision should only be made after talking with your care provider. Never stop taking your medication or reduce your dosage on your own. Discontinuing your medication may cause symptoms of your condition to return or worsen. Summary Discontinuing medication without consulting your healthcare provider can lead to complications and side effects. If you are experiencing any troubling side effects, talk with them to discuss the next steps. They can recommend options to treat and reduce extrapyramidal symptoms. If your extrapyramidal symptoms are severe, your provider can find another treatment option that may work for you. Frequently Asked Questions What drugs cause extrapyramidal side effects? Typical antipsychotics are the most frequent cause of drug-induced extrapyramidal side effects. However, these side effects can occur with any type of antipsychotic. Some other types of medications can also cause extrapyramidal symptoms, including antidepressant drugs and lithium. Learn More: Negative Effects of Antidepressants What is the medical condition EPS? EPS stands for extrapyramidal symptoms, which are also referred to as drug-induced movement disorders. EPS is a common adverse effect when taking agents that block dopamine receptors. Its symptoms can include parkinsonism, dystonia, and akathisia. How can I manage my extrapyramidal symptoms? Always ask your healthcare provider for help managing extrapyramidal symptoms. They may recommend a lower dose or a different medication to help minimize these side effects. They may also prescribe medications to help you cope, such as benzodiazepines and anticholinergics. Never alter your dose or stop taking a medication without talking to your physician. 15 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. University of Southern California Herman Ostrow School of Dentistry. 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Int Neuropsychiatric Dis J. 2022;17(4):1-7. doi:10.9734/INDJ/2022/v17i430207 Maia TV, Frank MJ. An integrative perspective on the role of dopamine in schizophrenia. Biolog Psychiatry. 2017;81(1):52-66. doi:10.1016/j.biophsych.2016.05.021 National Institute of Mental Health. Mental health medications. Mental Health America. Atypical antipsychotics. Sykes DA, Moore H, Stott L, et al. Extrapyramidal side effects of antipsychotics are linked to their association kinetics at dopamine D2 receptors. Nat Commun. 2017/8:763. doi:10.1038/s41467-017-00716-z By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Helpful Report an Error Other Submit