Table of ContentsView AllTable of ContentsSymptomsDiagnosisCausesTreatmentOther Side EffectsDiscontinuing MedicationFrequently Asked Questions

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Symptoms

Diagnosis

Causes

Treatment

Other Side Effects

Discontinuing Medication

Frequently Asked Questions

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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 withantipsychotic medicationsbut 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 symptomsgenerally 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 recentcocaine 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

Tardive Dyskinesia

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 affectsthe nervous systemand 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.

RecapExtrapyramidal effects impact coordination and motor control. Some of these effects include akathisia, dystonia, parkinsonism, tardive dyskinesia, and neuroleptic malignant syndrome.

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:

Causes of Extrapyramidal Side Effects

Dopamine is known for its role in mood and addiction. Excessive dopamine activity is believed to play a part inschizophrenia 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:

Treatment for Extrapyramidal Side Effects

Treatment of these extrapyramidal symptoms depends upon the medication that induced them and the symptoms experienced.Benzodiazepine drugsare 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 antipsychoticsare 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:

RecapExtrapyramidal 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.

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:

These effects may go away in time, but if they don’t or you find them bothersome, contact your physician.

Other than extrapyramidal side effects, the most common side effects of atypical antipsychotics include:

These effects may go away in time. If they don’t or they get worse, talk about your options with your care provider.

RecapAntipsychotics can also produce a range of other side effects beyond extrapyramidal side effects.

Antipsychotics can also produce a range of other side effects beyond extrapyramidal side effects.

Should You Discontinue Your Medication?

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 QuestionsTypical 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 AntidepressantsEPS 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.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.

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

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

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.

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 oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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