Tardive dyskinesia (TD) is a condition that presents as involuntary uncontrollable and repetitive movements of the face, tongue, limbs, and trunk that can occur after prolonged use of dopamine receptor blocking agents such as antipsychotics. This case report describes a 63-year-old male patient who developed severe TD in June of 2021. His highest recorded abnormal involuntary movement scale (AIMS) score was 34 in September of 2022. In addition to escitalopram, aripiprazole was added as adjunct treatment for his depression in 2018. Dosing of aripiprazole ranged from 5-10mg for three years. Aripiprazole was weaned over a three-week in December of 2021.

Also the patient has family history of Parkinson's disease which is known for increasing risk of developing TD in patients treated with antipsychotic medications. But, just one month prior (May 4, 2021) to the onset of TD, this patient received Janssen COVID-19 vaccination. After being quickly tapered off aripiprazole the patient continued escitalopram and clonazepam.

In February of 2022 he was started on Valbenazine 40mg daily. He showed a dramatic improvement in TD with a 75% reduction of AIMS score despite some remaining truncal movements. This case discusses the importance of routine monitoring and early identification of tardive dyskinesia in patients with depression who are being treated with low dose antipsychotic not remarkable inducing TD in small doses. There is discussion about the importance of pharmacogenomic testing and gene variations that should be considered when prescribing psychotropics. Furthermore COVID-19 vaccination(s) may also play a role in TD susceptibility and severity.