To the Editor: Cases of tardive dyskinesia associated with atypical neuroleptic medications have been reported (1); however, we are not aware of any cases in which tardive dyskinesia has been associated with ziprasidone. Ziprasidone, a newer atypical neuroleptic, is a serotonin 5-HT_2A, dopamine D₂, and α₁ inhibitor, with a greater affinity for the 5-HT_2A receptors than for the D₂ receptors. It is a benzothiazolylpiperazine, structurally dissimilar to other antipsychotics, and is the only atypical antipsychotic that is an agonist at 5-HT_1A receptor sites, an antagonist at 5-HT_1D receptor sites, and an inhibitor of both norepinephrine and serotonin reuptake. Ziprasidone is indicated for the treatment of schizophrenia and schizoaffective disorder by the Food and Drug Administration, but several studies have suggested its effectiveness in the treatment of acute mania and bipolar disorder (2).

We report the case of a patient with bipolar disorder who had a history of tardive dyskinesia with typical neuroleptics. His symptoms had been latent for many years, including during a period of treatment with risperidone, but they reemerged with ziprasidone treatment.

This case suggests that ziprasidone may be associated with the reemergence of tardive dyskinesia, particularly in a patient with several indicated risks, including long-term exposure to traditional neuroleptics and a diagnosis of bipolar disorder.