comon drugs that cause psychiatric symptoms.

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disclaim all liability in connection with its use.

 

This is the first of a two-part series on drug induced psychiatric symptoms that

is based on the July 8, 2002 issue of The Medical Letter on Drugs and

Therapeutics. The Medical Letter is a highly respected reference source written

for physicians and pharmacists that we often use because of its reputation as an

objective and independent source of drug information.

Many drugs can cause psychiatric symptoms. However, psychiatric symptoms may

also emerge during drug treatment due to an underlying illness, previously

unrecognized mental illness, or psychosocial factors. The stopping or withdrawal

of some drugs can also cause symptoms such as anxiety, psychosis, delirium,

agitation or depression.

This article lists psychiatric symptoms associated with some families or classes

of drugs. The type of psychiatric symptom is listed and then an explanatory

note. Examples of some drugs in the family are given. The list of examples is

not exhaustive.

Alcohol, agents that cause hallucinations and other drugs not generally used for

medical purposes are omitted. Withdrawal reactions in individuals addicted to

narcotics are also omitted.

We will refer a number of times to anticholinergic drugs and anticholinergic

adverse effects in the list below. An anticholinergic is a drug that blocks the

effects of acetylcholine, a substance produced by the body which is responsible

for certain nervous system activities (parasympathetic). Drugs with

anticholinergic effects (including antidepressants, antihistamines,

antipsychotics, drugs for intestinal problems, antiparkinsonians) inhibit the

secretion of acid in the stomach, slow the passage of food through the digestive

system, inhibit the production of saliva, sweat, and bronchial secretions, and

increase the heart rate and blood pressure. Adverse effects of these drugs

include dry mouth, constipation, difficulty urinating, confusion, worsening of

glaucoma, blurred vision, and short term memory problems.

What You Can Do

Keep in mind Rule 3 of our rules for safer drug use: Assume that any new symptom

you develop upon starting a new drug may be caused by the drug. If you have a

new symptom, psychiatric or otherwise, report it to your doctor.

Family: Amphetamine-like Drugs

Herbal dietary supplements containing ephedra should also be considered as

amphetamine-like drugs.

 

Reactions: Bizarre behavior, hallucinations, paranoia, agitation, anxiety,

mania, nightmares

Notes: Usually with overdose or abuse; can occur with inhaler abuse; depression

on withdrawal

Examples: This family includes the diet drugs such as sibutramine (MERIDIA) and

phentermine (IONAMIN)

 

 

Family: Anabolic Steroids (Body-building Steroids)

 

Reactions: Psychosis, mania, depression, anxiety, aggressiveness, paranoia

Notes: Most reports are with abuse

Examples: Oxymetholone (ANADROL); oxandrolone (OXANDRIN); stanozolol (WINSTROL).

There are many illegal sources of anabolic steroids. Anabolic steroids may also

be contained in dietary or herbal supplements.

 

 

Family: Angiotensin-converting Enzyme (ACE) Inhibitors

Reactions: Mania, anxiety, hallucinations, depression, psychosis

Notes: Many reports

Examples: Captopril (CAPOTEN); enalapril (VASOTEC); lisinopril (PRINIVIL,

ZESTRIL)

 

 

Family: Anticholinergics and Atropine

Reactions: Confusion, memory loss, disorientation, depersonalization, delirium,

auditory and visual hallucinations, fear, paranoia, agitation, bizarre behavior

Notes: More frequent in the elderly and children with high doses; can occur with

transdermal scopolamine (TRANSDERM SCOP); Atropine eye drops, particularly when

mistaken for nose drops can cause sudden incoherent speech, delirium with high

fever, flushed dry skin, hallucinations, or amnesia

Examples: Many drugs have anticholinergic properties including some

antidepressants, antihistamines, antipsychotics, drugs for intestinal problems,

and antiparkinsonian drugs

 

 

Family: Antidepressants, Tricyclic

Reactions: Mania or hypomania, delirium, hallucinations, paranoia, irritability,

dysphoria

Notes: Patients with bipolar disorder are at highest risk for mania;

anticholinergic effects may cause delirium in elderly

Examples: Amitriptyline (ELAVIL); doxepin (SINEQUAN); imipramine (TOFRANIL)

 

 

Family: Antiepileptics (Drugs for Seizure Disorders)

Reactions: Agitation, confusion, delirium, depression, psychosis, aggression,

mania, toxic encephalopathy (disease of the brain), nightmares

Notes: Usually with high doses or high blood concentrations

Examples: Phenytoin (DILANTIN)

 

 

Family: Barbiturates

Reactions: Excitement, hyperactivity, visual hallucinations, depression,

delirium-tremens-like syndrome (seen in alcohol withdrawal)

Notes: Especially in children and the elderly, or on withdrawal

Examples: Phenobarbital (SOLFOTON); aprobarbital (ALURATE); butabarbital

(BUTISOL)

 

 

Family: Benzodiazepines

Reactions: Rage, hostility, paranoia, hallucinations, delirium, depression,

nightmares, anterograde amnesia, mania, disinhibition

Notes: During treatment or on withdrawal; may be more common in the elderly

Examples: Diazepam (VALIUM); flurazepam (DALMANE); alprazolam (XANAX)

 

 

Family: Beta-blockers

Reactions: Depression, psychosis, delirium, anxiety, nightmares, hallucinations

Notes: With oral or eye drop preparations, incidence of depression may be

overestimated

Examples: Atenolol (TENORMIN); metoprolol (LOPRESSOR, TOPROL); propranolol

(INDERAL); levobunolol (BETAGAN); betaxolol (BETOPTIC); timolol (TIMOPTIC)

 

 

Family: Calcium Channel Blockers

Reactions: Depression, delirium, confusion, psychosis, mania

Notes: Several reports

Examples: Amlodipine (NORVASC); diltiazem (CARDIZEM, DILACOR, TIAZAC); verapamil

(CALAN, ISOPTIN, VERELAN)

 

 

Family: Cephalosporin Antibiotics

Reactions: Euphoria, delusions, depersonalization, illusions

Notes: Kidney disease is a risk factor

Examples: Cefaclor (CECLOR); cefuroxime (CEFTIN); cephalexin (KEFLEX)

 

 

Family: Dopamine Agonists for Parkinson's Disease

Reactions: Hallucinations, paranoia, delusions, confusion, mania,

hypersexuality, anxiety, depression, nightmares

Notes: During treatment or on withdrawal

Examples: Bromocriptine (PARLODEL); pergolide (PERMAX); pramipexole (MIRAPEX)

 

 

Family: Estrogens

Reactions: Panic attacks, depression

Notes: Several reports

Examples: Conjugated estrogens (PREMARIN); estradiol (ESTRACE)

 

 

Family: Fluoroquinolone Antibiotics

Reactions: Psychosis, confusion, agitation, depression, hallucinations,

paranoia, Tourette-like syndrome (a form of tic), mania

Notes: Many reports

Examples: Ciprofloxacin (CIPRO); levofloxacin (LEVAQUIN); sparfloxacin (ZAGAM)

 

 

Family: Histamine H-1 Blockers

Reactions: Hallucinations

Notes: Especially with overdosage of the older antihistamine drugs such as

diphenhydramine

Examples: Chlorpheniramine (CHLOR-TRIMETON); diphenhydramine (BENADRYL);

loratadine (CLARITIN); fexofenadine (ALLEGRA)

 

 

Family: Histamine H-2 Blockers

Reactions: Delirium, confusion, psychosis, mania, aggression, depression,

nightmares

Notes: Especially in the elderly and seriously ill

Examples: Cimetidine (TAGAMET); famotidine (PEPCID); nizatidine (AXID);

ranitidine (ZANTAC)

 

 

Family: Monoamine Oxidase (MAO) Inhibitor Antidepressants

Reactions: Mania or hypomania

Examples: Isocarboxazid (MARPLAN); phenelzine (NARDIL); tranylcypromine

(PARNATE)

 

 

Family: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Reactions: Depression, paranoia, psychosis, confusion, anxiety

Notes: Probably more common with indomethacin (INDOCIN); one case of auditory

hallucinations with celecoxib (CELEBREX)

Examples: Ibuprofen (MOTRIN); naproxen (NAPROSYN); meloxicam (MOBIC); rofecoxib

(VIOXX)

 

 

Family: Opioids

Reactions: Nightmares, anxiety, agitation, euphoria, dysphoria, depression,

paranoia, psychosis, hallucinations, dementia

Notes: Usually with high doses; also occurs with intrathecal (administration

into the spine) morphine; especially in the elderly

Examples: Narcotic pain relievers such as morphine, codeine, and oxycodone

(OXYCONTIN)

 

 

Family: Procaine Derivatives (procainamide, procaine penicillin G)

Reactions: Fear of imminent death, hallucinations, illusions, delusions,

agitation, mania, depersonalization, psychosis

Notes: Probably due to procaine

Examples: Procainamide (PROCANBID); procaine penicillin G is an injectable form

of penicillin given by a doctor

 

 

Family: Salicylates

Reactions: Agitation, confusion, hallucinations, paranoia

Notes: With chronic intoxication

Examples: Aspirin

 

 

Family: Selective Serotonin Reuptake Inhibitors (SSRIs)

Reactions: Mania, hypomania, hallucinations

Notes: Anxiety, irritability, aggression or impulsivity on withdrawal

Examples: Escitalopram (LEXAPRO); citalopram (CELEXA); fluoxetine (PROZAC);

paroxetine (PAXIL); sertraline (ZOLOFT)

 

 

Family: Statins

Reactions: Anxiety, depression, obsessions, delusions

Notes: Several reports

Examples: Atorvastatin (LOPID); fluvastatin (LESCOL); pravastatin (PRAVACHOL);

simvastatin (ZOCOR)

 

 

Family: Steroids, Oral

Reactions: Psychosis, delirium, mania, depression

Notes: 1 percent to 3 percent incidence, may be dose-related; can occur on

withdrawal

Examples: Prednisone (DELTASONE, METICORTEN); prednisolone (METRETON)

 

 

Family: Steroids, Inhaled

Reactions: Hyperactivity, aggression, disinhibition

Notes: Several reports

Examples: Triamcinolone (AZMACORT); beclomethasone (VANCERIL)

 

 

Family: Sulfonamides

Reactions: Confusion, disorientation, depression, euphoria, hallucinations

Notes: Several reports

Examples: Sulfamethoxazole and trimethoprim (BACTRIM, SEPTRA, COTRIM)

 

 

Family: Thiazide Diuretics

Reactions: Depression, suicidal ideation

Notes: After weeks to months of use

Examples: Hydrochlorothiazide (HYDRODIURIL); chlorthalidone (HYGROTON)

 

__________

Posted 9/02

http://www.citizen.org/eletter/articles/psychiatric.htm

 

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