Guest guest Posted January 9, 2005 Report Share Posted January 9, 2005 Drug Induced Psychiatric symptoms JoAnn Guest Jan 07, 2005 20:30 PST ======================================================================== Drug Induced Psychiatric symptoms http://www.citizen.org/eletter/articles/psychiatric.htm This web site is intended only as a reference for use in an ongoing partnership between doctor and patient in the vigilant management of the patient's health. It is not a substitute for a doctor's professional judgment, and serves only as a reminder of concerns that may need discussion. This website does not list every possible adverse reaction, interaction, precaution and effect of a drug; and all information is presented without guarantees by the authors and consultants who 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. Family: 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 _________________ JoAnn Guest mrsjo- DietaryTi- www.geocities.com/mrsjoguest/Genes AIM Barleygreen " Wisdom of the Past, Food of the Future " http://www.geocities.com/mrsjoguest/Diets.html The all-new My – Get yours free! 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