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This is the second of a two-part series on drug-induced psychiatric symptoms that began in last month’s Worst Pills, Best Pills News. The information is based on the July 8, 2002 issue of The Medical Letter on Drugs and Therapeutics. Regular readers of Worst Pills, Best Pills News will recognize The Medical Letter as a 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...
This is the second of a two-part series on drug-induced psychiatric symptoms that began in last month’s Worst Pills, Best Pills News. The information is based on the July 8, 2002 issue of The Medical Letter on Drugs and Therapeutics. Regular readers of Worst Pills, Best Pills News will recognize The Medical Letter as a 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.
In Part 1, we discussed families of drugs that can cause psychiatric symptoms. This article lists, for some specific drugs, psychiatric symptoms associated with their use. The type of psychiatric symptom is listed and then an explanatory note, if needed. The list is in alphabetical order by generic name with one or more brand name examples in parenthesis in capital letters.
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.
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.
| Drug | Reactions | Notes |
|---|---|---|
| Acetazolamide (DIAMOX) | depression, delirium, confusion, stupor | especially in the elderly, or in those with kidney disease, low levels of protein in the blood, or when taken with salicylates |
| Acyclovir (ZOVIRAX) | hallucination, fearfulness, confusion, insomnia, abnormal acuteness of hearing, paranoia, depression | at high doses, particularly in patients with chronic kidney failure |
| Amantadine (SYMMETREL) | illusions, visual hallucinations, delusions, depression | risk increases with the duration of treatment and is more common in the elderly |
| Asparaginase (ELSPAR) | confusion, depression, paranoia | may occur frequently |
| Baclofen (LIORESAL) | hallucinations, paranoia, nightmares, mania, depression, anxiety, confusion | sometimes with high doses, but usually occurs after sudden withdrawal |
| Bupropion (WELLBUTRIN) | psychosis, agitation, anxiety, nightmares, mania | agitation and anxiety are the most common |
| Buspirone (BUSPAR) | vivid dreams, delirium, mania, panic attack | reported in a few patients |
| Caffeine - found in many dietary supplements for weight loss and body building in combination with ephedra. Also sold as a natural herbal energizer under the gurana. | anxiety, confusion, psychotic symptoms | occurs with excessive doses, anxiety is seen on withdrawal |
| Chlorambucil (LEUKERAN) | hallucinations, lethargy, seizures, stupor, coma | with high doses |
| Chlorquine (ARALEN) | confusion, delusions, hallucinations, mania | several reports |
| Clarithromycin (BIAXIN) | mania | many reports |
| Clonidine (CATAPRES) | depression, delirium, psychosis, hallucinations | may resolve with continued use |
| Clozapine (CLOZARIL) | delirium | risk is less when starting with a low dose and slowly increasing; psychosis has been seen following abrupt withdrawal |
| Cyclobenzaprine (FLEXERIL) | hallucinations | especially in the elderly |
| Cytarabine (CYTOSAR-U) | confusion | especially with high doses |
| Dapsone | Insomnia, agitation, hallucinations, mania, depression | several reports; may occur even with low doses |
| Deet (OFF) | mania, hallucinations | seen with excessive or prolonged use |
| Dextromethorphan (ROBITUSSION DM) | psychosis | several reports with high doses |
| Digoxin (LANOXIN) | delirium, depression, psychosis, mania, visual hallucinations | depends on dose; elderly at higher risk |
| Disopyramide (NORPACE) | hallucinations, psychosis, paranoia, panic, depression | seen within 24 to 48 hours after starting |
| Disulfiram (ANTABUSE) | catatonia, delirium, depression, psychosis | not related to alcohol reactions |
| Dronabinol (MARINOL) | anxiety, psychosis, confusion | most disturbing in the elderly |
| Efavirenz (SUSTIVA) | vivid dreams or nightmares, hallucinations, anxiety, depression, psychosis, confusion | several reports |
| Erythropoietin (EPOGEN) | visual hallucinations | reported in dialysis and marrow transplant patients |
| Ganciclovir (CYTOVENE) | psychosis, delirium, confusion | several reports |
| Ifosfamide (IFEX) | hallucinations, emotional lability, confusion, psychosis | several reports, especially in the elderly |
| Interleukin-2 (PROLEUKIN) | hallucinations, confusion | especially with high doses |
| Interferon alfa (ROFERON-A) | irritability, emotional lability, depression, agitation, paranoia | depression is also seen on withdrawal |
| Isoniazid (INH) | psychosis, hallucinations, mania | several reports |
| Isotretinoin (ACCUTANE) | depression, suicidality | several reports |
| Ketamine (KETALAR) | nightmares, hallucinations, delirium, emotional lability | acute; frequent with usual doses |
| Levodopa (SINEMET) | hallucinations, delusions, mania, depression, anxiety, panic attacks, confusion nightmares | dependent on dose; anxiety may occur in "off" phase |
| Levonorgestrel implant (NORPLANT) | major depression, panic disorder | several reports |
| Lidocaine (ZYLOCAINE) | hallucinations, psychosis, paranoia, delusions, agitation, anxiety | several reports |
| Mefloquine (LARIAM) | vivid dreams or nightmares, hallucinations, depression, confusion, psychosis, aggression, agitation, anxiety | vivid dreams and nightmares are frequent |
| Methyldopa (ALDOMET) | depression, amnesia, nightmares, psychosis | incidence of depression may be overestimated |
| Methylphenidate (RITALIN) | hallucinations, anxiety | seen in children and adults |
| Methysergide (SANSERT) | depersonalization, hallucinations, agitation, depression | several reports |
| Metoclopramide (REGLAN) | depression, anxiety, mania | several reports; confusion in the elderly |
| Metronidazole (FLAGYL) | depression, agitation emotional lability, confusion, hallucinations | many reports |
| Nevirapine (VIRAMUNE) | hallucinations, delirium, psychosis | several reports |
| Ondansetron (ZOFRAN) | panic attack, difficulty in speaking | occurs rarely |
| Pilocarpine (PILOCAR) | confusion, agitation, memory loss | eye use (ocular) especially in elderly and demented patients |
| Propafenone (RYTHMOL) | agitation, delusions, disorientation, mania, paranoia | several reports |
| Pseudoephedrine (SUDAFED) | hallucinations, paranoia, psychosis | reported in children with usual doses |
| Qunidine (DURAQUIN, QUINAGLUTE DURA-TABS, QUINIDEX | confusion, agitation, psychosis | usually related to dose |
| Selegiline (ELDEPRYL) | hallucinations, mania, nightmares, behavioral disturbance, confusion, hypersexuality, delusions | several reports |
| Sildenafil (VIAGRA) | aggression, confusion, delusions, hallucinations, mania, paranoia | several reports |
| Sumatriptan (IMITREX) | panic-like somatic symptoms | especially with a history of anxiety |
| Theophylline (BRONKODYL, CONSTANT-T, SLO-BID, THEO-DUR) | mutism, hyperactivity, anxiety, mania | seen with high blood level concentrations |
| Tizanidine (ZANAFLEX) | hallucinations | reported in three percent of patients in clinical trials |
| Trazodone (DESYREL) | delirium, hallucinations, paranoia, mania | several reports |
| Trimethoprim-Sulfamethoxazole (BACTRIM) | delirium, psychosis, depression, hallucinations | several reports |
| Venlafaxine (EFFEXOR) | visual hallucinations, mania | few reports |
| Vinblastine (VELBAN) | depression, anxiety | may occur commonly and is related to dose |
| Vincristine (ONCOVIN) | hallucinations, anxiety | may be related to dose |
| Zaleplon (SONATA) | visual illusions, anxiety, depression, hallucinations | |
| Zolpidem (AMBIEN) | psychosis, hallucinations, sensory distortions | women may be at greater risk; higher doses may increase the risk |
