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Drug Induced Psychiatric Symptoms (Part 2)

Worst Pills, Best Pills Newsletter article November, 2002

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