Symptoms of Drug-Induced Psychosis
Psychosis affects how a person feels emotionally and physically, how they think, and their behaviors. According to the DSM IV, symptoms of drug-induced psychosis can include: 1
Delusions
- Grandiose delusions, including unfounded beliefs that someone possesses exceptional talent, has made a significant discovery, or holds a significant status. They might also believe they have considerable power or knowledge or can directly communicate with a deity.
- Delusional jealousy, or beliefs that an intimate partner has been unfaithful, even if that occurrence is impossible.
- Paranoid or persecutory delusions, beliefs that someone is being conspired against, harmed, attacked, or harassed.
- Somatic delusions, beliefs of something wrong with one’s body, such as a missing part, or an experience of strange sensations throughout the body.
- Reference delusions, the belief someone can read other people’s thoughts or that another person’s actions are directed against them.
- Bizarre delusions, when a person believes in a phenomenon that is impossible to happen in a normal life.
- Mixed delusions, when a person experiences a mix of different types of delusions.
Feelings
- Confusion
- Agitation or aggression
- Anger
- Paranoia
- Lack of interest in activities
Behaviors
- Difficulties carrying on conversations
- Trouble remembering things
- Difficulty maintaining hygiene or other routine daily activities
- Inappropriate behaviors
- Becoming angry for no obvious reason
- Becoming inactive or lethargic
- Becoming completely unaware of the surrounding environment
How Long Will Drug-Induced Psychosis Last?
For many people, the psychotic symptoms they are experiencing will only last while the prescription drug is in the system. After withdrawal, the hallucinations, delusions, and other symptoms should end. However, every case is different.
Risk Factors
Many factors can increase a person’s risk of developing prescription drug-induced psychosis,2, such as taking medications at high doses or for extended periods or combining multiple medications with other substances.
Individuals with pre-existing mental health conditions, such as schizophrenia or bipolar disorder, are more susceptible to experiencing drug-induced psychosis, along with those who are experiencing a substance use disorder. Stress or recent traumatic events can also play a role, as well as age, as both adolescents and older adults may face higher risks due to developmental factors and drug metabolism.
Genetic factors such as a person’s family history of individual sensitivity to specific medications can also predispose individuals to psychosis, along with taking specific drugs that are commonly linked to psychotic symptoms.
What Type of Prescription Drugs Can Cause Drug-Induced Psychosis?
While prescription drugs can affect individuals differently, some medications are more commonly related to medication-induced psychotic disorders.
Medications that have been known to induce psychosis include:
Antiparkinsonian Drugs
Parkinson’s disease is a chronic, progressive neurodegenerative disease that is often treated with medication. The cause of psychosis in the medication is due to its dopaminergic activity. Antiparkisonian drugs are associated with the highest risk of prescription-induced psychosis, with symptoms developing in up to 60% of Parkinson’s patients, especially older patients who require higher doses of the drugs.3
Commonly prescribed medications for Parkinson’s disease are:
- Levodopa
- Dopamine agonists like pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro).
- MAO-B inhibitors like selegiline (Eldepryl or Zelapar) and rasagiline (Azilect).
- Anticholinergics like benztropine (Cogentin) and trihexyphenidyl (Artane).
- Amantadine
- Adenosine A2A receptor antagonists like istradefylline (Nourianz).
Stimulants
Stimulants are commonly prescribed for attention deficit hyperactivity disorder (ADHD), narcolepsy, and more. Typically, taking these medications in high doses, with prolonged use, or with pre-existing mental health conditions can increase a person’s risk for psychosis.4
Common prescription stimulants that may cause psychosis are:
- Amphetamines such as Adderall, Dexedrine, Evekeo, and Vyvanse.
- Methylphenidate such as Ritalin, Concerta, Metadate, and Daytrana.
- Dexmethylphenidate, such as Focalin.
- Modafinil such as Provigil.
- Armodafinil such as Nuvigil.
Antidepressants
Antidepressants are primarily used to treat depression and anxiety disorders, but some can potentially lead to psychosis, especially if a person is taking a high dose or has higher risk factors.5
These are the types of antidepressants that have been associated with an increased risk of psychosis:
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).
- Tricyclic antidepressants (TCAs) such as amitriptyline, nortriptyline (Pamelor), imipramine (Tofranil), and desipramine (Norpramin).
- Monoamine Oxidase Inhibitors (MAOIs) such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan).
- Trazodone
- Bupropion (Wellbutrin), although it is less commonly associated with psychosis, bupropion could cause such symptoms in high doses or if a person has pre-existing conditions.
Opioids and Pain Relievers
Opioids can cause psychosis for some individuals because of their effects on neurotransmitters. Many people use opioids for long periods, which can lead to neurotoxicity and interaction with other drugs, potentially damaging brain cells and disrupting normal brain function.6 Opioid use can lead to the need for higher and higher doses, resulting in overdose.
The most common opioids and pain relievers that have been associated with psychotic symptoms are:
- Oxycodone like OxyContin or Percocet.
- Hydrocodone like Vicodin or Norco.
- Morphines like MS Contin and Kadian.
- Fentanyl like Duragesic and Actiq.
- Codeine
- Tramadol
- Diphenhydramine (Benadryl), although it is primarily over-the-counter (OTC), high doses can lead to confusion, agitation, and hallucinations.
Combining any of these medications with alcohol, sedatives, or other drugs, either prescription or non-prescription, can exacerbate the risk of psychosis.
Heart Medications
Heart medications can be prescribed when someone suffers from a variety of heart problems, including heart arrhythmias, atrial fibrillation, and a variety of other symptoms and diseases that can lead to heart failure. In some patients, they may cause psychosis and related symptoms.7
A few heart medications associated with psychotic symptoms are:
- Digoxin, mainly used for heart failure and atrial fibrillation
- Antiarrhythmics, such as quinidine or procainamide, which are used for heart arrhythmias
- Beta-blockers and calcium channel blockers that are used for hypertension, angina, and heart failure, such as propranolol, metoprolol, atenolol, verapamil, and diltiazem
- ACE inhibitors and ARBs like enalapril, lisinopril, losartan, and valsartan, commonly used for hypertension and heart failure
- Statins for lowering cholesterol, like atorvastatin, simvastatin, and rosuvastatin
Corticosteroids
Corticosteroids are anti-inflammatory medications used to treat asthma, rheumatoid arthritis, and lupus. The occurrence of psychiatric reactions associated with corticosteroid use varies widely, which is indicative of a highly unpredictable medication. They are often influenced by dosage amount, treatment duration, and individual health and risk factors, but corticosteroids have the potential to cause psychosis.8
Commonly used corticosteroids are:
- Prednisone
- Hydrocortisone
- Dexamethasone
- Methylprednisolone
- Betamethasone
Why Does the Side Effect of Medication-Induced Psychosis Occur?
Prescription medications can sometimes lead to psychosis due to their impact on brain chemistry and function. One key factor is how these drugs affect neurotransmitter systems, particularly dopamine, serotonin, and norepinephrine. These disruptions can lead to delusions and hallucinations.
Drug interactions can also be a contributing factor, such as combining medications or other substances like alcohol or OTC drugs. High doses or overdoses can also overwhelm the brain’s ability to regulate mood and perception, resulting in psychotic symptoms.9
In addition, some side effects are more likely to occur due to the personal health of the person taking the medications, such as their body’s ability to process medications, pre-existing health conditions, and genetic or biological factors.
