Times are tough! There is a lot to worry about, from financial challenges and political turmoil to unusual weather patterns and health concerns. It’s hardly any wonder that tens of millions of Americans are relying upon anti-anxiety agents and antidepressants. Very few prescribers warn their patients that a medication they may be taking could have unanticipated psychiatric drug side effects. In other words, medications for diabetes, heartburn or hypertension can sometimes trigger unexpected psychological reactions. Even worse, drugs specifically targeted to treat depression can sometimes cause suicidal thoughts.
Depression–A Challenging Drug Reaction:
Depression is a devastating disorder. It can rob people of their motivation, appetite, sex drive, concentration, sleep and energy. Relationships suffer. Major depressive disorder sucks the joy out of life.
When depression strikes spontaneously, it can be challenging to treat. If it occurs as a side effect of medication, diagnosis can be difficult and treating can be even more problematic.
Healthcare professionals don’t always warn their patients that psychological depression can be an adverse drug reaction. But hundreds of medications may impact mood.
Reserpine and Depression:
One of the earliest connections between prescribed medicine and depressive symptoms involves a blood pressure medication called reserpine. It was derived from a plant called Rauwolfia serpentina and was widely used after its FDA approval in 1955. More recently, however, it has fallen out of favor because of numerous side effects, including psychological depression.
Drug companies and the FDA are sometimes slow to recognize this adverse reaction. That’s in part because it may take weeks or months for depressive symptoms to show up. At first, they may be subtle. A clinical trial that only lasts several weeks may not reveal unexpected psychiatric drug side effects.
Prozac and Suicidal Ideation:
Also, people resist the idea that a drug intended to make patients feel better could have such a negative impact on their lives. We too were slow to recognize the possibility that the antidepressant fluoxetine (Prozac) could trigger suicidal thoughts.
This drug was first approved by the FDA in 1987. A physician wrote to us shortly thereafter to tell us about the tragic suicide of his daughter. Initially, we could not believe an antidepressant could trigger suicidal thoughts. But by 1990 psychiatrists from Harvard published six case reports of people who developed “intense violent suicidal preoccupations after 2-7 weeks of fluoxetine treatment” (American Journal of Psychiatry, Feb. 1990).
Our interactions with the maker of Prozac and the FDA left much to be desired. Both organizations denied there could be a connection. Today, fluoxetine and many other antidepressants carry a prominent warning in their prescribing information about suicidal thoughts and behaviors.
Weight Loss Drugs and Depression?
There are many other medicines that may cause depression as a side effect, but those designed to affect appetite deserve special scrutiny. In the mid-2000s, a drug called rimonabant was approved in Europe. It blocked cannabinoid receptors and helped people lose weight.
However, in 2007 the FDA decided not to approve it because the agency was not convinced it was safe. That turned out to be a smart move. By 2009, rimonabant had been pulled off the global market because of serious psychiatric side effects, including suicide.
Semaglutide: Ozempic and Wegovy?
Might this be a problem for the hottest drugs in the pharmacy today? Semaglutide is the active pharmaceutical ingredient in three different drugs: Ozempic, Rybelsus and Wegovy. Doctors prescribe the first two to help control blood sugar in people with type 2 diabetes. Wegovy is indicated to help people lose weight.
Is depression an adverse effect of semaglutide? There are some case reports, but there is no mention of psychiatric reactions in the prescribing information for either Ozembic or Rybelsus.
The Wegovy information cautions doctors:
“Monitor patients treated with WEGOVY for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.”
Patients should discuss such reactions with their healthcare providers, who may consider changing the treatment plan.
Reglan: A Drug For Heartburn:
When Sylvia was put on a heartburn medicine called metoclopramide (Reglan), she never expected to experience psychiatric drug side effects or a psychotic breakdown. After all, how could something for your stomach affect your brain?
Yet Sylvia was in and out of a mental hospital during the time she was on metoclopramide because she experienced hallucinations, depression, confusion and anxiety.
She wondered whether any of her medicines might be contributing to her problems but her psychiatrist didn’t think that was likely. Little did he know that the metoclopramide that was prescribed for her GI tract can cause psychiatric symptoms such as severe depression and hallucinations, confusion, anxiety, seizures, insomnia, involuntary muscle contractions and restlessness.
Unexpected Psychiatric Drug Side Effects:
People are not surprised when a medication prescribed for anxiety, ADHD, depression or psychosis causes emotional ups and downs. That’s also true for hallucinogens! Remember the famous song, White Rabbit, sung by Grace Slick and Jefferson Airplane:
“One pill makes you larger, and one pill makes you small
And the ones that mother gives you, don’t do anything at all
Go ask Alice, when she’s ten feet tall…”
If you have not listened to White Rabbit in awhile, please scroll up and click on the link. It is a memorable performance that is worth a moment of your time.
Antibiotics and Hallucinations?
Stories of hallucinations associated with LSD or “magic mushrooms” do not surprise health professionals or patients. What surprises people are stories about antibiotics and hallucinations:
Linda was put on an antibacterial drug called ofloxacin (Floxin) for a routine urinary tract infection. She took her medicine for granted, expecting a rapid cure with few, if any, side effects. In the past, antibiotics had caused some stomach upset and mild diarrhea.
Ofloxacin was different. Insomnia, anxiety, visual disruption, paranoid thoughts and hallucinations panicked Linda. She was diagnosed with toxic psychosis.
Drug-Induced Depression:
Like Sylvia and Linda, most people are unprepared for psychiatric reactions to everyday medicines. We heard from one bereaved daughter whose father committed suicide after taking the cholesterol-lowering drug simvastatin for a few years.
She wrote:
“Prior to that he had never been depressed. I have since met a patient who can directly attribute the start of depression with beginning on simvastatin and its end with stopping the drug.”
The Beta Blocker Blues:
Another reader described her downward spiral after starting hormone replacement therapy. The migraines that resulted led to a prescription for a beta blocker called propranolol.
Within months she found herself severely depressed and barely able to function. When the hormones were discontinued, her migraines stopped. Without headaches or beta blocker medication, the depression lifted.
Corticosteroids and Psychiatric Drug Side Effects:
Prednisone and other corticosteroids are frequently prescribed to ease severe allergic reactions or sinusitis. A bad case of poison ivy often merits a substantial dose of oral steroid. Commonly, a doctor will prescribe a big starting dose that tapers down over the next week or two or three.
Big doses of prednisone, even for just a few days, can trigger some strange reactions, including anxiety, emotional lability, irritability, insomnia, depression, agitation, distractibility, memory impairment, auditory and visual hallucinations and other delusions. There is even a name for this condition: “steroid psychosis.”
Anticholinergic Drugs, Memory Loss and Confusion:
Here is another improbable connection. The bladder seems remote from the brain and drugs to treat so-called overactive bladder appear totally unrelated to mental clarity.
This reader shared a story that may be far more common than most people realize:
“I am a 49-year-old female who has been on oxybutynin (Ditropan) for a few years. I had my family doctor refer me to a psychiatrist because I was having much more trouble remembering things.
“On my first visit to the specialist, I gave her a list of all the medications I was on. (I was taking six medications and had to write them down, as I could never remember them.) As soon as she saw the oxybutynin, she told me that confusion is a side effect.
“I never even tied the two together. The bladder and the head are rather far apart! I immediately stopped taking the Ditropan and felt much better right away. I was attributing my depression and confusion to menopause. It worries me that there could be thousands of people suffering and not making the connection.”
If you would like a list of other anticholinergic drugs that you would never suspect could cause confusion or memory problems, here is a link.
Health Professionals and Psychiatric Drug Side Effects:
Many physicians do not warn patients about psychiatric side effects. We have heard from many people who got a big dose of prednisone for a skin problem but they were not warned about irritability, insomnia or other unpleasant emotional complications. When someone reports anxiety, depression or insomnia, doctors may assume the problem lies with the patient’s coping skills or life circumstances.
This faulty thinking is sometimes extended to patients having trouble getting off anxiety medicines such as lorezepam (Ativan) or alprazolam (Xanax) or antidepressants like venlafaxine (Effexor), paroxetine (Paxil) and sertraline (Zoloft). Some physicians believe withdrawal difficulties are caused by a return of the patient’s initial psychological complaints.
One woman was distressed that her doctor did not take her symptoms of dizziness, bizarre dreams, headaches, sensory disturbances and anxiety seriously. Although he had heard of paroxetine withdrawal, he thought only “troubled” or seriously depressed patients had such problems, and she didn’t fit that category.
Tramadol:
Now that doctors are wary 0f prescribing opioid pain relievers like hydrocodone or oxycodone, they are turning to drugs like tramadol. They may not realize that this pain reliever can cause hallucinations (see this link). Stopping tramadol can also trigger brain zaps, tremors, nightmares, depression and hallucinations. Here is a link to over 500 stories about tramadol.
To discover the large number of medications that can cause unexpected and potentially serious mental changes, why not download our free Guide to Psychological Side Effects?
Physicians and patients must recognize that symptoms ranging from depression or disorientation to anxiety and hallucinations might be due to medication. Certain antibiotics, cholesterol-lowering drugs, pain relievers and steroids such as prednisone are just a few of the commonly prescribed drugs that can trigger psychiatric side effects.
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