Psychiatric side effects associated with the ten most commonly dispensed prescription drugs: a review

Journal of Family Practice, August, 1991 by John R. Hubbard, James L. Levenson, Graham A. Patrick

An association of HCTZ use and self-induced water intoxication (SMWI) in schizophrenic and other psychiatric patients has been discussed in the literature.[77,78] In a large retrospective study of psychiatric patients with polydipsia, HCTZ therapy was often noted.[78] Although HCTZ probably does not cause SIWI, it may exacerbate the hyponatremia caused by SIWI, usually in combination with some degree of syndrome of inappropriate antidiuretic hormone secretion (SIADH) secondary to psychiatric medications or psychosis itself.

Although the side effects of delirium and confusion are not well supported in the literature, they may occur in HCTZ overdose. For example, confusion and delirium were observed in a 65-year-old man with end-stage renal disease,[79] perhaps because this diuretic is cleared primarily by renal mechanisms. In considering the psychiatric aspects of these drugs, it is also very important to note that HCTZ therapy can raise lithium levels dangerously. For example, in an elderly woman on lithium treatment for manic depressive episodes, lithium levels reached a near lethal concentration (3.9 mg/L) causing changes in her mental status after HCTZ was started.80 The mechanism probably relates to the inverse relationship between sodium and lithium levels. Thus, depressed sodium concentration caused by HCTZ results in enhanced lithium levels. Overall, these reports suggest that therapy with hydrochlorothiazide/triamterene could cause unexpected behavioral changes, but much more documentation is needed to clarify the incidence of these adverse reactions.

Tenormin

GENERIC-ATENOLOL

General Information. Atenolol is administered at doses of 50 to 200 mg per day.[2,11] This drug is an antihypertensive agent that is also used for angina pectoris, arrhythmias, migraine headaches, and essential tremor.[2] The beta-adrenergic blocking action of the drug competes with sympathetic neurotransmitters for receptor sites, thereby causing depression of sympathetic tone.[3]

POTENTIAL PSYCHIATRIC SIDE EFFECTS

**** Sexual dysfunction including decreased

libido and arousal

(****) Memory loss

* Confusion, delirium, hallucinations

Discussion. Although infrequently, atenolol may cause memory loss, hallucinations, and sexual problems. In several small controlled studies, atenolol produced no apparent adverse psychiatric changes such as anxiety, depression, or altered memory.[81-86] In one of the studies, however, mild but statistically significant decreases in memory acquisition and short-term and long-term memory were noted.[84] Short-term memory loss and psychotic behavior were also noted in a 1983 case report, but drug rechallenge was refused.[87]

Physicians should inquire about sexual dysfunction in patients using atenolol. In a 1988 placebo-controlled study, atenolol appeared to produce both short-term (1 to 4 weeks) and long-term (1 year) sexual dysfunction in libido, erection, and ejaculation.[88] The possibility that some patients are vulnerable to atenolol-induced sexual dysfunction has been supported by other investigations, including both retrospective[89] and controlled studies.[90] An apparent decreased state of arousal has also been reported.[91,92] For example, a 6-week, placebo-controlled study involving 16 patients found (by questionnaire) depressed arousal secondary to use of 100 mg of atenolol per day.[91]