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

Cases of other psychiatric side effects, such as confusion, paranoia, and visual hallucinations, have also been reported.[87,91-94] Although adverse neuropsychiatric effects are often found to be more frequent with the hydrophilic B-blocking agents such as propranolol than with hydrophilic agents like atenolol,[2] others feel that all beta-blockers cause cognitive dysfunction and sedation with equal frequency.[86]

Premarin

GENERIC-CONJUGATED ESTROGEN OTHER COMMON BRAND NAMES-PROGENS

General Information. This estrogen is administered at a dose of 0.3 to 1.25 mg per day for 1 to 23 days of the 28 day menstrual cycle.[2] For abnormal uterine bleeding, 25 mg is given intravenously or intramuscularly. Conjugated estrogen is often used for postmenopausal problems such as osteoporosis.[2,3] It iS also used for female menopausal symptoms, atrophic vaginitis, prostatic carcinoma, and hormonally induced uterine bleeding.[2,3] Estrogens stimulate the synthesis of specific proteins in responsive tissues by binding to specific cell receptors.[3] Hypocalcemia may occur with estrogen use.[3] Endometrial cancer is also thought to be increased by unopposed estrogen.[3,95]

POTENTIAL PSYCHIATRIC SIDE EFFECTS

**** Alteration of sexual behavior

* Hypomania

* Panic attacks

Discussion. Because conjugated estrogen is generally used in postmenopausal women as a replacement therapy, it is not surprising that associated behavioral or psychiatric effects of menopause such as depression are actually helped by this drug.[96] Estrogen treatment appears to influence sexual behavior and in most cases helps to reduce psychosexual problems in estrogen-deficient women.[97,98] Estrogens probably have little or no direct effect on sexual desire in women, but may indirectly enhance feelings of femininity.[99] In at least one bilaterally castrated male, satisfactory sexual activity has been maintained by the use of estrogen.100

Case reports have suggested that hypomania[96] or panic attacks[101] can also occur with estrogen use. In cases of panic attack, symptoms abated after discontinuation of the drug.[101]

Cardizem

GENERIC-DILTIAZEM

General Information. Initially, diltiazem is administered at 30 mg each morning and night, and then at up to 360 mg per day.[3,11] Diltiazem is used mainly to treat angina pectoris and hypertension.[3,11] Diltiazem is a benzothiazepine that acts by inhibition of the slow-channel calcium.[2,11] By blocking calcium entry into myocardial cells, it produces a direct negative inotropic action, dilates peripheral and coronary arteries, and prevents coronary artery spasm.[2,3,11]

POTENTIAL PSYCHIATRIC SIDE EFFECTS

* Psychosis and hallucinations

* Mania or hyperactivity

Discussion. Several studies indicate that calcium channel blockers such as diltiazem may actually have therapeutic uses in psychiatric illness, particularly mania.[102,103] The scientific documentation for possible psychiatric side effects of diltiazem consists of only a few case studies. Drug-induced psychosis has been reported, one case with associated manic features[104] but without drug rechallenge.[104,105] Diltiazem-induced mania was reported in another case,[106] but drug rechallenge reported later did not appear to confirm the original finding. [107,108] Overall, therefore, it appears that diltiazem is a relatively safe drug with regard to potential adverse psychiatric side effects.