Skip to main content Accessibility help

Psychiatric side-effects of medications: recent developments

  • Nora Turjanski and Geoffrey G. Lloyd


Medications often induce neuropsychiatric side-effects. This article reviews psychiatric side-effects that are well known and describes those induced by recently developed medications. Therapeutic innovations have been prominent in the treatment of HIV infection, Parkinson's disease and epilepsy and therefore psychiatric side-effects caused by these agents are described in more detail.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Psychiatric side-effects of medications: recent developments
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Psychiatric side-effects of medications: recent developments
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Psychiatric side-effects of medications: recent developments
      Available formats



Hide All
Aarsland, D., Larsen, J. P., Cummins, J. L. et al (1999a) Prevalence and clinical correlates of psychotic symptoms in Parkinson disease: a community-based study. Archives of Neurology, 56, 595601.
Aarsland, D., Larsen, J. P., Lim, N. G. et al (1999b) Olanzapine for psychosis in patients with Parkinson's disease with and without dementia. Journal of Neuropsychiatry and Clinical Neuroscience, 11, 392394.
Adkins, J. C. & Noble, S. (1998) Tiagabine. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential in the management of epilepsy. Drugs, 55, 437460.
Alciati, A., Starace, F., Scaramelli, B. et al (2001) Has there been a decrease in the prevalence of mood disorders in HIV-seropositive individuals since the introduction of combination therapy? European Psychiatry, 16, 491496.
Antoniou, T. & Tseng, A. L. (2002) Interactions between recreational drugs and antiretroviral agents. Annals of Pharmacotherapy, 36, 15981613.
Ashton, C. H. & Young, A. H. (1998) Drug-induced psychiatric disorders. In Davies' Textbook of Adverse Drug Reactions (5th edn) (eds Davies, D. M., Ferner, R. E. & de Glanville, H.) pp. 669731. London: Chapman & Hall Medical.
Bannon, M. J. & Roth, R. H. (1983) Pharmacology of mesocortical dopamine neurons. Pharmacological Reviews, 35, 5368.
Barber, R., Panikkar, A., McKeith, I. G. (2001) Dementia with Lewy bodies: diagnosis and management. International Journal of Geriatric Psychiatry, 16, S12S18.
Bergman, J. & Lerner, V. (2002) Successful use of donepezil for the treatment of psychotic symptoms in patients with Parkinson's disease. Clinical Neuropharmacology, 25, 107110.
Besag, F. M. (2001) Behavioural effects of the new anticonvulsants. Drug Safety, 24, 513536.
Bing, E. G., Burnam, M. A., Longshore, D. et al (2001) Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Archives of General Psychiatry, 58, 721728.
*British Medical Association & Royal Pharmaceutical Society of Great Britain (2004) British National Formulary. London & Wallingford: BMJ Books & Pharmaceutical Press.
* Brown, T. M. & Stoudemiere, A. (1998) Psychiatric Side-effects of Prescription and Over the Counter Medications. Recognition and Management. Washington, DC: American Psychiatric Press.
Brunner, J., Parhofer, K. G., Schwandt, P. et al (2002) Cholesterol, essential fatty acids and suicide. Pharmacopsychiatry, 35, 15.
Cannas, A., Spissu, A., Floris, G. L. et al (2001) Chronic delusional hallucinatory psychosis in early-onset Parkinson's disease: drug-induced complication or sign of an idiopathic psychiatric illness? Neurological Sciences, 22, 5354.
Catalan, J., Meadows, J. & Douzenis, A. (2000) The changing patterns of mental health problems in HIV infection: the view from London, UK. AIDS Care, 12, 333341.
Catalan-Alonso, M. J. & Del Val, J. (2001) Dopaminomimetic psychosis in Parkinson's disease: first symptom of early dementia? Revista de Neurologia, 32, 10851087.
Colebunders, R. & Verdonck, K. (1999) Reply to Gonzalez and Everall: Lest we forget: neuropsychiatry and the new generation anti-HIV Drugs. AIDS, 13, 869.
Cote, L. (1999) Depression: impact and management by the patient and family. Neurology, 52 (suppl. 3), S7S9.
Cummings, J. L. (1992) Depression and Parkinson's disease: a review. American Journal of Psychiatry, 149, 443454.
Doder, M., Rabiner, E. A., Turjanski, N. et al (2000) Imaging serotonin HT1A binding in non depressed and depressed Parkinson's disease patients with 11C–WAY 100635 PET. Neurology, 54 (suppl. 3), A112.
* Everall, I. P., Drummond, S. & Catalan, J. (2004) Guidelines for the Prescribing of Medication for Mental Health Disorders for People with HIV Infection (Draft) (Council Report CR127). London: Royal College of Psychiatrists. On-line only at
Factor, S. A., Molho, E. S., Podskalny, G. D. et al (1995) Parkinson's disease: drug-induced psychiatric states. Advances in Neurology, 65, 115138.
Fernandez, H. H., Trieschmann, M. E., Burke, M. A. et al (2002) Quetiapine for psychosis in Parkinson's disease versus dementia with Lewy bodies. Journal of Clinical Psychiatry, 63, 513515.
Fernandez, H. H., Trieschmann, M. E., Burke, M. A. et al (2003) Long-term outcome of quetiapine use for psychosis among parkinsonian patients. Movement Disorders, 18, 510514.
Foster, R., Olajide, D. & Everall, I. P. (2003) Antiretroviral therapy-induced psychosis: case report and brief review of the literature. HIV Medicine, 4, 139144.
Friedman, J. H. & Factor, S. A. (2000) Atypical antipsychotics in the treatment of drug-induced psychosis in Parkinson's disease. Movement Disorders, 15, 201211.
Garcia-Escrig, M., Bermejo-Pareja, F. & Fernanadez Ponsati, J. T. (1999) Levodopa-induced psychosis in patients with idiopathic Parkinson disease. Medicina Clinica (Barcelona), 112, 245250.
Goetz, C. G., Blasucci, L. M., Leurgans, S. et al (2000) Olanzapine and clozapine. Comparative effects on motor function in hallucinating Parkinson's disease patients. Neurology, 55, 789794.
Gonzalez, A. & Everall, I. P. (1998) Lest we forget: neuropsychiatry and the new generation anti-HIV Drugs. AIDS, 12, 23652367.
Graham, J. M., Grunewald, R. A. & Sagar, H. J. (1997) Hallucinosis in idiopathic Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry, 63, 434440.
Guberman, A. (1996) Vigabatrin. Canadian Journal of Neurological Sciences, 23, S13S17.
Halliday, G. M., Blumbergs, P. C., Cotton, R. G. et al (1990) Loss of brainstem serotonin- and substance P-containing neurons in Parkinson's disease. Brain Research, 510, 104107.
Harry, T. C., Matthews, M. & Salvary, I. (2000) Indinavir use: associated reversible hair loss and mood disturbance. International Journal of STD & AIDS, 11, 474476.
Holcomb, H. H., Sternberg, D. E. & Heninger, G. R. (1983) Effects of electroconvulsive therapy on mood, parkinsonism and tardive dyskinesia in a depressed patient: ECT and dopamine systems. Biological Psychiatry, 18, 865873.
Holroyd, S., Currie, L. & Wooten, G. F. (2001) Prospective study of hallucinations and delusions in Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry, 70, 734738.
James, J. S. (2000) St John's wort warning: do not combine with protease inhibitors, NNRTIs. AIDS Treatment News, Feb. 18 (337), 35.
Jellinger, K. A. (1991) Pathology of Parkinson's disease. Changes other than the nigrostriatal pathway. Molecular and Chemical Neuropathology, 14, 153197.
Kalviainen, R. (2001) Long-term safety of tiagabine. Epilepsia, 42 (suppl. 3), 4648.
Kanner, A. M. & Rivas Nieto, J. C. (1999) Depressive disorders in epilepsy. Neurology, 53 (suppl. 2), S26S32.
Karch, F. E. & Lasagna, L. (1975) Adverse drug reactions. A critical review. JAMA, 234, 12361241.
Ketter, T. A., Post, R. M. & Theodore, W. H. (1999) Positive and negative psychiatric side-effects of anti-epileptic drugs in patients with seizure disorders. Neurology, 53 (suppl. 2), S53S67.
Khan, A., Faught, E., Gilliam, F. et al (1999) Acute psychotic symptoms induced by topiramate. Seizure, 8, 235237.
Klein, C., Gordon, J., Pollak, L. et al (2003) Clozapine in Parkinson's disease psychosis: 5 year follow-up review. Clinical Neuropharmacology, 26, 811.
Lambert, M. V. & Robertson, M. M. (1999) Depression in epilepsy: etiology, phenomenology and treatment. Epilepsia, 40 (suppl. 10), S21S47.
Lancman, M. (1999) Psychosis and peri-ictal confusional states. Neurology, 53 (suppl. 2), S33S38.
Lang, J. P., Halleguen, O., Picard, A. et al (2001) Apropos of atypical melancholia with Sustiva (efavirenz). Encephale, 27, 290293.
Lawson, D. H. (1998) Epidemiology. In Davies' Textbook of Adverse Drug Reactions (5th edn) (eds Davies, D. M., Ferner, R. E. & de Glanville, H.) pp. 619. London: Chapman & Hall Medical.
Lera, G. & Zirulnik, J. (1999) Pilot study with clozapine in patients with HIV-associated psychosis and drug-induced parkinsonism. Movement Disorders, 14, 128131.
Levinson, D. F. & Devinsky, O. (1999) Psychiatric adverse events during vigabatrin therapy. Neurology, 53, 15031511.
Manson, A. J., Schrag, A. & Lees, A. J. (2000) Low-dose olanzapine for levodopa induced dyskinesias. Neurology, 55, 795799.
Maricle, R. A., Nutt, J. G. & Carter, J. H. (1995) Mood and anxiety fluctuation in Parkinson's disease associated with levodopa infusion:preliminary findings. Movement Disorders, 10, 329332.
Mayberg, H. S. & Solomon, D. H. (1995) Depression in Parkinson's disease: a biochemical and organic viewpoint. In Behavioral Neurology of Movement Disorders (eds Weiner, W. J. & Lang, A. E.) New York: Raven Press.
McKeith, I. G., Galasko, D., Kosaka, K. et al (1996) Consensus guidelines for the clinical and pathological diagnosis of dementia with Lewy bodies (DLB). Report of the consortium on DLB international workshop. Neurology, 47, 11131124.
Melamed, E., Friedberg, G. & Zoldan, J. (1999) Psychosis. Impact on the patient and family. Neurology, 52 (suppl. 3), S14S16.
Meyer, J. M., Marsh, J. & Simpson, G. (1998) Differential sensitivities to risperidone and olanzapine in a human immunodeficiency virus patient. Biological Psychiatry, 44, 791794.
Mohr, E., Mendis, T., Hildebrand, K. et al (2000) Risperidone in the treatment of dopamine-induced psychosis in Parkinson's disease: an open pilot trial. Movement Disorders, 15, 12301237.
Nissenbaum, H., Quinn, N. P., Brown, R. G. et al (1987) Mood swings associated with the ‘on-off phenomenon in Parkinson's disease’. Psychological Medicine, 17, 899904.
Oinonen, K. A. & Mazmanian, D. (2002) To what extent do oral contraceptives influence mood and affect? Journal of Affective Disorders, 70, 229240.
Parkinson Study Group (1999) Low dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease. New England Journal of Medicine, 340, 757763.
Peyriere, H., Mauboussin, J.M., Rouanet, I. et al (2001) Management of sudden psychiatric disorders related to efavirenz. AIDS, 15, 13231328.
Piscitelli, S. C., Burstein, A. H., Chaitt, D. et al (2000) Indinavir concentrations and St John's wort. Lancet, 355, 547548.
Puzantian, T. (2002) Central nervous system adverse effects with efavirenz: case report and review. Pharmacotherapy, 22, 930933.
Reading, P. J., Luce, A. K. & McKeith, I. G. (2001) Rivastigmine in the treatment of parkinsonian psychosis and cognitive impairment: preliminary findings from an open trial.
Movement Disorders, 16, 11711174.
Riley, D. E. & Lang, A. E. (1993) The spectrum of levodopa-related fluctuations in Parkinson's disease. Neurology, 43, 14591464.
Sabato, S., Wesselingh, S., Fuller, A. et al (2002) Efavirenz-induced catatonia. AIDS, 16, 18411842.
Sackellares, J. C., Krauss, G., Sommerville, K. W. et al (2002) Occurrence of psychosis in patients with epilepsy randomized to tiagabine or placebo treatment. Epilepsia, 43, 394398.
Saint-Cyr, J. A., Taylor, A. E. & Nicholson, K. (1995) Behavior and the basal ganglia. In Advances in Neurology (vol. 65) (eds Weiner, W. J. & Lang, A. E.) New York: Raven Press.
Sano, M., Stern, Y., Cote, L. et al (1990) Depression in Parkinson's disease: a biochemical model. Journal of Neuropsychiatry and Clinical Neuroscience, 2, 8892.
Sanz de la Garza, C. L., Paoletti-Duarte, S., Garcia-Martin, C. et al (2001) Efavirenz-induced psychosis. AIDS, 15, 19111912.
Starkstein, S. E., Preziosi, T. J., Berthier, M. L. et al (1989) Depression and cognitive impairment in Parkinson's disease. Brain, 112, 11411153.
* Stockley, I. (2002) Stockley's Drug Interactions: A Sourcebook of Interactions, Their Mechanisms, Clinical Importance and Management (6th edn). London: Pharmaceutical Press.
Swindells, S., Zheng, J. & Gendelman, H. E. (1999) HIV-associated dementia: new insights into disease pathogenesis and therapeutic interventions. AIDS Patient Care and STDs, 13, 153163.
Targum, S. D. & Abbott, J. L. (2000) Efficacy of quetiapine in Parkinson's patients with psychosis. Journal of Clinical Pharmacology, 20, 5460.
Thomas, L., Trimble, M., Schmitz, B. et al (1996) Vigabatrin and behaviour disorders: a retrospective survey. Epilepsy Research, 25, 2127.
Tiffani, T. & Cummings, J. L. (1998) Depression in Parkinson's disease. Pharmacological characteristics and treatment. Drugs & Aging, 12, 5574.
Tolosa, E. (2003) Advances in the pharmacological management of Parkinson disease. Journal of Neural Transmission. Supplementum, (64), 6578.
Treisman, G. J. & Kaplan, A. I. (2002) Neurologic and psychiatric complications of antiretroviral agents. AIDS, 16, 12011215.
Trimble, M. R. (1991) Behavior and personality disturbances. In Neurology in Clinical Practice (2nd edn) (eds Bradley, W. G., Daroff, R. B., Fenichel, G. M. et al), pp. 81100. Stoneham, MA: Butterworth-Heinemann.
Trimble, M. R., Rusch, N., Betts, T. et al (2000) Psychiatric symptoms after therapy with new antiepileptic Drugs: psychopathological and seizure related variables. Seizure, 9, 249254.
Trosch, R. M., Friedman, J. H., Lannon, M. C. et al (1998) Clozapine use in Parkinson's disease: a retrospective analysis of a large multicentered clinical experience. Movement Disorders, 13, 377382.
Tseng, A. L. & Fosy, M. M. (1999) Significant interactions with new antiretrovirals and psychotropic drugs. Annals of Pharmacotherapy, 33, 461473.
Valldeoriola, F., Nobbe, F. A. & Tolosa, E. (1997) Treatment of behavioural disturbances in Parkinson's disease. Journal of Neural Transmission. Supplementum, 51, 175204.
Vuilleumier, P. & Jallon, P. (1998) Epilepsy and psychiatric disorders: epidemiological data. Revue Neurologique, 154, 305317.
Wolters, E. C., Kuiper, M. A., Zwaan, W. A. et al (1994) Dopaminomimetic psychosis: therapeutic strategies. In Mental Dysfunction in Parkinson's Ddisease (eds Wolters, E. C. & Scheltens, P.) pp. 281284. Dordrecht: ICG Publications.
Wolters, E. C., Jansen, E. N. H., Tuynman-Qua, H. G. et al (1996) Olanzapine in the treatment of dopaminomimetic psychosis in patients with Parkinson's disease. Neurology, 47, 10851087.
Wolters, E. C. (1999) Dopaminomimetic psychosis in Parkinson's disease patients. Neurology, 52 (suppl. 3), S10S13.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Psychiatric side-effects of medications: recent developments

  • Nora Turjanski and Geoffrey G. Lloyd
Submit a response


Are antidepressants anticonvulsants?

Faouzi Dib Alam, Specialist Registrar, Royal Peston Hospital, Sharoe Green Lane, Preston, PR2 9HT
30 August 2006

I read with interest this excellent article by Turjanski and Lloyd (APT 2005) on psychiatric side-effects of medications. In particular I was interested in the section under the heading of treatment of psychiatric complications on p. 65.The paper talks about tricyclic antidepressants being proconvulsants, and the need to start antidepressants at small doses to minimise the risk of seizures in patients with depression and co-morbid epilepsy.I recently undertook a review of antidepressants in epilepsy and found data to suggest that some antidepressants can exert anticonvulsant action.

In two separate studies, the use of tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) by patients with epilepsy more frequently led to reduced seizure frequency than to exacerbation (Ojemann et al,1987; Gross et al, 2000).It had previously been argued that the serotonergic and noradrenergic effects of antidepressant drugs are anticonvulsant, not proconvulsant (Jobe et al, 1984). Following this an unblinded, open-label, add-on trial of fluoxetinewas conducted in 17 patients with complex partial seizures where 6 patients showed complete disappearance of their daily seizures and in the others the seizure frequency was lowered by 30% (Favale et al, 1995). Meanwhile Hovorka et al evaluated 43 epileptic patients on citalopram who suffered from depression and found that their monthly seizure frequency did not worsen (Hovorka et al, 2000).Finally an open, multicentered, uncontrolled study in 45 epilepsy patients with depression who were treated with citalopram, was conducted, and found an overall improvement in seizure frequency in all 39 patients who completed the study (Specchio et al, 2004).

The above data cast some doubts on whether or not antidepressants reduce seizure threshold especially in patients who suffer from epilepsy.

In the end I suppose the question remains to be answered: are antidepressants anticonvulsants or proconvulsants??

Ojemann, L.M., Baugh-Bookman, C., Dudley, D.L., Effect of psychotropic medications on seizure control in patients with epilepsy. Neurology 1987;37:1525–7.

Gross, A., Devinsky, O., Westbrook, L.E., Wharton, A.H., Alper, K. Psychotropic medication use in patients with epilepsy: effect on seizure frequency. J Neuropsychiatry Clin Neurosci 2000;12:458–64.

Jobe,P.C.,Ko, K.H., Dailey, .JW. (1984) Abnormalities in norepinephrine turnover rate in the central nervous system of the genetically epilepsy-prone rat. Brain Res 290:357-360[ISI] [Medline].

Favale, E., Rubino,V., Mainardi, P., Lunardi, G., Albano, C.Anticonvulsant effect of fluoxetine in humans. Neurology.1995 Oct;45 (10):1926

Hovorka, J., Herman, E., Nemcová, I.,Treatment of Interictal Depression with Citalopram in Patients with Epilepsy. Epilepsy & Behavior, Volume 1, Number 6, December 2000, pp. 444-447(4)

Specchio, L.M., et al. Citalopram as treatment of depression in patients with epilepsy. Clin Neuropharmacol. 2004 May-Jun;27(3):133-136.
... More

Conflict of interest: None Declared

Write a reply


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *