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If you or a loved one are taking psychiatric drugs, you may be dismayed to discover how many "psychiatric symptoms" can be caused or worsened by the drugs themselves. In fact, nearly all psychiatric symptoms, including the most severe ones such as hallucinations and delusions, can be produced by these drugs. The present chapter describes the overall ways in which psychiatric medications can adversely affect how you think, feel, and act. Chapter 4 provides detailed information on the adverse effects of specific drugs.
Do not be misled by a doctor or friend who tells you that you're taking only a "small dose" of a psychiatric drug. Although the risk of harmful drug effects does usually increase with the size of the dose, some people are very sensitive to mind-altering drugs and can suffer bad reactions even from small doses. One of the most important observations in psychopharmacology is that all psychotropic drugs have complex and variable effects, and will not affect everyone the same way. A drug's effect commonly varies within the same person over time, and among different people. Severe adverse reactions often occur when the dose has been changed up or down or when another drug has been added but they can appear for the first time at any time during the treatment.
Consider the wide variety of responses that people have to caffeine, a relatively mild stimulant. Some individuals can drink six or more cups a day without any dramatic effect on their psyche. But others are so sensitive that even the small amount of caffeine in decaffeinated coffee can make them feel jittery and anxious. For them, a full cup of coffee would be a prescription for physical symptoms that feel like a spontaneous "panic attack".
Likewise, some people cannot drink coffee late in the day without being kept awake all night by the stimulant effects, while others routinely have coffee with dinner, or even later in the evening, without experiencing any apparent interference with their sleep. Some people suffer a stomachache from drinking one or two cups of coffee, while others never experience any stomach upset from much greater amounts. Some people can stop drinking coffee without any major withdrawal effects, while others develop headaches and become temporarily fatigued and lethargic, even depressed.
The effects of psychiatric drugs are similarly variable. One person may "feel nothing" after a 10-20 mg dose of Prozac, while another person may develop severe agitation and insomnia, and even become psychotic. One person with insomnia may hardly notice the impact of 5 mg of Valium taken before bedtime, while another will sleep like a log and feel "sluggish" and "irritable" for a day or two afterward. Some children may seem unaffected by a 5 mg dose of Ritalin; others become zombie-like.
Individual responses to psychiatric drugs also vary over time. Some effects tend to appear after a week or two, while others may not appear for months or years. Similarly, a person may react to a drug one way and then in an entirely different fashion at a later date after restarting it.
Unfortunately drugs that affect the brain and mind can seriously impair your mental function before you recognize that anything is the matter. You may not realize that your thinking is slowed, your emotions dulled, or your coordination impaired. You may believe that your newly developed feelings of anxiety or depression are due to events in your life rather than to the drug you are taking. If you feel euphoric or "high" from taking the drug, you may think that you are doing "better than ever" when, in fact, your judgment has been impaired.
Your doctor may fail to notice these drug side effects or mistakenly attribute them to something else such as your psychological problems. Family or friends may become increasingly dismayed by the deterioration in your memory, attention span, sensitivity or emotional responsiveness, while you and your doctor remain seemingly unaware that anything is wrong.
Patients often suffer from common adverse drug effects that their doctors have never warned them about. In order to encourage their patients to start drugs or to stay on them, doctors frequently misinform their patients by inflating the benefits and minimizing the hazards of psychiatric medications. Many doctors nowadays feel that they should cajole or push their patients to take these medications against the patients' better judgment.
Even when patients develop serious drug-induced adverse reactions - such as depression or psychosis, weight loss and fatigue, or abnormal movements of the body - doctors tend to attribute the effects to something other than the drug. On a particular occasion, one of us was presenting grand rounds - a special educational seminar for doctors at a hospital - when a case history came to our attention. It concerned a middle-aged business executive who became violent for the first time while taking Prozac36. In a minor altercation at a gas station, he assaulted a stranger with a crowbar.
Experience, prudence, and reason suggest that the drug should be suspected as the cause of the problem when unusual, irrational behavior erupts for the first time after the patient has started taking it. Yet some of the doctors at the grand rounds totally rejected the possibility that the patient's unprecedented, extreme, and bizarre violence had been caused or exacerbated by Prozac. They recommended raising his dose of Prozac instead of stopping it37.
Too many health professionals are reluctant or resistant to recognizing adverse drug effects, especially those that affect the patient's emotional state. They find it easier, apparently, to blame the effects on the patients "mental illness". Yet a doctor's refusal to face the dangers of medication can lead to irreversible and ultimately tragic adverse drug reactions.
In our consultations, we find that patients are rarely told all they need to know about the psychiatric drugs they are taking. Of course, some patients are reluctant to know in advance about the dangers to which they are being exposed; but it remains the doctor's responsibility to insist on informing them. But physicians are not alone in withholding facts about drug hazards; printed handouts from doctors' offices or pharmacies, as well as textbooks and drug advertisements, also often fail to give sufficient emphasis to the dangerous effects of psychiatric drugs38. (See Chapter 6 for a discussion of the possible motivations that lead some health professionals to minimize the risks of these drugs).
Very few studies have examined the danger of potentially permanent changes in brain chemistry caused by long-term use of psychiatric medication. However, enough is known and suspected about these dangers to make a thoughtful person cautious about using any psychiatric drug.
Prozac, Zoloft, Paxil, and Luvox are recent examples of drugs tailormade in the laboratory to stimulate the activity of the serotonin system. In the case of Prozac, the brain's compensatory mechanisms were documented from the beginning of the research involving this drug.
All four drugs, known as selective serotonin reuptake inhibitors (SSRIs), block the normal removal of the neurotransmitter serotonin from the synaptic cleft - the space between nerve cells. The resultant overabundance of serotonin then causes the system to become hyperactive. But the brain reacts against this drug-induced overactivity by destroying its capacity to react to stimulation by serotonin. This compensatory process is known as "downregulation". Some of the receptors for serotonin actually disappear or die off.
To further compensate for the drug effect, the brain tries to reduce its output of serotonin. This mechanism is active for approximately ten days and then begins to fail, whereas downregulation continues indefinitely and may become permanent. Thus we know in some detail about two of the ways in which the brain tries to counterbalance the effects of psychiatric drugs. There are other compensatory mechanisms about which we know less, including counterbalancing adjustments in other neurotransmitter systems. But, overall, the brain places itself in a state of imbalance in an attempt to prevent or overcome overstimulation by the drugs.
The brain probably has compensatory mechanisms to ward off or reverse the effects of all psychiatric drugs. Some of these mechanisms have already been recognized and studied. For instance, downregulation of overstimulated neurotransmitter systems occurs with all of the older "tricyclic" antidepressants such as amitriptyline (Elavil) and imipramine (Tofranil). Downregulation also takes place with stimulant drugs such as Ritalin and the amphetamines Dexedrine and Adderall.
Psychiatric drugs do not always overstimulate neurotransmitter systems. Some drugs inhibit or block nerve transmission in the brain. When this happens, the brain again tries to compensate by reacting in the opposite direction - this time by "upregulation" of the suppressed neurotransmitter system. The "antipsychotic" drugs - such as Thorazine, Haldol, Prolixin, Risperdal, and Zyprexa - tend to suppress the dopamine system. The brain tries to overcome this effect by making the dopamine system hypersensitive. As discussed below, this upregulation can lead to severe, even permanent neurological disorders.
In its attempts to overcome the effects of psychiatric drugs, the brain becomes distorted in its functioning. And as already emphasized, the brain cannot immediately recover its original functions once the drugs are stopped. In some cases, the brain may never recover.
Physicians who prescribe psychiatric drugs for long-term use believe that the drugs are useful, but their views are based on personal impressions and unproven assumptions rather than on scientific evidence. Medical doctors rely heavily on medications and tend to be very biased in favor of their use. For example, many doctors who prescribe psychiatric drugs recommend them for long-term use as soon as they become available on the market. They recommend that patients take a new psychiatric drug for months or years, even though the studies used for FDA approval typically last for only a few weeks39.
The widespread use of Zyprexa exemplifies how new and potentially dangerous drugs are often prescribed with unjustified enthusiasm for their safety and efficacy. In 1996 Zyprexa was approved by the FDA for the treatment of psychosis and a few years later for the treatment of bipolar disorder. Drugs approved for such manifestations are called neuroleptics or antipsychotics. All are extremely dangerous.
As required by the FDA, all neuroleptic drugs, including the newer ones like Zyprexa, must carry a "class warning" about the dangers of tardive dyskinesia (TD)40. Tardive dyskinesia is a disfiguring and potentially disabling, usually permanent neurological disorder characterized by tics, spasms, and abnormal movements. These drugs also cause neuroleptic malignant syndrome (NMS), a potentially fatal disease of the brain with effects similar to those associated with severe viral encephalitis41. For the neuroleptics that have been extensively studied, as we document in Chapter 4, the rates of tardive dyskinesia and neuroleptic malignant syndrome are very high.
The controlled trials used for the approval of Zyprexa lasted only six weeks and were conducted on adults diagnosed with schizophrenia. Yet immediately after Zyprexa became available on the market, doctors began recommending it for indefinite, even lifetime usage. Doctors also began prescribing it for people with no psychotic symptoms, even for children with behavior problems.
Despite the absence of long-term studies and the newness of the drug, doctors accepted the drug manufacturers promotional pitch that Zyprexa is safer than other drugs used for the same purpose. In fact, almost all psychiatric drugs start out amid claims of being "safer" and "more effective". Rarely in psychiatry is this enthusiasm confirmed by more sober, realistic appraisals based on time and experience.
In the case of Zyprexa and other newer antipsychotics, long-term use revealed that many patients were at higher risk of developing elevated blood sugar, diabetes, pancreatitis, elevated cholesterol, and considerable weight gain. Some patients gained over 60 pounds a year, and several died from these complications. In his clinical and forensic practice Peter Breggin has evaluated several cases of rapid death caused by acute Zyprexa-induced diabetes and pancreatitis.
In 2004, the FDA mandated that newer antipsychotics carry a warning about the risk of hyperglycemia and diabetes. Moreover, a systematic analysis had also revealed that older, frail patients with dementia prescribed atypical antipsychotics had nearly double the risk of dying, and here again the FDA in 2002 ordered a "black box" warning about the risk of premature death from such drugs. Some recent reviews find that older antipsychotics also appear to significantly increase this risk of premature death among the frail elderly and we believe that the FDA "black box" warning should be applied equally to this entire class of drugs (Trifiro et al., 2006 [372]).
Even when drugs later prove to be useless or highly dangerous when prescribed over the long term, many doctors continue to push patients to take them for many months or years at a time. Regarding Ritalin and other stimulants, for example, there is no substantial evidence for positive effects on any behavior, including hyperactivity, beyond the first several weeks42. These drugs can temporarily subdue the behavior of children and make them more obedient, conforming, and quiet in the classroom. But they are routinely prescribed for months and years, even over entire lifetimes. Similarly, although Ritalin is known to disrupt growth hormone production, causing significant growth inhibition, it is routinely prescribed throughout childhood.
All the so-called antianxiety drugs - such as Xanax, Ativan, Klonopin, Valium, and Librium - are known to be highly addictive. After only a few weeks of treatment with Xanax, many patients suffer from severe withdrawal symptoms when they cease taking the drug. Others feel unable to stop without help43. Indeed, after several weeks of treatment, many Xanax patients develop anxiety that is more severe than before their treatment began.
Despite these limits on the long-term use of drugs such as stimulants and minor tranquilizers, large numbers of physicians continue to prescribe them for months or even years at a time. Some doctors trust their "clinical judgment" more than the scientific data; others simply haven't kept up with the scientific literature. In addition, most of the seminars that doctors attend are sponsored by drug companies and too often provide opinions that are biased toward the long-term use of drugs. The doctors never see negative comments about the long-term use of drugs in the eye-catching pharmaceutical advertising that they read in almost every professional journal. Nor are they likely to hear this kind of critical information from the drug salespersons who regularly visit them in their offices. Doctors may also fail to realize that their patients have become addicted and want to stay on their drugs in order to avoid withdrawal reactions. Overall, doctors often take the easy route of writing prescriptions rather than the more arduous route of helping their patients to find more complex long-term solutions to their emotional difficulties.
Meanwhile, as noted, the patients themselves may feel compelled to take the drugs to avoid painful and frightening withdrawal reactions such as anxiety, agitation, insomnia, depression, fatigue, and abnormal sensations in the head or body. Depending on the drug, one or more withdrawal symptoms can develop within hours or days of cutting back on the medication. These reactions can become severe enough that patients begin to pressure their doctor into continuing to prescribe drugs. In effect, the prescribing physician maintains or "enables" the patients' drug dependence.
Some drug advocates believe that years of clinical use by thousands of patients can prove a drug's long-term usefulness and safety. And some individual doctors feel that their own prescription of a drug over many years can demonstrate its safety. These beliefs have led to tragic outcomes for millions of patients. One of these has already been described - millions of patients suffering from lifelong dependence on addictive tranquilizing drugs such as Xanax, Valium, Ativan, Klonopin, and Librium.
Overconfidence in clinical judgment concerning the long-term safety of drugs has led to an even more tragic outcome. Millions of patients have been afflicted with gross neurological disorders from taking antipsychotic drugs. This class of drugs - starting with Thorazine, and now including many others such as Haldol, Prolixin, Navane, Risperdal, Clozaril, and Zyprexa - was used for two decades before it was generally recognized that the entire group frequently causes tardive dyskinesia and neuroleptic malignant syndrome. Even today, fifty-five years after the first neuroleptics were introduced, many doctors fail to realize the frequency or severity of these dangers and prescribe the drugs without adequately monitoring their use or warning patients and their families.
The brain is the "target organ" for psychiatric drugs. All drugs approved for psychiatric purposes directly affect the brain, causing a variety of mental or psychiatric symptoms. Commonly reported effects include confusion, memory difficulties, dulled emotions, artificial feelings of euphoria, depression, anxiety, agitation, personality changes, and psychosis. A review of handbooks or textbooks, as well as the discussions in Chapter 4, will confirm that psychiatric symptom or disorder can also be caused by psychiatric drugs.
By law, every psychiatric drug must have an FDA-approved label listing all mental and behavioral side effects, sometimes including suicide and violence. This information is based on reports of adverse effects made during the drug testing process as well as after the drug has been marketed. However, in its efforts to be politically accommodating, and partly owing to its administrative limitations, the FDA often fails to force the drug companies to list well-known serious adverse effects in a drugs official label. Not until 1986 did the FDA require drug companies to include neuroleptic malignant syndrome in the labels (and package inserts) for all antipsychotic or neuroleptic drugs - nearly three decades after this disorder was initially described44.
As we have been emphasizing, any psychiatric drug can and will impair mental function. The impairments associated with most psychiatric drugs can also be caused by an endless variety of other kinds of trauma, including head injury extreme fatigue, chronic illness or stress, lack of oxygen to the brain, chronic use of alcohol, or exposure to toxins such as lead or carbon monoxide.
Sometimes these symptoms of mental dysfunction are aggravated by emotional problems. However, if problems develop for the first time or worsen after you have started a psychiatric drug, you should suspect the drug. Even in cases where the symptoms seem to get worse when you're upset, the underlying cause may be the psychiatric drug. Many drug-induced adverse reactions, from agitation to memory problems and neurological tremors, can worsen under stress. Conversely, they can improve during rest and relaxation.
The term toxic psychosis or, more simply psychosis is often used to describe the extreme negative impact that psychiatric drugs frequently have on the brain. Although psychosis has many meanings, in general it refers to a loss of touch with reality often accompanied by hallucinations or delusions45.
Drug-induced impairment of overall brain function may also be called confusion or delirium. Delirium is a disturbance of consciousness and cognition (thinking processes) that usually develops over a short period of time46. Related terms are organic brain syndrome and dementia. Finally, the term mania is often used to describe an especially dangerous psychosis that is commonly caused by psychiatric drugs (as further discussed below and in Chapter 4).
Initially these disorders often manifest as memory problems and disorientation, but they eventually involve impairments of all higher mental functions such as judgment, insight, and abstract reasoning. Mood or feelings may be unstable, disturbed, or inappropriate. Hallucinations and delusions may develop.
A significant percentage of patients who take psychiatric drugs will develop full-blown toxic psychoses or deliriums, but many more will develop milder variations of these drug-induced symptoms.
In trying to decide if you have a drug-induced symptom - such as memory problems, slowed thinking, or dulled feelings - your own perception of yourself is the most sensitive instrument there is for detecting when your brain and mind aren't working right. If you sense that a drug is interfering with your normal mental processes, take your perceptions seriously. You could be mistaken - and other people may try to reassure you that "nothing's the matter" or that "you're doing fine". But you could also be right about suffering from the ill effects of medication.
Keeping track of your changing mental responses soon after you take a dose of medication, compared to when the drug effect is wearing off, may help you to determine if you are having a drug-induced problem. If the symptoms become worse soon after taking the drug, you may be suffering from a drug toxic effect. If they grow worse when the drug effect is wearing off, you may be suffering from withdrawal symptoms. It can be difficult, of course, to distinguish between drug effects and your own psychological reactions.
On the other hand, psychiatric drugs can confuse your reasoning and judgment, leading you to believe that you are being helped when in fact you are being mentally impaired.
If you are taking a psychiatric drug, you may eventually find yourself experiencing one or more of the following drug-induced mental abnormalities:
Impaired Concentration. Almost any psychiatric drug can make it harder for you to pay attention to conversations, to focus on reading anything complicated, or to work consistently on a project. The subjective awareness of impaired concentration is a subtle but important sign of drug-induced toxicity.
Poor Memory. Psychiatric drugs can make it difficult for you to remember things such as a list of items to get at the grocery, the time your children said they were coming for dinner, or the name of the person who just left a phone message for your wife or husband. You may find it harder to recall recipes or simple operations on your computer, to find the word or phrase you want, or to remember the name of some familiar object. As in the case of impaired concentration, you may notice your poor memory before your family or psychiatrist do, and even before it can be detected by psychological testing.
Confusion or Disorientation. This is a more serious sign of brain dysfunction caused by psychiatric drugs. It may be harder for you to find your way around buildings or within places you've been before. You may discover that you've walked or driven by a familiar place without realizing it or that you have difficulty driving somewhere using written directions. Malls and other large spaces are more confusing than they used to be. You may lose your bearings more easily.
Slowed or Simplified Mental Functioning. You may find it harder to follow complicated questions or directions, to think about more than one thing at a time, or to carry out a logical sequence of thought. You may find yourself wishing that people would slow down and not expect such quick responses. While you used to think of yourself as "quick", you now seem "slow". You may become baffled by conversations involving more than one person, or you may be unable to carry out more than one task at a time, such as talking on the phone while you prepare dinner.
Exaggerated Responses to Stress. You may find yourself increasingly less able to handle everyday stresses, such as getting the children ready for school, trying to arrive at work on time, having a conflict with friends or co-workers, being late for an appointment, falling behind in a project, or being interrupted.
Increased Irritability Anger or Aggressivity. To your embarrassment, you find yourself getting unusually annoyed, frustrated, or irritable, and sometimes you hurt peoples feelings without meaning to. You may also find yourself becoming unexpectedly angry or aggressive. In the worstcase scenario, you may do something dangerous or harmful that you would otherwise never do, landing you in trouble at work, at home, or on the street. These drug-induced problems are called "paradoxical reactions" or "disinhibition".
Sleep Difficulties. You may have trouble falling asleep or staying asleep. Overall, you may not be sleeping as deeply as before, and when you do sleep, you may not wake up refreshed. Some psychiatric drugs can make you sleepy during the daytime, impairing your daily activities. Other psychiatric drugs can stimulate you at night, keeping you awake and leaving you sleepy and exhausted the next day.
Emotional Blunting and Insensitivity. The highs and the lows of your emotions may have been leveled off by the drug you are taking. You don't care about anyone or anything as much as you used to; your feelings often seem blunted; your internal landscape is bland and less colorful; you feel "blah". This drug-induced diminished responsiveness and loss of vitality is given many different labels in the medical literature, including indifference, apathy lethargy and diminished or blunted affect. Other labels for this overall flattening of the mind, spirit, and energy level include fatigue, malaise, and depression.
Fatigue. You find that you don't have the same amount of mental or physical energy that you once did and that you get tired and discouraged much more easily. You may be sluggish or lethargic when you get up in the morning and exhausted by the evening.
Malaise. You feel not just lethargic or fatigued but "ill", "worn out", "blah" - as if you have the flu or some other debilitating physical ailment. These drug-induced reactions are sometimes referred to as "flu-like symptoms" in the medical literature.
Depression. Many psychiatric drugs can lead to depression, involving a loss of enjoyment of life, feelings of gloom and hopelessness, and even suicidal feelings or attempts. The final draft of the label for Prozac - the description included on the package insert - initially said that "depression" was "frequently" reported as an adverse effect of the drug. However, the reference to depression was edited out at the last minute. Secret documents in the files of Eli Lilly the manufacturer of Prozac, reveal that, in comparison to placebos and other antidepressants, the drug caused an increased rate of suicide attempts in controlled clinical trials47. Patients often become more depressed on antidepressants, but doctors then mistakenly increase the dose.
Almost all psychiatric drugs - from the minor tranquilizers to stimulants like Ritalin - can cause depression48. For example, depression is generally recognized as a potential result of taking Antabuse, anticonvulsants, antidepressants, barbiturates, benzodiazepine tranquilizers, beta-blockers, calcium channel blockers, narcotics, neuroleptics, and stimulants.
Reduced Imagination and Creativity. You feel as if you've lost your old "spark" when it comes to thinking about solutions to problems, new ways of looking at things, or even what to do with your time on a free saturday afternoon. Too often, you feel bored.
Impaired Self-Insight, Self-Understanding, or Self-Awareness. You no longer feel confident about your appraisals of your own behavior, and other people give hints or signals that they think you're not behaving as appropriately as you think you are. You have trouble figuring out how you're feeling and why you're feeling that way, and you're not sure whether the drug is helping you or causing you problems. Friends or family may comment that you're not looking well, or may inquire whether you're feeling ill, when you haven't even noticed anything wrong.
Feeling "Out of Touch" with Yourself or Others. You feel disconnected, remote, or out of touch with yourself and your feelings, and perhaps with the feelings of other people as well. It's as if there's a dark glass or a great distance between you and other people, such that you're not quite the same person you used to be. These reactions are called "depersonalization" or "derealization".
Personality Changes. Even if you don't notice it, other people who care about you may say that you are not acting like yourself. You may have become moody less sensitive, more irritable, more careless, withdrawn, "high" or mildly euphoric, or somewhat "out of it". In drug-reaction reports, this symptom of toxicity is often called "personality disorder".
Emotional Instability. Your feelings seem to go up and down without any reason, and you have more trouble controlling what you feel and when and how you show it. This condition is sometimes referred to as "increased lability" in reports of adverse drug reactions.
Anxiety. Many different drugs can make you feel agitation, anxiety and panic. To add to your confusion, these symptoms are commonly caused by drugs used to treat anxiety and panic disorder. Relatively short-acting tranquilizers such as Xanax or Ativan can cause episodes of anxiety when the drug effect wears off and the brain rebounds several hours after each dose49. Most antidepressants and stimulants can also cause anxiety and agitation. And Prozac-like drugs, as well as antipsychotic drugs, can cause a particularly distressing syndrome known as akathisia, which involves anxiety or inner irritability that leads to a compulsive need to move about. It can feel like being tortured from the inside out.
Euphoria and Mania. If you feel "wonderful" while taking a psychiatric drug, the feeling may not be realistic. Instead, you may be so "high" that your judgment is impaired. Many psychiatric drugs can produce unrealistic feelings of well-being and confidence. When this effect becomes obviously abnormal, it is called euphoria or hypomania (mild mania). Temporary euphoria can be followed by its opposites, despair and depression.
Drug-induced euphoria sometimes progresses into a psychosis called mania. Probably all antidepressants and stimulants are capable of causing mania, which is characterized by exaggerated or unrealistic feelings of being happy or "high", excitability, insomnia, boundless energy, racing thoughts, grandiose schemes, and feelings of extreme self-importance and omnipotence. Irritability insensitivity to others, paranoia, and aggression often go along with being manic. During mania, a person can become "physically assaultive or suicidal"50.
Mania can ruin anyone's life. Manic people can become very paranoid and react with violence toward innocent victims, including loved ones. They have been known to offend important people, quit jobs, leave marriages, commit criminal acts, or do something so bizarre or harmful that it results in jail or involuntary commitment to a mental hospital.
Mania, depression, and other abnormalities of emotional control commonly result from taking psychiatric drugs. These drug-induced "mood disorders" are mentioned many times in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), which is the source of all official diagnoses in psychiatry. The manual makes clear that a number of psychiatric drugs, including antidepressants, can cause mania51.
Rates of mania caused by antidepressants frequently reach or surpass 1 percent of patients. They are probably several times higher for children receiving psychiatric drugs52.
Neurological Problems, Including Spasms and Seizures. Most psychiatric drugs can cause a variety of neurological and muscular abnormalities, including headaches, impaired sleep, abnormal dreams and nightmares, incoordination or awkwardness, weakness, muscle spasms (sometimes called myoclonic spasms), tics, tremors, abnormal visual or auditory perceptions, and strange discomforts in the skin or head. Many psychiatric drugs can also cause a variety of seizures or convulsions. The most serious seizures are grand mal convulsions with loss of consciousness. Seizures can be caused by the direct action on the brain of drugs such as antidepressants, stimulants, and antipsychotic agents, as well as by withdrawal from many drugs, especially those that calm or sedate the brain, such as antianxiety drugs (benzodiazepine minor tranquilizers), sleeping pills, and antiepileptic medications.
All of the psychiatric symptoms caused by the chemical effects of psychiatric drugs can also be considered to be neurological symptoms, since they are caused by impairments of brain function.
Withdrawal and Rebound. Most if not all psychiatric drugs can cause withdrawal reactions. Usually the withdrawal effect is the opposite of the drug's direct effect. Withdrawal from sedative minor tranquilizers such as Xanax will typically produce anxiety, agitation, insomnia, and, in extreme cases, seizures. Withdrawal from stimulants such as Ritalin and Adderall can produce fatigue, excessive sleep, and depression, but also opposite effects such as hyperactivity, agitation, and insomnia. In Chapter 9 we consider the kinds of withdrawal reactions that are typical of individual drugs or classes of drugs.
Most of us know that recreational drugs can impair the ability of individuals to assess how they are really doing. We've seen or heard of cases in which alcohol drinkers or cocaine users show no judgment about how impaired they have become. Similarly psychiatric drugs can compromise a person's ability to evaluate how he or she is doing.
"Georgia was taking antidepressants for years and felt that they were `life-saving'. She doubted if she could survive without them. But her husband was concerned that they were making her less emotionally present. He urged her to see a doctor who would be willing to offer psychotherapy while trying to reduce or eliminate her use of drugs. She reluctantly decided to try."
"Four months later, no longer taking antidepressants, Georgia felt like she was `alive' for the first time in years. She had completely forgotten how much zest she had for living. The drug had been suppressing her vitality without her realizing it. She had mistakenly thought she was chronically depressed and in desperate need of continued medication."
A more extreme example is tardive dyskinesia, the disorder involving permanent twitches and spasms caused by neuroleptic or antipsychotic drugs such as Haldol and Risperdal. Numerous studies have shown that most patients with these drug-induced twitches deny that they are having any such problem, especially while they are taking the drugs53.
Prozac, Zoloft, Paxil, Luvox, Effexor, and other drugs that overstimulate the serotonin system often produce personality changes such as irritability, aggressiveness, mood instability, and varying degrees of euphoria. The person taking the drug may feel "better than ever", whereas members of the family may feel that the individual has become a "different person" with many negative personality traits.
Patients may become dependent on minor tranquilizers, such as Xanax or Valium, without realizing what is happening to them until months or years have gone by. They may believe that they need to take more and more of the drug to control their anxiety and insomnia when, in fact, the drugs are actually worsening their condition. Even when they realize that they have become addicted, people often find the problem too difficult to face. They often end up denying that they have an addiction while continuing to take the drugs.
Many patients on psychiatric drugs may find that they have lost the sharpness of their memory function. This outcome is commonly associated with lithium, tranquilizers, and a variety of antidepressants. Both patients and doctors may mistakenly attribute the problem to "depression", rather than to the drug and, in the case of older patients, may mistakenly attribute the memory difficulties to aging. It is worth emphasizing that the psychiatric drug you are taking may be impairing your alertness, mental acuity emotional awareness, social sensitivity or creativity without your realizing it. It may be causing adverse physical or A mental effects that you are unable to recognize or appreciate. Furthermore, since these drug-induced symptoms resemble the impairments associated with psychiatric problems, it's easy for you, your doctor, or your family to mistakenly blame them on emotional problems.
The impairment of judgment caused by brain dysfunction is called anosognosia54, a condition that was first noticed in stroke patients who denied they were suffering from partial paralysis. From a more psychological perspective, it is called denial - the rejection of obvious mental impairment.
Psychiatric drugs are especially dangerous because they can render you unable to recognize their harmful effects. You can become seriously harmed without realizing what is happening. In many cases, people do not become aware of the damaging effects of drugs until after recovering from taking them.
You have now learned about how psychiatric drugs in general can impair your brain and mind. The next chapter focuses on the specific effects of individual drugs. If you or someone you care about is taking a psychiatric drug, you may want to learn all you can about its potential adverse effects.