Psychiatric Side Effects of Prescription and Over-the-Counter Medications

Abstract

This first edition of this unique textbook is somewhat of a psychiatrically oriented combination of the Medical Letter Handbook of Adverse Drug Interactions and Goodman and Gilman's Pharmacological Basis of Therapeutics. The purpose is to facilitate the early detection and prompt treatment of neuropsychiatric toxicity resulting from medication use. While the authors state the book is “merely an introduction to the subject,” they have presented a comprehensive guide to the various psychiatric and neurologic side effects that can result from the use of practically any medication. They have achieved this in a highly readable and well-organized fashion. The book is divided into 2 sections. Part I discusses drugs with actions directed at the central nervous system. This section includes chapters on antipsychotics, agents used to treat movement disorders, antidepressants (including psychostimulants), lithium, anticonvulsants, anesthetic agents, sedative-hypnotics (including ethanol), analgesics, and cholinergic agents. Part II details the side effects of agents with actions not directed at the central nervous system. These include antibiotics, cardiovascular agents, antineoplastic agents, antilipemic agents, drugs affecting the endocrine system, gastrointestinal agents, hematologic agents, modulators of immunity, pulmonary agents, and uricosurics. The list of medications discussed appears exhaustive and includes some esoteric and rarely used medications along with drugs that are still being studied but have not yet been released. Each chapter begins with a general discussion of the side effects seen with each class of medication, along with how frequently they are seen. Percentages of side effects listed are based on the authors' best judgment of the literature (the 40 pages of references would indicate a thorough review was performed). Introductions to each chapter begin with interesting historical information on the class of drug, e.g., the 3 stages of bromide encephalopathy. Each chapter then goes on to discuss the pathophysiology of the side effects, along with drug interactions (both pharmacokinetic and pharmacodynamic). The suggested treatment of the side effects is then presented. One of the more remarkable aspects of this book is the range of pharmacologic agents addressed. Information is presented on drugs that range from interferon to digoxin. One does not usually think of antibiotics as a cause of encephalopathy, and yet many common medications that cause various psychiatric and neurologic side effects would appear to be overlooked in such a fashion. Unfortunately, the authors chose to not include information on the psychiatric side effects due to illicit drugs or those caused by herbal and homeopathic remedies. Such a work is sorely needed. While the authors agree that the potential side effects of any given medication are often rarely observed, the side effects detailed in this text are seen quite frequently. They include such common complaints as dizziness, sedation, agitation, insomnia, anxiety, and depression, along with more unusual symptoms such as confusion, hallucinations, seizures, and delirium. Anyone who deals with patients that present with such symptoms would benefit from having this book at his or her disposal. Certainly it should be part of the library of every psychiatrist, and it should be available in every emergency department in the country. It should also be noted that a CD-ROM comes with the book, which includes the entire text along with a search engine to find wanted information. For those wishing to gain further insight into the issues discussed, the authors present almost 200 suggested additional readings.