Medication-Induced Psychosis: Recognizing Symptoms and What to Do in an Emergency

When someone suddenly starts seeing things that aren’t there, believing they’re being followed, or speaking in ways that make no sense, it’s easy to assume it’s schizophrenia or another long-term mental illness. But what if it’s not? What if it’s caused by a pill they took yesterday - a steroid, an antibiotic, or even an over-the-counter sleep aid? Medication-induced psychosis is more common than most people realize, and it’s often mistaken for something far more serious. The good news? In most cases, it’s reversible - if you know what to look for and act fast.

What Exactly Is Medication-Induced Psychosis?

Medication-induced psychosis isn’t a mental illness in the traditional sense. It’s a reaction - a temporary break from reality triggered by a drug’s effect on the brain. The symptoms look a lot like schizophrenia: hallucinations, delusions, disorganized speech, and bizarre behavior. But here’s the key difference: these symptoms start within hours or days after taking a medication - or during withdrawal - and usually fade once the drug is stopped.

The DSM-5, the official guide doctors use to diagnose mental conditions, says this counts as medication-induced psychosis if the symptoms appear during intoxication or within one month after stopping the substance. It’s not about getting high on illegal drugs (though those can cause it too). It’s about prescription meds, even ones you’ve taken for years without issue.

Think of it like an allergic reaction - but instead of a rash or swelling, your brain misfires. The body didn’t break down the drug properly. The dosage was too high. Or maybe you have a hidden genetic sensitivity. Whatever the reason, the result is the same: your mind loses touch with reality.

Common Symptoms to Watch For

The signs don’t always come all at once. Often, they creep in slowly. You might notice someone becoming unusually anxious, irritable, or withdrawn - then suddenly, they’re talking to empty corners or insisting their neighbor is spying on them through the walls.

Here are the most frequent symptoms:

• Delusions: False, fixed beliefs that aren’t based in reality. The most common? Paranoia - thinking someone is out to harm them, that they’re being watched, or that their thoughts are being broadcast.
• Hallucinations: Seeing, hearing, or feeling things that aren’t there. Auditory hallucinations - hearing voices - are the most common. Sometimes people smell strange odors or feel bugs crawling on their skin.
• Disorganized speech: Jumping from topic to topic, using made-up words, or speaking in a way that’s impossible to follow.
• Confusion and memory issues: Forgetting where they are, what day it is, or how they got there.
• Mood swings: Sudden rage, panic, or emotional flatness.
• Impaired judgment: Acting in ways that are wildly out of character - like stripping off clothes in public or trying to drive while convinced they’re being chased.

It’s important to note: not every odd behavior means psychosis. But if these symptoms appear suddenly - especially after starting or changing a medication - it’s a red flag.

Which Medications Can Trigger It?

You might be surprised by how many common drugs carry this risk. It’s not just street drugs or powerful psychiatric meds. Even routine prescriptions can cause trouble.

Here are the top culprits based on clinical reports:

• Corticosteroids (like prednisone): Used for asthma, arthritis, and autoimmune diseases. Psychosis occurs in about 5.7% of high-dose users - often with mood swings before full psychosis sets in.
• Antimalarials (like mefloquine): Prescribed for travel to malaria zones. The European Medicines Agency has logged over 1,200 psychosis cases since the 1980s.
• Antiretrovirals (like efavirenz): Used for HIV. About 2.3% of users report hallucinations or severe anxiety.
• Antiepileptics (like vigabatrin): Can cause psychosis in up to 1.1% of users.
• Antidepressants (SSRIs/SNRIs): Rare, but possible - especially when starting or increasing the dose.
• Stimulants (like methylphenidate or amphetamines): Used for ADHD. High doses can trigger paranoia and hallucinations.
• Beta-blockers and ACE inhibitors: Blood pressure meds. Uncommon, but documented.
• First-gen antihistamines (like diphenhydramine): Found in sleep aids and allergy pills. Overdose or sensitivity can cause confusion and hallucinations.
• Opioids and NSAIDs: Even ibuprofen in very high doses has been linked to psychosis in rare cases.
• Alcohol and benzodiazepine withdrawal: Not the drugs themselves - but quitting them cold turkey can trigger severe psychosis, sometimes leading to delirium tremens.

And yes - cannabis can do it too. Up to 10% of users report psychotic symptoms, especially with high-THC strains. The difference? For most, it fades within days. But for those with a genetic vulnerability, it can be the first sign of schizophrenia.

Who’s at Higher Risk?

Not everyone who takes these drugs will develop psychosis. But some people are far more vulnerable:

• People with a personal or family history of mental illness - especially schizophrenia or bipolar disorder.
• Women: Studies show women are more likely than men to develop psychosis from steroids and antimalarials.
• Older adults: Slower metabolism means drugs stick around longer, increasing risk.
• Those with substance use disorders: Nearly 74% of people admitted for first-time psychosis have a history of drug or alcohol abuse.
• People on multiple medications: Drug interactions can amplify side effects.

If you’ve ever had depression, anxiety, or a psychotic episode before - even years ago - your brain might be more sensitive. Tell your doctor before starting any new medication.

Emergency Management: What to Do Right Now

If someone is actively hallucinating, paranoid, or acting dangerously - don’t wait. Call emergency services or take them to the nearest ER. But don’t panic. Here’s what happens next:

1. Stop the suspected drug: This is the single most important step. In most cases, symptoms begin to fade within 24 to 72 hours after stopping the medication. For steroids, it may take weeks - but they almost always improve.
2. Supportive care: ER teams check for dehydration, electrolyte imbalances, or muscle breakdown (rhabdomyolysis), especially with stimulant use. IV fluids and monitoring are common.
3. Antipsychotics if needed: Medications like olanzapine or quetiapine may be given to calm severe agitation or hallucinations. But they’re not always necessary - and they must be used carefully to avoid interactions.
4. Withdrawal management: If the psychosis is from alcohol or benzo withdrawal, doctors will give a slow taper of benzodiazepines to prevent seizures or delirium tremens - which can be deadly.
5. Observation: Many patients are held for 24-48 hours to ensure symptoms don’t worsen and to rule out other causes like infection or brain injury.

In rare cases, if the person is a danger to themselves or others, temporary involuntary hold under mental health laws may be needed. This isn’t punishment - it’s protection while they’re disoriented.

Recovery and Long-Term Outlook

The prognosis is usually excellent - if caught early.

• Steroid-induced psychosis: Clears in 4-6 weeks after stopping the drug.
• Cocaine or amphetamine psychosis: Often gone in under 72 hours.
• Alcohol withdrawal psychosis: Resolves in days with proper medical care.
• Antidepressant-induced: Usually fades within 1-2 weeks of dose adjustment.

But here’s the catch: 7-10% of people who present with first-time psychosis in the ER are later found to have an underlying condition like schizophrenia - not just a drug reaction. That’s why follow-up is critical.

Doctors recommend psychiatric check-ins for at least three months after symptoms disappear. Why? Because if the psychosis returns after the drug is long gone, it’s likely not medication-induced anymore. It’s something deeper.

Some people, especially those with long-term alcohol abuse, may develop permanent brain damage - like Wernicke-Korsakoff syndrome - which causes lasting memory and confusion problems. This isn’t psychosis from a single pill. It’s a chronic condition from years of damage.

How to Prevent It

Prevention starts with awareness - both for patients and doctors.

• Always tell your doctor about every medication you take - including supplements, herbal remedies, and OTC drugs like NyQuil or Benadryl.
• Ask: “Can this cause mental side effects?” before starting any new drug, especially steroids, antimalarials, or stimulants.
• Watch for early warning signs: Increased anxiety, insomnia, irritability, or vivid dreams can come before full psychosis. Report them immediately.
• Don’t stop meds cold turkey - especially antidepressants or benzodiazepines. Taper under medical supervision.
• Know your family history: If psychosis runs in your family, be extra cautious with new medications.

The FDA now requires warning labels on drugs like efavirenz and mefloquine - but many people never read them. If your pill comes with a patient guide about mental health risks, read it. Keep it. Show it to a loved one.

When to Call a Doctor

You don’t need to wait for full-blown hallucinations. If someone you care about:

• Starts acting strangely after starting a new medication
• Complains of hearing voices or seeing things
• Believes they’re being watched or persecuted
• Becomes extremely agitated or aggressive

- call their doctor today. Don’t wait for a scheduled appointment. If the doctor isn’t available, go to urgent care or the ER. This isn’t overreacting. It’s lifesaving.

Medication-induced psychosis is treatable. It’s not a life sentence. But it won’t fix itself. And the longer you wait, the harder it becomes to tell if it’s just a drug reaction - or the start of something permanent.