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Uncommon, but serious side effects
of psychiatric medications that you should know about

Medications for depression, bipolar and anxiety disorders can make life livable again. They can also have side effects. Those who take them are familiar with symptoms like dry mouth, weight gain, sexual problems, insomnia and others that often subside after awhile, or become tolerable.

But some of these medications carry risks of rare, but serious side effects that anyone who takes these medications should be aware of. Quite often, doctors don’t talk about them.

Some of these are diabetes, akathisia, diabetes, neuroleptic malignant syndrome (NMS), serotonin syndrome, Stevens-Johnson Syndrome and tardive dyskinesia. Here’s what you should know about them.

Akathisia
Symptoms: Shuffling of feet while sitting, pacing or rocking while standing. Fidgety leg movements while lying down.
Associated with: Antipsychotic medication, MAO inhibitors and SSRI antidepressants, lithium; more likely with longer treatment.
How common: Relatively common, 25 percent and higher. Risk is increased with higher potency drugs, higher dose, increased rate of dose escalation. Often misdiagnosed.
Risks: Not life threatening, but distressing and anxiety-provoking. May cause patients to stop taking beneficial treatment.
Treatment: Reduce dose of drug or switch to newer (atypical) antipsychotic, if benefits outweigh risks. Additional medications may reduce symptoms.

Diabetes/high blood sugar
Symptoms: Excessive thirst, frequent urination, nausea or vomiting.
Associated with: Atypical antipsychotics (aripiprazole, closapine, risperidone, quetiapine, ziprasidone).
How common: Relatively rare, but nine percent more likely with atypical antipsychotics than with classic antipsychotics.
Risks: Elevated blood sugar levels can result in kidney failure, cardiovascular disease and arteriosclerosis.
Treatment: Patients should have their blood sugar checked as directed by their doctor.

Neuroleptic malignant syndrome (NMS)
Symptoms: High fever, stiff muscles, sweating, a fast or irregular heart beat, change in blood pressure, involuntary movements (including akathisia above) and tremors, decreased consciousness and/or confusion. NMS can affect your kidneys.
Associated with: Antipsychotics(chlorpromazine, droperidol, fluphenazine, haloperidol, loxapine, mesoridazine, perphenazine, pimozide, trifloperazine, thiordiazine, thiothixene) , atypical antipsychotics(aripiprazole, closapine, risperidone, quetiapine, ziprasidone) , tricyclic antidepressants (amitriptyline, trimipramine), lithium, benzodiazepines (fluoxetine and chlordiazepoxide in combination), other neuroleptic drugs (memantine, methylphenidate, dexmethylphenidate).
How common: 0.02 percent to 12.2 percent, more common in males by two to one.
Risks: Life-threatening; call your doctor immediately if symptoms occur.
Treatment: May stop all neuroleptic drugs that may be the cause.

Serotonin syndrome
Symptoms: Restlessness, hallucinations, loss of coordination, fast heart beat, diarrhea, nausea.
Associated with: Use of selective serotonin reuptake inhibitors (SSRIs [citalopram, escitalopram, fluvoxamine, fluoxetine, paroxetine, sertraline, ) alone or in combination with medicines used to treat migraine headaches called triptans. More likely to occur when starting or increasing the dose of an SSRI or a triptan. Other drugs linked to serotonin syndrome (lithium, buspirone, trazodone, amytriptiline, imipramine, desipramine, fluoxetine, fluoxetine and olanzapine, nefazodone). Avoid MAO inhibitors while taking SSRIs and/or SNRIs, also avoid SSRIs and the herbal product St. Johns Wort.
Risks: Life-threatening; call your doctor immediately if symptoms occur.
Treatment: Dependent on the symptoms, drug, etc.

Stevens-Johnson Syndrome
Symptoms: Blistering, bleeding, swelling of the mucous membranes, typically in the mouth, eyes, and vagina; progresses rapidly.
Associated with: Lamictal (most likely within first eight weeks of use); increased risk for Lamictal taken with valproic acid (Depakene) or divalproex (Depakote). More likely in first month of treatment, at high dosages and rapid dose escalation. Also barbiturates; Tegretol (carbamazepine). An allergic reaction.
How common: 0.02 percent
Risks: Can be life-threatening. Call your doctor or 911 immediately.
Treatment: Similar to treatment of severe burn victims

Tardive dyskinesia
Symptoms: Involuntary movements of the face, tongue, lips, trunk or extremities.
Associated with: Antipsychotics (chlorpromazine, fluphenazine, haloperidol, loxapine, mesoridazine, perphenazine, pimozide, trifloperazine, thiordiazine, thiothixene) and atypical antipsychotics (aripiprazole, closapine, risperidone, quetiapine, ziprasidone).
How common: Three times more likely in people taking these drugs than in others.
Risks: Can be irreversible. Call your healthcare professional right away if you get muscle movements that cannot be stopped.
Treatment: Use of antipsychotics for shorter period; additional medications may be effective. Symptoms may stop when drug is discontinued.

“Sometimes people who develop side-effects from medications” says Jack E. Fincham, Ph.D., R.Ph., University of Missouri, “feel frustrated and blame themselves.” It’s important to talk it over with your doctor or therapist. Always remember, it’s not your fault if you experience an adverse reaction to a medication.  Always monitor your body and functions to alert yourself for changes that need to be mentioned to your health care providers.”

Related articles
Side effects
Weight gain
Sexual side effects
Guide to psych meds

More articles

Sources
Jack E. Fincham, Ph.D., R.Ph.
Professor of Pharmacy Practice
School of Pharmacy, University of Missouri - Kansas City

Stevens-Johnson syndrome associated with single high dose of lamotrigine in a patient taking valproate, Giuseppe Famularo MD PhD1, Claudio De Simone MD2, Giovanni Minisola MD3
Dermatology Online Journal 11 (1): 25

Akathisia - A Brief Review, D E Nelson, Scottish Medical Journal, October 2001

U.S. Food and Drug Administration