Which drug effect can cause mental health concerns?

October 10, 2025 •

4 min read

Studies have found that severe psychiatric reactions occur in nearly 6% of patients treated with systemic corticosteroids, and mild to moderate reactions in about 28% [1.4.3]. This highlights a crucial question for patient safety: which drug effect can cause mental health concerns?

Quick Summary

Numerous prescription and over-the-counter drugs can induce psychiatric symptoms by altering brain chemistry. This overview details common medication classes and explains which drug effect can cause mental health concerns.

Key Points

Neurotransmitter Imbalance: The primary drug effect that can cause mental health concerns is the alteration of brain neurotransmitters like dopamine, serotonin, and acetylcholine [1.4.2, 1.10.1].
Corticosteroid Risk: Corticosteroids (e.g., prednisone) are strongly associated with psychiatric effects, with the risk of psychosis and mania increasing at higher doses [1.4.1].
Dopamine Agonist Effects: Drugs for Parkinson's disease that act as dopamine agonists can trigger impulse control disorders, such as compulsive gambling or shopping [1.6.4].
Anticholinergic Burden: Commonly found in OTC medications, anticholinergic drugs can cause confusion and delirium and are linked to an increased risk of dementia in the elderly [1.5.2].
Patient Action is Crucial: If you suspect a medication is causing psychiatric symptoms, contact your doctor immediately and do not stop the drug abruptly [1.9.1, 1.9.3].

How Do Medications Impact Mental Health?

Medications produce their intended effects by interacting with the body's complex systems, but these interactions can also lead to unintended consequences, including psychiatric symptoms [1.2.1]. The primary way a drug effect can cause mental health concerns is by altering the balance of neurotransmitters—the chemical messengers in the brain that regulate mood, cognition, and behavior [1.4.2].

Key Pharmacological Mechanisms

Dopaminergic Effects: Drugs that increase dopamine activity, such as stimulants and dopamine agonists, can trigger psychosis, mania, and impulse control disorders. An excess of dopamine in certain brain pathways is strongly linked to symptoms like hallucinations and delusions [1.10.1, 1.10.2].
Serotonergic Effects: Medications that influence serotonin can also disrupt mood. While many antidepressants work by increasing serotonin, this system is delicate. Some drugs, like corticosteroids, are believed to cause depression by lowering serotonin levels [1.8.3].
Anticholinergic Effects: Anticholinergic drugs block the action of acetylcholine, a neurotransmitter vital for memory and cognitive function. This blockade can lead to confusion, delirium, memory loss, and hallucinations, particularly in older adults [1.5.4].
HPA Axis Disruption: Systemic corticosteroids mimic the body's stress hormone, cortisol. Prolonged use can disrupt the hypothalamic-pituitary-adrenal (HPA) axis, the body's central stress response system. This dysregulation is linked to a wide range of psychiatric conditions, including depression, mania, and anxiety [1.4.2].

Common Medications That Can Cause Mental Health Concerns

A wide variety of drugs, used for everything from inflammation to heart disease, have been associated with psychiatric adverse events [1.2.1].

Corticosteroids

Commonly prescribed for inflammation in conditions like asthma and autoimmune diseases, corticosteroids (e.g., prednisone) are well-known for causing psychiatric side effects. The risk increases significantly with higher doses; one study noted psychiatric effects in 1.3% of patients on less than 40 mg of prednisone daily, rising to 18.4% for those on 80 mg daily [1.4.1]. Effects can range from euphoria and insomnia to severe depression, mania, and psychosis (often called "steroid psychosis") [1.4.1, 1.4.4].

Dopamine Agonists

Used to treat Parkinson's disease and restless legs syndrome, these drugs (e.g., pramipexole, ropinirole) directly stimulate dopamine receptors. While they help control motor symptoms, this action can lead to serious behavioral issues. Impulse control disorders—such as pathological gambling, compulsive shopping, and hypersexuality—are a significant concern, affecting as many as one in seven patients on these drugs [1.6.1, 1.6.4]. Hallucinations are also common [1.2.1].

Anticholinergics

Found in many over-the-counter allergy and sleep aids (e.g., diphenhydramine) as well as prescription drugs for conditions like overactive bladder, anticholinergics carry a significant risk of cognitive side effects [1.5.1]. In older adults, the use of these drugs is linked to an increased risk of dementia, brain atrophy, and poorer performance on memory and executive function tests [1.5.2, 1.5.5]. Even at normal doses, they can cause delirium and confusion [1.5.4].

Beta-Blockers

Prescribed for hypertension and heart conditions, the link between beta-blockers (e.g., propranolol, metoprolol) and depression has been long-debated [1.7.3]. While some large-scale analyses have found no significant association, other evidence suggests they can cause fatigue, decreased energy, and sexual dysfunction, which may be interpreted as or contribute to depressive symptoms [1.7.4, 1.7.1, 1.7.3].

Fluoroquinolone Antibiotics

This class of antibiotics (e.g., ciprofloxacin, levofloxacin) has been linked to a range of psychiatric side effects, including anxiety, insomnia, confusion, delirium, psychosis, and in rare cases, suicidal ideation [1.11.1, 1.11.3]. Regulatory agencies have issued warnings about these risks, advising that the drugs be discontinued at the first sign of such symptoms [1.11.4].

Comparison of Drug Classes and Psychiatric Side Effects


Drug Class	Common Uses	Potential Psychiatric Side Effects
Corticosteroids	Inflammation, Asthma, Autoimmune diseases	Euphoria, Mania, Depression, Psychosis, Anxiety, Insomnia [1.4.1, 1.4.4]
Dopamine Agonists	Parkinson's Disease, Restless Legs Syndrome	Impulse Control Disorders, Hallucinations, Psychosis [1.6.1, 1.6.4]
Anticholinergics	Allergies, Overactive Bladder, Insomnia	Confusion, Delirium, Memory Loss, Dementia Risk [1.5.4, 1.5.2]
Beta-Blockers	Hypertension, Heart Conditions	Fatigue, Sexual Dysfunction, Depression (disputed) [1.7.1, 1.7.3]
Fluoroquinolones	Bacterial Infections	Anxiety, Delirium, Psychosis, Suicidal Ideation [1.11.1, 1.11.3]

What to Do if You Suspect a Medication is Affecting Your Mental Health

If you experience new or worsening mental health symptoms after starting a medication, it is critical to take action.

Do not stop the medication abruptly. Suddenly discontinuing certain drugs can cause withdrawal or other harmful effects [1.9.1].
Contact the prescribing doctor immediately. Your healthcare provider needs to evaluate whether the symptoms are linked to the medication. They can assess the risks and benefits of continuing the drug [1.9.3].
Keep a symptom journal. Document the symptoms, when they started, and their severity. This information can help your doctor make an informed decision.
Discuss alternative treatments. Depending on the situation, your doctor might lower the dose, switch you to a different medication, or prescribe an additional medication to manage the psychiatric side effects [1.9.1].

Conclusion

Many essential medications carry a risk of causing or worsening mental health conditions. These effects often stem from the drug's influence on the brain's delicate chemical balance. Awareness of which drug effect can cause mental health concerns is the first step toward prevention and effective management. Patients and caregivers should be vigilant for changes in mood or behavior after starting a new treatment and maintain open communication with healthcare providers. Never hesitate to report concerning symptoms, as prompt action can prevent more severe complications.

Learn more about medication safety from the National Institute of Mental Health.

Frequently Asked Questions

Yes, some OTC medications, particularly those with anticholinergic properties like certain allergy medicines (e.g., diphenhydramine) and sleep aids, can cause confusion, delirium, and cognitive impairment, especially in older adults [1.2.1, 1.5.4].

The onset of psychiatric side effects varies widely. For example, symptoms from corticosteroids can emerge within a few days or weeks of starting treatment [1.4.4]. Other drug effects may only become apparent after a longer duration of use.

In most cases, psychiatric symptoms induced by medication are reversible and resolve after the dosage is reduced or the drug is discontinued under a doctor's supervision [1.4.3, 1.6.4]. However, some studies suggest prolonged use of certain drugs, like anticholinergics, may contribute to less reversible conditions like dementia [1.5.5].

Risk factors include high medication dosage, older age, a pre-existing history of mental illness, and the use of multiple medications. For example, the risk of steroid-induced psychosis is much higher with prednisone doses over 40 mg/day [1.4.1, 1.2.1].

Yes, certain classes of antibiotics, most notably fluoroquinolones (like ciprofloxacin), have been linked to psychiatric side effects including anxiety, depression, confusion, and in rare cases, psychosis and suicidal thoughts [1.11.1, 1.11.3].

Drug-induced psychosis is a psychotic episode directly caused by substance use or medication, and symptoms typically resolve with detoxification and abstinence [1.10.4]. Schizophrenia is a chronic primary psychotic disorder with a more complex origin, though substance use can sometimes trigger its onset in vulnerable individuals [1.9.2].

Be direct and specific. Tell your doctor, "I started taking [Medication Name] on [Date] and have since been experiencing [Symptom, e.g., anxiety, low mood, confusion]." Providing a clear timeline helps your doctor assess the situation accurately [1.9.3].