Which drugs trigger psychosis? A comprehensive guide to medication and substance-induced episodes

According to one study, up to 25% of all hospital admittances for psychosis are a result of drug use, highlighting a significant connection between substance use and mental health. The issue of which drugs trigger psychosis is complex, as various recreational and prescription substances can induce or worsen these episodes, with effects varying based on the individual and the specific substance.

Quick Summary

A review of recreational drugs and prescription medications that can cause temporary or persistent psychotic symptoms such as hallucinations and delusions. Various classes of substances are explored, alongside factors that increase risk and distinctions from primary psychotic disorders. Treatment approaches often involve discontinuation of the substance and medication management.

Key Points

• Diverse Triggers: Psychosis can be triggered by a wide range of recreational drugs, such as stimulants and cannabis, as well as several prescription medications, including corticosteroids and antiparkinsonian drugs.

• Dopamine Overload: Stimulant-induced psychosis is often driven by an overstimulation of the brain's dopamine system, leading to symptoms like paranoia and hallucinations.

• Genetic Vulnerability: A genetic predisposition or family history of psychotic disorders can significantly increase a person's risk of experiencing drug-induced psychosis.

• Withdrawal-Related Psychosis: Psychosis can occur not only during active drug use but also during withdrawal from substances like alcohol or benzodiazepines, especially in cases of long-term dependency.

• Distinguishing from Schizophrenia: Drug-induced psychosis typically has a more sudden onset and shorter duration than schizophrenia, often resolving once the substance is out of the system.

• Importance of Cessation: The most critical step in treating drug-induced psychosis is the immediate discontinuation of the causative agent, which is often sufficient to resolve symptoms.

• Personalized Risk: An individual's unique response to a substance depends on factors like dose, potency, and underlying mental health, making the outcome unpredictable.

Understanding Drug-Induced Psychosis

Drug-induced psychosis (DIP), also known as substance-induced psychotic disorder, is characterized by the presence of hallucinations, delusions, or both, that develop during or shortly after intoxication or withdrawal from a substance. These episodes can cause a person to experience a loss of contact with reality. DIP can last from hours to weeks and may sometimes unmask an underlying psychotic disorder.

Recreational Drugs and Psychosis

Stimulants

Stimulant drugs are particularly associated with triggering psychosis due to their impact on the brain's dopamine system. High doses and prolonged use increase the risk.

• Cocaine: Can cause paranoid delusions and hallucinations in a significant number of users, with methods like freebasing or injection raising the risk.
• Amphetamines: These drugs, including methamphetamine, can lead to paranoia, persecutory delusions, and hallucinations, such as the sensation of insects on the skin (formication). Chronic use may result in persistent psychotic symptoms.
• MDMA (Ecstasy): This substance can induce paranoia, anxiety, and perceptual disturbances.

Hallucinogens and Dissociatives

These drugs directly alter perception, and high doses or adverse reactions can lead to psychotic episodes.

• LSD and Psilocybin (Magic Mushrooms): Can cause intense hallucinations and perceptual changes. Adverse experiences ('bad trips') can involve delusions and paranoia.
• PCP and Ketamine: Dissociative effects can include hallucinations, delusions, and a feeling of detachment from reality. PCP-induced psychosis can have a prolonged duration.

Cannabis

Cannabis use is linked to an increased risk of psychosis, especially in individuals with genetic vulnerability or those who start using at a young age. Higher THC content in cannabis is associated with a greater risk. Symptoms may include paranoia, delusions, and hallucinations.

Alcohol and Depressants

Psychosis can occur during heavy alcohol intoxication and particularly during withdrawal in individuals with long-term dependency.

• Alcohol: Delirium tremens is a severe form of withdrawal-induced psychosis.
• Benzodiazepines: Can trigger psychotic episodes during intoxication or abrupt withdrawal after extended use.

Prescription Medications and Psychosis

Certain prescription drugs can also induce psychotic side effects (iatrogenic psychosis).

Corticosteroids

Systemic corticosteroids like prednisone can cause psychiatric effects, including psychosis, especially at high doses (e.g., >40 mg/day of prednisone). The mechanism may involve disruption of the HPA axis and hippocampal function. Symptoms can include mood changes and full psychosis, and may also occur during withdrawal.

Antiparkinsonian Medications

Dopamine agonists used for Parkinson's disease can induce psychosis due to their action on dopamine levels.

Anticholinergics

These drugs, which block acetylcholine receptors, can cause anticholinergic toxicity or psychosis. Many medications, including some antidepressants and antihistamines, have anticholinergic effects.

Other Medications

Other drug classes occasionally linked to psychosis include:

• Antibiotics: Fluoroquinolones have been associated with psychiatric side effects.
• Antidepressants: May induce psychotic symptoms in some individuals.
• Anticonvulsants: Some, like levetiracetam, have been reported to cause psychosis.
• Cardiovascular medications: Certain types have been associated with psychiatric adverse events.

Drug-Induced Psychosis vs. Schizophrenia

Distinguishing DIP from schizophrenia is important, with key differences noted below:

Feature	Drug-Induced Psychosis (DIP)	Schizophrenia
Onset	Sudden, linked to substance use/withdrawal.	More gradual.
Duration	Typically resolves within days to weeks after stopping the substance.	Chronic, requiring at least 6 months of symptoms for diagnosis.
Primary Cause	Directly caused by substance use or withdrawal.	Complex factors, substance use can be a trigger.
Treatment	Substance discontinuation, possible temporary antipsychotics.	Long-term medication and therapy.
Prognosis	Generally good if substance is stopped.	Often chronic.

Risk Factors for Drug-Induced Psychosis

Certain factors increase vulnerability to DIP:

• Genetic predisposition: Family history of psychotic disorders is a significant risk factor.
• Individual sensitivity: Responses vary between people.
• Dose and potency: Higher amounts and stronger substances increase risk.
• Age of first use: Younger age of initiation, especially with cannabis, is a risk factor.
• Underlying psychiatric conditions: Can increase vulnerability.

Conclusion

Psychosis can be triggered by a wide array of recreational drugs and prescription medications. The risk varies depending on the substance, dosage, individual genetic predisposition, and other factors. Stimulants, hallucinogens, cannabis, corticosteroids, and antiparkinsonian medications are notable examples. While drug-induced psychosis is often temporary once the substance is discontinued, it can be severe and may require immediate medical intervention. Early identification and cessation of the causative substance, often supported by medication and therapy, are crucial for a favorable outcome. Understanding the link between substances and mental health is vital for prevention and treatment.

References

• National Institutes of Health (NIH) PMC: Medication-induced Psychotic Disorder. A Review.
• American Addiction Centers: Substance-Induced Psychosis: Symptoms, Causes, and Treatment.
• Medical News Today: Drug-induced psychosis and schizophrenia: How do they differ?.
• Cureus: Corticosteroid-Induced Psychosis: A Report of Two Cases and Review of the Literature.
• The Rheumatologist: When Steroids Cause Psychosis.
• Psychiatric Times: Cannabis-Induced Psychosis: A Review.

Frequently Asked Questions

How long does drug-induced psychosis last?

In most cases, drug-induced psychosis is temporary and lasts for a few days to a few weeks, with symptoms typically resolving once the substance is cleared from the body. However, in some cases, particularly with chronic use of certain drugs like methamphetamine or cannabis, symptoms may persist for months or longer.

Can prescription medications cause psychosis?

Yes, several prescription medications can cause psychosis as a side effect. Common examples include high-dose corticosteroids, dopamine agonists used for Parkinson's, and anticholinergic drugs. Some antibiotics, antidepressants, and anticonvulsants have also been linked to rare cases.

Is drug-induced psychosis the same as schizophrenia?

No, they are distinct conditions. Drug-induced psychosis is directly caused by substance use, with a sudden onset and generally temporary duration. Schizophrenia is a chronic condition with different causes, though substance use can trigger or unmask it in genetically vulnerable individuals.

Can drug withdrawal trigger psychosis?

Yes, abrupt withdrawal from certain substances can trigger psychosis. This is most famously associated with severe alcohol withdrawal, known as delirium tremens, but can also occur when withdrawing from depressants like benzodiazepines or opioids.

What are the common symptoms of drug-induced psychosis?

Symptoms can include hallucinations (seeing, hearing, or feeling things that aren't there), delusions (false, strongly held beliefs), paranoia, agitation, confused thinking, and disorganized speech.

Is there a link between cannabis and psychosis?

Yes, significant evidence links cannabis use with an increased risk of psychosis, particularly for those with genetic predispositions or those who use high-potency cannabis frequently. Early onset of cannabis use is also a risk factor.

What is the primary treatment for drug-induced psychosis?

The initial treatment for drug-induced psychosis typically involves the discontinuation of the offending substance. In acute or severe cases, hospitalization may be necessary, and antipsychotic medication may be used to manage symptoms temporarily.

How does stimulant psychosis manifest?

Stimulant-induced psychosis often features intense paranoia, persecutory delusions, and vivid hallucinations. Users of methamphetamine, for instance, may experience formication, the sensation of insects crawling under their skin.