How Pharmaceutical Drugs Affect Mental Health
When discussing the effects of drugs on mental health most of us would assume we always mean recreational drugs, such as cannabis, cocaine, spice, or LSD, but did you know that some “normal” medicines prescribed by the doctor can also have negative impact on your mental health? Such side effects can occur with some medicines however this is NOT to say that you should stop taking your prescription medication but awareness of possible causes of your mental health symptoms may help you manage them more effectively.
If you are prescribed any of the medication below and you suspect that it could be causing you mental health side effects, please DO NOT stop taking your medication before speaking to your GP first. This is essential for your mental and physical well-being, some medicines can cause dangerous withdrawal effects when stopped abruptly and you risk seeing deterioration in your health condition if you stop prescribed treatment. Instead, you can speak to your GP who can offer you a range of options, from reducing the dose of your current medication to switching to an alternative medication all together or even adding another therapy to manage the mental health side effects.
Below are some examples of prescription medication that could cause mental health side effects:
Isotretinoin (Roaccutane) – prescribed for severe acne.
Depression, anxiety, and suicidal thoughts are some of the side effects linked to Isotretinoin. Other side effects can include erectile dysfunction and reduced libido, which as a consequence can affect people’s mental health. (British National Formulary, 2021)
Over the past two decades, nearly 18,000 cases of depression, anxiety, and emotional lability linked to isotretinoin use were reported, including 2,278 cases of suicidal ideation, 602 cases of attempted suicide, and 368 reports of completed suicide (Hlavinka, 2019).
British Medical Journal found there is an increased risk of attempted suicide for up to six months after the end of treatment with isotretinoin (Sundström, et al., 2010). If you are currently taking or stopped taking isotretinoin in the last 6 months, you should closely monitor your mental health and seek professional advice if symptoms present.
Beta-blockers – prescribed to treat high blood pressure (hypertension).
For example atenolol, carvedilol, propranolol, and some other drugs whose chemical names end with “-olol”. The three most commonly adverse effects reported with their use are fatigue, sexual dysfunction, and depression. (British National Formulary, 2021) 
Corticosteroids – prescribed to treat inflammation of the blood vessels and muscles as well as rheumatoid arthritis, lupus, Sjogren’s syndrome and gout. Examples: cortisone, methylprednisolone, prednisone and triamcinolone.
Research suggests that corticosteroids lower serotonin levels in the body, which can cause depression and other psychiatric disorders. Withdrawal from corticosteroids can also trigger depression.
Stimulants – for example methylphenidate (Ritalin) prescribed to treat ADHD and modafinil prescribed to treat excessive daytime sleepiness, whether caused by hypersomnia, narcolepsy or sleep apnoea. Stimulant medications increase the level of dopamine in the body and research suggests that prolonged exposure to higher levels of dopamine may cause depression.
Anticonvulsants – For example: carbamazepine, gabapentin, lamotrigine, pregabalin and topiramate. Anticonvulsant medications have long been used to treat seizures, but now are increasingly being used to treat conditions like neuropathic pain, bipolar disorder, mood disorders and mania.
Anticonvulsants work by affecting neurotransmitters, which serve as chemical messengers in the brain. This medication may stop seizures from spreading by blocking the flow of signals from the central nervous system (CNS) rather than raise the threshold for seizures. All CNS depressants, including anticonvulsants, can cause depression.
Alternatives: for seizures phenytoin can be used as an alternative, which raises the seizure threshold. For chronic neuropathic pain, venlafaxine can be used, which affects two neurotransmitters, serotonin and norepinephrine, that are thought to play roles in regulating pain. You must consult your doctor to find out if these are suitable for you.
Antidepressants – oddly enough the use of antidepressants has been linked with mania, suicidal thoughts and behaviour. Patients should be monitored for suicidal behaviour, self-harm, or hostility, especially at the start of treatment or if the dose is changed (British National Formulary, 2021).
This applies to different types of antidepressants, including selective serotonin reuptake inhibitors (SSRIs) such as escitalopram or fluoxetine; serotonin/norepinephrine reuptake inhibitors (SNRIs) such as duloxetine or venlafaxine; tricyclic antidepressants such as nortriptyline; and monoamine oxidase inhibitors (MAOIs) such as phenelzine or tranylcypromine. (Bruce, 2021)
As aforementioned, these are only possible side effects from the medicines and it does not necessarily mean that you will get them, or if you do get them it definitely does not mean you should stop your treatment. However, it is important patients understand what to expect when taking these medicines which will enable them to seek prompt advice from a healthcare professional. In all cases, the risk of side effects must be balanced against the risk and discomfort of not treating the disease.
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Disclaimer – Please note we are 3rd year pharmacy students. We are not qualified to provide medical advice. This blog is for information only. Please consult your doctor or pharmacist for advice.