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

It starts with a whisper - a feeling that someone’s watching you, even when you’re alone. Then the voices come. Not in your head like thoughts, but clear, loud, and real. You see shadows moving where there’s nothing. You’re sure your pills are poisoned. You can’t sleep. You can’t think straight. You don’t know what’s real anymore. And you’re terrified.

This isn’t schizophrenia. It’s not a lifelong mental illness. It’s medication-induced psychosis - a sudden, terrifying reaction to a drug you were told was safe. And it’s more common than most doctors admit.

What Exactly Is Medication-Induced Psychosis?

Medication-induced psychosis happens when a drug - prescription, over-the-counter, or even herbal - triggers hallucinations or delusions. These symptoms aren’t just side effects. They’re full-blown breaks from reality. The DSM-5, the standard guide doctors use to diagnose mental disorders, says these symptoms must appear during or within a month after taking the drug or going through withdrawal.

Unlike schizophrenia, where symptoms last for months or years, medication-induced psychosis usually clears up once the drug is stopped. But that doesn’t mean it’s harmless. In the moment, it’s just as dangerous. People have jumped from windows believing they could fly. Others have attacked loved ones thinking they were demons. Emergency rooms see these cases every week.

Common Symptoms - What to Watch For

The signs aren’t always obvious at first. Often, they creep in slowly. You might notice:

• Paranoia - thinking people are plotting against you, even if there’s no evidence
• Auditory hallucinations - hearing voices, whispers, or sounds that aren’t there
• Visual hallucinations - seeing people, animals, or objects that don’t exist
• Confused speech - jumping between topics, saying things that don’t make sense
• Extreme anxiety or agitation - pacing, yelling, or becoming violently upset over small things
• Loss of insight - refusing to believe you’re unwell, even when others are worried

These symptoms can come on fast - within minutes after taking cocaine or meth - or slowly, over weeks, like with steroids or antimalarials. Mood swings, irritability, or sleeplessness often show up first. That’s your warning sign.

Which Medications Can Cause This?

It’s not just illegal drugs. Many everyday prescriptions carry this risk. Here are the most common culprits:

• Corticosteroids - Used for asthma, arthritis, or autoimmune diseases. About 5.7% of people on high doses develop psychosis. It’s one of the most frequent causes.
• Mefloquine - An antimalarial drug. The European Medicines Agency has logged over 1,200 psychosis cases since the 1980s. Travelers to Southeast Asia or Africa are at risk.
• Efavirenz - An HIV medication. Around 2.3% of users experience severe psychiatric side effects, including hallucinations and suicidal thoughts.
• Antidepressants - Especially SSRIs and SNRIs. Rare, but documented. Often happens in the first few weeks of treatment.
• Stimulants - Methylphenidate (Ritalin), amphetamines (Adderall), even high-dose caffeine. Up to 96% of chronic cocaine users report hallucinations.
• Anticholinergics - First-generation antihistamines like diphenhydramine (Benadryl). Common in sleep aids and cold meds. Can cause delirium and psychosis in older adults.
• Levodopa - Used for Parkinson’s. Can trigger hallucinations in up to 40% of long-term users.
• Alcohol and benzodiazepine withdrawal - After heavy, long-term use, stopping suddenly can cause delirium and hallucinations.

Even ibuprofen in massive doses, muscle relaxants like baclofen, and chemotherapy drugs have been linked. The list keeps growing as more drugs are studied.

Who’s at Risk?

It’s not random. Certain people are far more likely to develop this:

• Those with a personal or family history of schizophrenia or bipolar disorder
• Women - Studies show higher vulnerability across nearly all drug classes
• Older adults - Their bodies process drugs slower, and brain changes make them more sensitive
• People with substance use disorders - 74% of first-episode psychosis patients have a history of drug or alcohol abuse
• Those taking multiple medications - Drug interactions can turn a safe dose into a dangerous one

And here’s the scary part: many doctors don’t connect the dots. A 2019 study found only 38% of primary care doctors felt confident spotting medication-induced psychosis. If you’re on a new drug and start feeling “off,” don’t assume it’s just stress.

Emergency Management - What Happens in the ER

If someone is in full psychosis - screaming, violent, or believing they’re being hunted - call emergency services immediately. Don’t try to reason with them. They’re not being difficult. Their brain is malfunctioning.

In the emergency room, the first step is always the same: stop the drug. That’s the only treatment that works for sure. But stopping isn’t always simple. If it’s a steroid, you can’t just quit cold turkey. If it’s alcohol or benzodiazepines, withdrawal can kill you.

Doctors will:

• Check vital signs - heart rate, temperature, blood pressure
• Run blood tests - to rule out infection, liver failure, or electrolyte imbalance
• Assess for withdrawal - especially if alcohol or opioids are involved
• Give a sedative - Often an atypical antipsychotic like olanzapine or quetiapine, given orally or by injection
• Provide fluids and monitoring - For stimulant cases, they watch for rhabdomyolysis (muscle breakdown)

Antipsychotics aren’t always needed. If the drug is cleared quickly - like with cocaine - symptoms may fade in hours. But if the person is dangerous to themselves or others, doctors can hold them under mental health laws for observation. This isn’t punishment. It’s protection.

Recovery and Follow-Up - It’s Not Over When the Symptoms Stop

Most people recover fully. Steroid-induced psychosis? Usually gone in 4 to 6 weeks. Cocaine-induced? Often gone in 24 to 72 hours. But recovery isn’t just about stopping the drug.

You need follow-up. Why? Because psychosis can mask a deeper illness. If symptoms return after stopping the drug, you might have an underlying condition like schizophrenia or bipolar disorder that was triggered - not caused - by the medication.

Doctors recommend psychiatric check-ups for at least three months after symptoms clear. Blood tests, brain scans, and detailed interviews help sort out what’s going on. Some people need ongoing therapy. Others just need to avoid certain drugs forever.

And here’s something no one tells you: once you’ve had medication-induced psychosis, you’re more likely to get it again - even with a different drug. Your brain remembers.

Prevention - How to Avoid This Before It Starts

You can protect yourself and your loved ones:

• Always tell your doctor about your mental health history - even if it was years ago
• Ask: “Can this drug cause hallucinations or paranoia?” before starting any new medication
• Keep a list of all your meds - including supplements and OTC drugs - and update it every visit
• Watch for early signs: trouble sleeping, sudden anxiety, feeling “not like yourself”
• Never stop a drug suddenly without medical advice - especially steroids, antidepressants, or seizure meds
• For high-risk drugs like mefloquine or efavirenz, read the FDA warning sheet. It’s there for a reason

And if you’re caring for someone on these drugs - check in daily. Ask: “Are you hearing or seeing things you didn’t before?” Don’t wait for a crisis.

Final Thought - This Is Real, and It’s Treatable

Medication-induced psychosis is not weakness. It’s not addiction. It’s a physiological reaction - like an allergic response, but to your brain.

Thousands of people wake up in emergency rooms terrified, wondering if they’ve lost their mind. The truth? They haven’t. With the right care, they’ll get back to normal. But only if someone recognizes the cause.

If you’re on a new drug and feel something’s wrong - trust your gut. Call your doctor. Go to the ER. Don’t wait. Don’t assume it’s ‘just stress.’

Your brain is listening. Make sure the people treating you are listening too.