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

It’s not rare for someone to wake up feeling paranoid, hearing voices, or believing things that just aren’t true - and not because of mental illness, but because of a medication they’ve been taking. Medication-induced psychosis can happen with drugs you’d never expect: steroids for back pain, antibiotics for a travel vaccine, even over-the-counter sleep aids. The symptoms are terrifying, but the good news? Most of the time, it’s reversible - if you catch it early.

What Does Medication-Induced Psychosis Actually Look Like?

Medication-induced psychosis isn’t just feeling ‘off.’ It’s a sudden break from reality. The most common signs are:

• Delusions - strong false beliefs, like thinking someone is spying on you, poisoning your food, or controlling your thoughts
• Hallucinations - hearing voices, seeing people who aren’t there, or feeling bugs crawling on your skin
• Disorganized speech - jumping between topics, saying things that don’t connect, or using made-up words
• Severe confusion or memory gaps
• Extreme agitation, aggression, or withdrawal

These symptoms don’t come out of nowhere. Often, they start subtly. A person on high-dose steroids might become unusually anxious or irritable for a few days before full psychosis hits. Someone taking an antimalarial drug for a trip might feel restless, then start seeing shadows move in the corner of their eye. The key is timing: symptoms appear within hours or days after starting a new medication - or during withdrawal.

It’s easy to mistake this for schizophrenia or bipolar disorder. But here’s the difference: in medication-induced psychosis, symptoms usually fade within days or weeks after stopping the drug. If they stick around longer than a month, that’s a red flag for something else.

Which Medications Can Trigger This?

You might be surprised how many common prescriptions carry this risk. It’s not just street drugs or hallucinogens. Even medicines you take daily can cause it:

• Corticosteroids (like prednisone): Up to 5.7% of people on high doses develop psychosis. It’s one of the most common drug triggers.
• Antimalarials (like mefloquine): Used for travel to malaria zones, this drug has caused over 1,200 reported psychosis cases worldwide since the 1980s.
• Antiretrovirals (like efavirenz for HIV): About 2.3% of users report hallucinations or paranoia - enough for the FDA to require warning labels.
• Antidepressants (SSRIs, SNRIs): Rare, but possible - especially when starting or changing doses.
• Anticholinergics (like diphenhydramine in Benadryl or sleep aids): Can cause delirium and hallucinations, especially in older adults.
• Stimulants (like Adderall, methylphenidate): High doses or misuse can trigger paranoia and auditory hallucinations.
• Levodopa (for Parkinson’s): Can cause vivid dreams, hallucinations, or delusions in up to 40% of long-term users.
• Alcohol or benzodiazepine withdrawal: After heavy, long-term use, stopping suddenly can cause severe psychosis that mimics schizophrenia.

Even ibuprofen or opioids in very high doses have been linked to psychotic episodes - though these cases are rare. The risk isn’t about being ‘weak-minded.’ It’s about biology. Some people’s brains react differently to certain chemicals. A history of mental illness, family history of psychosis, or being female increases the chance - but anyone can be affected.

Why It’s So Often Missed

Doctors don’t always connect the dots. A patient walks into the ER screaming that their neighbor is broadcasting thoughts through the walls. The ER team sees psychosis and assumes schizophrenia. They start antipsychotics. But what if the patient started prednisone for asthma two weeks ago? Or took a malaria pill before a trip? Or recently quit drinking?

Studies show only 38% of primary care doctors feel confident spotting medication-induced psychosis. That’s dangerous. Giving an antipsychotic to someone whose psychosis is caused by a steroid can mask the real problem - and delay the only cure: stopping the drug.

The trick is asking the right questions:

• When did the symptoms start?
• What new medications, supplements, or OTC drugs were started in the last 30 days?
• Have you changed doses recently?
• Are you withdrawing from alcohol, sleep meds, or opioids?
• Do you have a personal or family history of mental illness?

If the answer to any of these points to a medication, that’s the first clue.

What Happens in an Emergency?

If someone is in the middle of a psychotic episode - yelling at invisible people, acting violently, or believing they’re in danger - call emergency services immediately. Don’t try to reason with them. Their brain isn’t processing reality. Safety comes first.

In the hospital, the first step is always the same: stop the suspected drug. No exceptions. If it’s a steroid, they’ll taper it. If it’s an antimalarial, they’ll discontinue it. If it’s alcohol withdrawal, they’ll give benzodiazepines to prevent seizures or delirium tremens.

For severe symptoms - extreme agitation, hallucinations that cause self-harm risk - doctors may use a short course of an atypical antipsychotic like olanzapine or quetiapine. But this isn’t a long-term fix. It’s a bridge. The goal is to calm the person down while the body clears the drug.

They’ll also check for other dangers: dehydration, high body temperature, muscle breakdown (rhabdomyolysis) from stimulant overdose, or thiamine deficiency from chronic alcohol use. These can make psychosis worse and need urgent treatment.

Most people improve within 24 to 72 hours after stopping the drug. Steroid-induced psychosis might take 4 to 6 weeks to fully clear. Cocaine-induced psychosis often fades in under 3 days. But if symptoms linger past a month, the doctor will start looking for an underlying condition like schizophrenia.

Recovery and What Comes Next

The outlook is usually positive. Most people return to normal after stopping the medication. But recovery isn’t just about the symptoms disappearing. It’s about understanding what happened - and preventing it again.

After discharge, follow-up is critical. A psychiatrist should review the case within 2 to 4 weeks. They’ll ask: Did the symptoms fully resolve? Was there a prior mental health history? Could this have been the first sign of something else?

Some people never take the triggering drug again. Others might need to avoid similar ones. For example, if mefloquine caused psychosis, they’ll never take it again - and their doctor will choose a different malaria prevention drug. If steroids triggered it, future steroid use will be carefully monitored, with mood checks before and during treatment.

For those with a history of addiction or mental illness, ongoing support matters. Medication-induced psychosis doesn’t cause schizophrenia - but it can reveal an underlying vulnerability. That’s why long-term monitoring is part of the process.

How to Prevent It

You can’t always predict who will react badly - but you can reduce the risk:

• Always tell your doctor about every medication, supplement, and herbal product you take - including what you buy over the counter.
• If you’re starting a new drug with known psychiatric risks (steroids, antimalarials, efavirenz), ask: ‘Could this cause hallucinations or paranoia?’
• Keep a symptom journal. Note mood changes, sleep issues, or strange thoughts in the first week after starting a new medicine.
• If you’re on long-term steroids or Parkinson’s meds, schedule regular mental health check-ins with your doctor.
• Never stop alcohol, benzodiazepines, or opioids suddenly without medical help. Withdrawal can be deadly.

The FDA requires warning labels on drugs like efavirenz and mefloquine for a reason. Read them. If the label says ‘contact your doctor if you feel depressed, anxious, or hear voices’ - don’t ignore it. Call the same day.

Final Thought: It’s Not Your Fault

If you or someone you love has experienced medication-induced psychosis, it’s not weakness. It’s a biological reaction. Thousands of people have been through this - often without knowing why. The system isn’t perfect. But awareness is growing. More doctors are learning to ask the right questions. More patients are speaking up. And with the right action, most cases resolve completely - with no lasting damage.

The key is acting fast. If you suspect a medication is causing psychosis, don’t wait. Don’t assume it’s ‘just stress.’ Call your doctor. Go to the ER. Your brain is trying to tell you something - and it’s worth listening to.