By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Photo courtesy of pixabay.
Sometimes over-the-counter medications cause paranoia.
Dextromethorphan is a common antitussive (cough suppressant) medication found in over-the-counter medications. It is a common ingredient in over 140 over-the-counter medications. Unfortunately, Dextromethorphan has become an increasingly abused substance among those in the 18 to 25-year-old range. Abuse by younger teens is reported to be on the rise.
Because dextromethorphan can be purchased over-the-counter or stolen from grocery stores and pharmacies, many users have underestimated the serious, long-term effects of dextromethorphan abuse.
When taken according to directions most over-the-counter medications are relatively safe. Any medication, including over-the-counter medications, may result in side effects or allergic reactions. Abuse of Dextromethorphan can have some serious health consequences.
When Dextromethorphan is taken in larger than recommended amounts it can produce psychoactive effects. “Use in amounts exceeding those recommended, a practice which is known as “Robotripping,” may result in a toxidrome of psychomotor agitation, hallucinations and paranoia best characterized as Intoxication Delirium (Stanciu, C. et al., 2016.)
Dextromethorphan shares pharmacologic and neurobehavioral properties similar to opiates and phencyclidine (PCP.) Because of its cough suppression action is like the opiate codeine, as the dose increases it can produce dreamlike states and hallucinations somewhat like the “pipedreams” of opium smokers. As the dose increases significant unpleasant and health impairing results occur. At very high doses Delirium and misperceptions occur, resulting in paranoia and violent behavior similar to PCP intoxication.
“Intoxicated excited delirium describes the most serious and potentially deadly DXM-induced medical condition involving psychotic behavior, elevated temperature, and an extreme psychomotor agitation ﬁght-or-ﬂight response by the nervous system. Due to extreme violence frequently encountered such presentations, typically encountered in the emergency room setting with law enforcement involvement, have resulted in sudden death secondary to cardiac or respiratory arrest, an outcome associated with the use of physical restraints” (Stanciu, C. et al., 2016.)
One online user bulletin board, I will leave the website name out, included a number of user warnings. Users report tolerance to dextromethorphan happens rapidly, often after a single dose. Reports of paranoia were common, both paranoia caused by taking dextromethorphan and users reports of high anxiety which they called “paranoid” about the many other negative results from use.
Users have reported impaired daily functioning for as long as six years afterward.
On the way to psychosis and paranoia, users may experience a variety of alterations in perception. Commonly reported are auditory, visual, and tactile hallucinations. That may pass through a period of excitability and pressured speech which can easily be mistaken for bipolar mania. Nervousness, confusion, and disorientation can occur. A variety of physical symptoms are also likely, including tremors, slurred speech, and occasionally seizures. Some less pleasant symptoms include nausea, vomiting, respiratory depression, coma, and even death.
The particular gene responsible for metabolizing dextromethorphan is polymorphic meaning there are a number of different mutations of this gene in humans. Because of this a new user never knows just how dextromethorphan may affect them. Some people need to take a large amount to feel the effects while other people can have a serious adverse effect even at doses only a little above the label recommendations (Stanciu, C. et al., 2016.)
There are antidotal reports of serious interactions between dextromethorphan and commonly used substances such as alcohol and marijuana. In medical settings, life-threatening interactions between prescribed psychiatric medications and intentional overdoses of dextromethorphan-containing products.
Dextromethorphan is not the only drug of abuse which has been connected to an increased risk of developing paranoia. Reports of paranoia among drug users are common. Paranoia can be difficult to identify and diagnose. It is often only considered in the context of diagnosing the paranoid type Schizophrenia or Paranoid Personality Disorder. Recent studies have suggested that paranoia falls on a continuum and paranoia has rarely been studied outside the seriously mentally ill. Many things about the drug using lifestyle increase the risk of paranoia. Another reason for the shortage of information about rates of paranoia and its treatment among drug users has been the systematic exclusion of those with a substance use disorder from psychological research. Given the large overlap between those with a substance use disorder and a diagnosed mental illness, there’s a lot we haven’t learned about trust issues, suspicion, and various levels of paranoia among those with a co-occurring disorder.
I’ll continue to watch for and read research about the trust to suspicion continuum so watch for future posts on this topic.
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