What medications can alter personality or behavior?

From the Guidelines

Medications that can alter personality or behavior include psychiatric medications like antidepressants (fluoxetine, sertraline), antipsychotics (risperidone, olanzapine), mood stabilizers (lithium, valproate), and benzodiazepines (diazepam, alprazolam), as well as stimulants, neurological medications, and steroids. These medications can modify mood, thought patterns, and behavior by altering neurotransmitter levels in the brain, affecting regions that control mood, cognition, and behavior. Some key points to consider include:

• Antidepressants like fluoxetine and sertraline can reduce suicidal ideation and suicide attempts in nondepressed adults with cluster B personality disorders, but may have a disinhibiting effect in some individuals 1.
• Antipsychotics like risperidone and olanzapine can control problematic delusions, hallucinations, severe psychomotor agitation, and combativeness, but may have significant side effects involving the cholinergic, cardiovascular, and extrapyramidal systems 1.
• Mood stabilizers like lithium and valproate can reduce the rate of suicides and suicide attempts in adults with bipolar disorder, but may have potentially lethal side effects if not monitored carefully 1.
• Benzodiazepines like diazepam and alprazolam can manage insomnia, anxiety, and agitation, but may lead to tolerance, addiction, depression, and cognitive impairment with regular use 1.
• Stimulants like methylphenidate and amphetamines can affect attention, energy levels, and impulsivity, but may have potential for abuse and dependence 1.
• Neurological medications like levetiracetam and phenytoin may cause personality changes as side effects, and should be used with caution in patients with a history of seizure disorder 1.
• Steroids like prednisone can induce mood swings, irritability, or even psychosis at higher doses, and should be used with caution in patients with a history of mental health conditions 1. It's essential to consult a healthcare provider if concerning personality changes occur while taking any medication, rather than stopping treatment abruptly.

From the FDA Drug Label

Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric

Medications that can alter personality or behavior include:

• Antidepressants, such as sertraline 2 and fluoxetine 3, which can increase the risk of suicidal thinking and behavior, and may cause unusual changes in behavior, including symptoms such as anxiety, agitation, and impulsivity.
• These medications can cause changes in behavior, especially during the initial few months of treatment, or at times of dose changes.
• It is essential to monitor patients closely for clinical worsening, suicidality, and unusual changes in behavior when taking these medications.

From the Research

Medications that Can Alter Personality or Behavior

• The following medications have been found to alter personality or behavior:
  • Olanzapine/fluoxetine combination therapy, which is used to treat depressive episodes associated with bipolar disorder and treatment-resistant major depressive disorder 4, 5
  • Selective serotonin-reuptake inhibitors (SSRIs), such as fluoxetine, which are used to treat mood and other disorders, including major depression, dysthymia, panic disorder, and obsessive-compulsive disorder 6
  • Antipsychotics, mood stabilizers, and other medications, which have been found to reduce impulsivity and aggression in patients with borderline and antisocial personality disorders 7
  • Steroids, antiepileptic drugs, antimalarial drugs, and antiretroviral drugs, which can induce psychosis with persecutory delusions and auditory hallucinations as the most frequently reported symptoms 8

Personality Disorders and Medication

• Patients with personality disorders are often prescribed psychotropic medications, and evidence-based pharmacotherapy can be useful in treating circumscribed symptom domains, although it may only induce partial improvement 7
• Medications such as antidepressants, antipsychotics, and mood stabilizers can be used to reduce symptoms of personality disorders, including impulsivity, aggression, and psychotic-like symptoms 7

Side Effects of Medications

• SSRIs can cause side effects such as gastrointestinal disturbances, headache, sedation, insomnia, activation, weight gain, impaired memory, excessive perspiration, paresthesia, and sexual dysfunction 6
• Olanzapine/fluoxetine combination therapy can cause side effects such as weight gain, potential elevations in glucose, lipid and prolactin levels, although it does not increase the risk of treatment-emergent mania 4, 5
• Medications such as steroids, antiepileptic drugs, antimalarial drugs, and antiretroviral drugs can induce psychosis with persecutory delusions and auditory hallucinations as the most frequently reported symptoms 8