Over the counter cough medication can cause psychosis

Just because you can get it over the counter, it doesn't mean that the cough medicine you are taking will be completely safe.

A friend was rushed recently to the hospital for what seemed to be a nervous breakdown.

I learned of his breakdown through a mutual friend who sent me a text message, asking if I could come over and help get our friend to the hospital.  

When I arrived at his condo, our friend was clearly in an agitated state.  He claimed to be hearing voices and seeing people that weren't there.  Minutes before my arrival, he had banged on the doors of all of his neighbors shouting incoherently.

Anyway, with the help of a couple of people, we got him to the hospital and there the doctors confirmed our hunch that he was having a nervous breakdown.

My friend is certainly not the brightest guy in any room, but I've known him for years as being a particularly grounded and stable person.

Over the past couple of months, however, my friend had a tough time.  

He got flooded out during Ondoy last year, his father's kidneys shutdown permanently and has to go on dialysis three times a week, he lost his job and for the last few months had been living off his separation pay, and he has been having a hard time paying for his son's tuition fee.

Nevertheless, he seemed to be taking everything rather well.  His mother and siblings were helping him through the rough times.  There was no indication that he was either depressed or anxious before his breakdown.

Four days ago, I sent him a text message, asking if he wanted to have a couple of beers at our regular hangout in San Juan.  He declined the invitation, saying that he had a nasty cough.

Playing doctor, I asked him about the nature of his coughing and the medication he was taking just to make sure he was taking the right one.  He said it was a dry itchy cough and he was taking Vick's with the Dextromethorphan formulation.

At the hospital, the doctors attending to him noted that his breath smelled heavily of the cough medication and asked what he was taking.  After that, he was given a couple of tests and the doctors came back to us saying that he may have had overdosed on cough medication.

He is now under treatment at the psychiatric department of the hospital.

Anyway, I just did some research about Dextromethorphan and psychotic breakdowns.  Here's what I found out.

http://www.healthoma.com/what-can-robitussin-or-dextromethorphan-overdose-do/

Cough syrup overdosing is nothing new. Even children overdose on it because of the high they get from consuming and slowly it turns into addiction.

DXM, or dextromethorphan is a chemical that acts as an effective cough suppressant when taken properly. More than 80 cold medicines available legally over the counter contain dextromethorphan. When a medicine, which has this chemical, is taken in excess it produces psychedelic effect. Because of its legal availability DXM overdose is hard to track and keep a record of.

Robitussin, the other name for it is Dextromethorphan is a cough suppressant available over the counter in syrup as well as pill form.

Dextromethorphan is not addictive physically, but users who are entranced by its dissociative affects develop an addiction that’s more psychological. This also happens because this drug is widely and legally available over the counter.

Robitussin or Dextromethorphan overdose is a possibility that requires one to ingest a massive quantity of the drug. DXM is mixed with other chemicals for an added effect or in long run complicated medical problems.

More than physical DXM overdose, the possibility for panic or psychological breakdown as the result of a strong trip is more. Those who take it can become paranoid. There have been cases when such people get stuck in a “time loop” which means they will not return to their original perspective. Treating this order takes very long and is a gradual process.

Mixing DXM with other depressants can result in overdose and result in respiratory failure. When DXM and alcohol are taken together the affect is, vomiting and sometimes can lead to alcohol poisoning. Mixing DXM with serotonin-affecting hallucinogens like, Ecstasy may lead to Serotonin Syndrome and chronic depression.

Heavy, chronic use of DXM can lead to Olney’s Lesions to form on the brain. This type of brain damage can have an affect directly on memory, emotional behavior and cognitive ability. Some reports from research labs suggest that stopping Robitussin or Dextromethorphan Overdose can allow for minor damage to heal, more serious cases are where the patient’s mental deterioration continues even if he stops overdosing, this sometimes leads to epilepsy and psychosis on a permanent basis.

The risk of DXM overdose is real. It may not be life threatening, but will inevitably cause nausea and vomiting at high doses. In extreme cases when knowingly or unknowingly it is mixed with other things the harm it can cause may be permanent.

The safest advice is that if you read any of these symptoms; nausea, vomiting, itching or irritation on the skin, feeling confused, motor control loss, loss of sensory perception, rapid heartbeat, paranoia, muscle spasms etc, call a doctor or seek medical help at the earliest with relevant information. Things like for how long you have been overdosing on Robitussin or Dextromethorphan or with which other things and chemicals. The more information you give the better the doctor will be able to treat you.

Here's another one:

 http://webcache.googleusercontent.com/search?q=cache:http://www.biopsychiatry.com/dextromethorphan.htm

Dextromethorphan psychosis,
dependence and physical withdrawal 
by
Miller SC.
Addiction Services,
Veterans Administration Medical Center and Associate Professor,
Department of Psychiatry,
Wright State University School of Medicine,
Dayton, OH 45428, USA.
shannon.miller2@med.va.gov
Addict Biol. 2005 Dec;10(4):325-7. 

ABSTRACT

As part of a synthesis of evidence regarding the abuse and addiction liability of dextromethorphan (DM), an over-the-counter cough medicine available in over 140 preparations, an uncommonly published case of dextromethorphan dependence (addiction) is described, with specific, rarely published complications. The individual was interviewed and several medical databases were also reviewed (Medline, 1966-present; PubMed) for all content relating to the Keywords: dextromethorphan, abuse, dependence, cough medicine, addiction, withdrawal, psychosis. The patient evidenced history suggesting substance dependence, substance-induced psychosis and substance withdrawal in relation to DM. A literature review revealed that DM has specific serotonergic and sigma-1 opioidergic properties. Dextrorphan (DOR), the active metabolite of DM, has similar properties; however, DOR is a weaker sigma opioid receptor agonist, and a stronger NMDA receptor antagonist. DM and DOR display specific biological features of addiction, and are capable of inducing specific psychiatric sequelae. A specific, reproducible toxidrome with significant psychiatric effects occurred, when DM was abused at greater than indicated doses, with more profound and potentially life-threatening effects at even higher doses. DM withdrawal appears evident. DM's active metabolite, DOR, has pharmacodynamic properties and intoxication effects similar to dissociatives, and may be more responsible for the dissociative effect that this DM abuser sought. However, it is this same metabolite that may be fraught with the potentially life-threatening psychoses and dissociative-induced accidents, as well as addiction. While DM has been hypothesized as the most commonly abused dissociative, health-care providers seem largely unaware of its toxidrome and addiction liability.

 And here is yet another...

http://www.justice.gov/ndic/pubs11/11563/index.htm

Recommended dosages of DXM generally are safe but can cause nausea, gastrointestinal disturbances, slight drowsiness, and dizziness. Acute dosages (between 250 and 1,500 milligrams) can cause blurred vision, body itching, rash, sweating, fever, hypertension, shallow respiration, diarrhea, toxic psychosis, coma, and an increase in heart rate, blood pressure, and body temperature. Some abusers become violent after ingesting the drug. Little is known about the long-term effects of DXM abuse; however, anecdotal reporting and limited clinical research suggest that extensive and prolonged abuse may cause learning and memory impairment. While studies indicate that DXM is not addictive, some former DXM abusers report experiencing cravings for the drug.