Antibiotics: neuropsychiatric effects and psychotropic interactions.

Antibiotics are the second most commonly prescribed class of medication in the United States. An awareness and understanding of their potential effects on the central nervous system and their interactions with psychotropic agents is important in the evaluation of neuropsychiatric signs and symptoms in patients. Since the introduction of antibiotic agents in the 1930s, numerous (primarily anecdotal) reports have appeared describing psychiatric side effects ranging from anxiety and panic to major depression, psychosis, and delirium in patients with and without a premorbid psychiatric history. Risk factors have included prior psychopathology, coexisting medical conditions, slow acetylator status, advanced age, concomitant medications, and increased permeability of the blood-brain barrier, as well as high antibiotic dosage and intrathecal or intravenous administration. Psychiatric toxicity may result from various mechanisms of action, including antagonism of gamma-aminobutyric acid or pyridoxine, adverse interactions with alcohol, or inhibition of protein synthesis. Adverse pharmacokinetic and pharmacodynamic interactions between antibiotics and concomitant medications including lithium, benzodiazepines, carbamazepine, valproate, neuroleptics, antidepressants, methadone, and disulfiram have also been reported. Because such effects are often not recognized by clinicians, accurate epidemiologic data on their incidence are not available.