Common Side Effects of Psychiatric Medications

Common Side Effects of Psychiatric Medications

Adverse effects from antipsychotic and antidepressant medications may include:

• Sedation impaired thought.
• Anti-cholinergic side effects.
• Xerostomia (dry mouth).
• Increased appetite leading to weight gain.
• Dystonic reactions (muscle spasms).
• Motor restlessness e.g. pacing, fidgeting and shifting position whilst sitting or standing.
• Drug induced parkinsonism e.g. fine tremors, rigidity and bradykinesia.
• Tardive dyskinesia: rythmic involuntary movements of the orofacial muscles e.g. chewing, teeth grinding, grimacing, tongue protusion, lip smacking and sucking, rapid eye blinking, staring and rotation of the eyes
  (Chalmers 2001).

Anti-parkinsonian drugs are often prescribed to reduce some of these side effects. Examples of these include Benzhexol (Artane) and Benztropine (Cogentin).

Newer antipsychotics such as clozapine (Clozaril), olanzapine (Zyprexa) and resperidone (Risperdal) have fewer of the side effects associated with the more traditional medications which include: haloperidol (Haldol, Serenace), thioridazine (Melleril), fluphenazine (Modecate), pericyazine (Neulactil), pimozide (Orap), trifluoperazine (Stelazine), chlorpromazine and lithium carbonate
(Chalmers 2001).

(Adapted from DHS Antidepressant Information pamphlet for patients, 1999)

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Drug Interactions

• Drug combinations can increase the side effects of medications, particularly xerostomia.
• Antipsychotic and antidepressant medications may interact with one another and other medications.

All psychiatric medications should be checked for possible contraindications with drugs used in dentistry, as indicated in the MIMS guide.

Common Oral Side Effects of Psychiatric Medications

• Xerostomia (dry mouth)
• Muscle spasms of the mouth, face and neck
• Exaggerated facial expressions
• Sialorrhea (hypersalivation)
• Pain response – sensitivity varies
  (Friedlander et al 1993, Lemon & Reveal 1991)

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Xerostomia (Dry Mouth)

• Persistent dry mouth can be caused by systemic conditions and/or drug induced.
• Prevalence of oral dryness increases with age and use of medications.
• A wide variety of medications and illicit drugs referred to as ‘xerogenic’ drugs may induce dry mouth.
• The severity of dryness increases with multiple drug use.
• Anti-psychotic and anti-depressant medications can cause chronic xerostomia.
  (FDI 1999, Remick et al 1983)

Oral Problems associated with Xerostomia include:

• rampant caries (tooth decay)
• plaque formation is increased
• decreased saliva buffering capacity
• gingivitis (inflamed gums)
• glossitis (sore tongue)
• stomatitis (cracked lips and mouth)
• candidiasis (fungal infection)
• ulcers and lesions
  (Stiefel et al 1990, Sreebny 2000)

Other related problems include:

• difficulties eating and swallowing
• burning sensation in tongue and lips
• difficulty speaking
• change in taste sensation (dysgeusia)
• general discomfort and pain
• difficulty retaining dentures
• increased consumption of cariogenic fluids eg. soft drinks to relieve thirst.
  (Friedlander & Birch 1990)

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Counselling & Treatment Plan for Xerostomia

Questions to ask clients if Xerostomia suspected

• Is your mouth usually dry?
• Do you keep water at your bedside at night or do you get up at night to drink?
• Do you have any difficulties eating dry foods?
• Do you get cracked lips and soreness at the corners of the mouth?

Advocate if appropriate for:

• Use of the least anticholinergic medication.
• Reduction in the dosage of medication if possible, as xerogenic effects are dose-related.
• Provide dietary advice regarding the avoidance of highly refined carbohydrates, processed foods and carbonated drinks.
• Ensure client maintains non-sugary fluid intake e.g. water.
• Promote use of sugarless sweets and chewing gum to enhance natural saliva flow.
• Avoid alcohol and tobacco.
• Advise on possible use of artificial saliva preparations (e.g. Biotene’s Oral Balance, Oralube).
• There is increasing interest in systemic pharmacological agents and stimulants of salivary function. Two available in Australia are bromhexine and pilocarpine hydorchloride. Oral pilocarpine 5mg tablets are commercially available as Salagen. Pilocarpine is a potent stimulant of exocrine secretions and should be prescribed only where appropriate due to the possibility of adverse effects of the drug.
  (Rogers 1996, Winer & Bahn 1967).

Most importantly:

• Instruct clients in good oral hygiene maintenance – brushing teeth daily with a fluoride toothpaste (preferably twice a day or after meals).
• Recommend regular dental checkups for the long-term management of clients.
• Recommend use of a fluoride product e.g. toothpaste, rinses, gels.
  (Remick et al 1983)

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