Side effects
Side effects are the reason most people who quit a psychiatric medication quit. They are also the least well-explained part of most drug information sheets. These pages take the common ones one at a time: what causes them, which drugs are the worst offenders, how they are managed, and what the actual evidence base looks like.
Each page is written for patients, families, and clinicians who want the honest version. Every claim ties to a specific source. Cross-links to every medication known to cause the effect are on each page.
Akathisia: the drug side effect that feels unbearable
Akathisia is a movement disorder caused by antipsychotics and some antidepressants that produces an inner sensation of restlessness so severe it's frequently misread as anxiety or agitation. Which drugs cause it, how to recognize it, and how it's managed.
Anticholinergic burden in psychiatric prescribing
Anticholinergic burden accumulates across psychiatric drugs and causes cognitive slowing, delirium, falls, and dementia risk in older adults. Which psychiatric drugs contribute the most, how to score cumulative burden, and how to reduce it.
Antidepressant sexual dysfunction (and other psych meds that cause it)
Sexual side effects are the most common reason people quit SSRIs and SNRIs. What causes it, which drugs are the worst offenders, how it's managed, whether it goes away, and the honest story on post-SSRI sexual dysfunction (PSSD).
Antipsychotic and antidepressant weight gain
Weight gain from psychiatric medications is the leading cause of cardiovascular death in patients with schizophrenia and bipolar disorder. Which drugs cause it, how much, mechanism, and how to manage it (metformin, GLP-1 agonists, drug switches).
Hair loss from psychiatric medications
Telogen effluvium (diffuse hair thinning) from psychiatric drugs is under-reported but real. Which drugs cause it most (valproate, lithium, some SSRIs), when it reverses, and management.
Hyponatremia and SIADH from SSRIs
SSRIs cause syndrome of inappropriate antidiuretic hormone (SIADH) and hyponatremia, most commonly in older adults. Presentation, risk factors, which SSRIs are worst, management, and when to switch drugs.
Neuroleptic malignant syndrome (NMS): recognition and management
NMS is a rare but life-threatening reaction to dopamine-blocking drugs (usually antipsychotics) with fever, rigidity, autonomic instability, and altered mental status. Recognition, differential from serotonin syndrome, and management.
Priapism from trazodone (and other psychiatric drugs)
Trazodone causes rare but potentially serious priapism (persistent painful erection). Recognition, when it's an emergency, treatment, and which patients should avoid the drug. Also covers priapism from other psychiatric medications.
QTc prolongation from psychiatric medications
QTc prolongation is a repolarization abnormality that can lead to torsades de pointes and sudden cardiac death. Which psychiatric drugs cause it, thresholds that matter, ECG monitoring recommendations, and how to manage combinations.
Serotonin syndrome: how to recognize it and what to do
Serotonin syndrome is a life-threatening reaction from too much serotonergic activity, usually from drug combinations. Hunter criteria, the classic triad (mental status changes, autonomic instability, neuromuscular findings), triggers, and management.
SSRI bleeding risk (platelet dysfunction)
SSRIs impair platelet function by depleting platelet serotonin, roughly doubling GI bleeding risk and modestly raising intracranial hemorrhage risk. Which patients are highest-risk, perioperative considerations, and management.
SSRI emotional blunting
Emotional blunting is a common but under-discussed SSRI side effect: reduced emotional range, feeling flat or muted, less capacity for both distress and joy. How common, which drugs, and what to do.
SSRI-induced bruxism (teeth grinding)
SSRIs and SNRIs cause jaw clenching and teeth grinding in a substantial minority of patients. Presentation, mechanism, dental complications, and management with buspirone augmentation, dose reduction, or switch.
Tardive dyskinesia (TD): recognition, prevention, and VMAT2 treatment
Tardive dyskinesia is a movement disorder from prolonged dopamine-blocking exposure that can be irreversible. Recognition, which drugs cause it, prevention through drug choice, and treatment with valbenazine or deutetrabenazine (VMAT2 inhibitors).