Why common antibiotics can trigger mental disorders

Earlier this year, it was reported that Alana Cutland, a 19-year-old Cambridge University student, jumped from a light aircraft over Madagascar in July 2019 after taking doxycycline for 11 days

Becky Goodwin remembers very well the moment earlier this year when she hit her lowest point.

The 30-year-old had just said goodbye to her husband Tom (36) and their children, aged seven and four, when they were walking the dog.

"As soon as they left, I burst into tears for no reason and cried uncontrollably," says Becky, a full-time mother from Hull.

I went upstairs to the bathroom, took some scissors out of the closet, and wondered if I should kill myself. I was so low I really believed Tom and the kids would be better off without me, ”she says.

“The only thing that stopped me was that at that very moment someone was delivering a brochure through the mailbox below and the sound seemed to shock me back to reality.

"I tried to pull myself together before the kids got home so they wouldn't see me in this condition."

Becky's story is not one of years of gradual psychiatric decline. Instead, in just three months, she switched from a happy, healthy mother and wife to someone consumed with hopelessness because of the prescription drug doxycycline.

The antibiotic was prescribed for Becky's acne and is used to treat infections of all kinds, from breast and dental infections to sexually transmitted diseases. It is also used to prevent malaria when traveling.

Earlier this year it was reported that Alana Cutland, a 19-year-old Cambridge University student, jumped to her death from a light aircraft over Madagascar in July 2019 after taking doxycycline for 11 days.

Alana, who was studying biological science, was on a research trip to the island and within a few days fell sick, showed signs of paranoia and withdrew.

Her concerned parents had arranged flights home and the small plane was taking her to the main airport when she threw open the plane door.

Upon investigating her death, coroner Tom Osborne, after consulting with experts studying doxycycline's effects on psychiatric well-being, concluded that the drug was to blame.

Last month, Mr Osborne, chief medical examiner at Milton Keynes, wrote to the Medicines and Health Products Regulatory Authority (MHRA) – the body that reviews drug safety in the UK – asking them to do a review of the information sent with doxycycline and the possibility of that it can increase the risk of hallucinations and thoughts of suicide.

Upon investigating her death, coroner Tom Osborne, after consulting with experts studying doxycycline's effects on psychiatric well-being, concluded that the drug was to blame

Upon investigating her death, coroner Tom Osborne, after consulting with experts studying doxycycline's effects on psychiatric well-being, concluded that the drug was to blame

In his letter to the MHRA, Mr Osborne said, “The evidence shows that she had a psychotic reaction as a result of taking the medicine (doxycycline) and yet there is nothing in the package insert that highlights or mentions this possibility. The information sent with the drug should be reviewed to prevent future deaths. "

The MHRA is now examining the safety of the drug.

In the meantime, could there be a lot more patients suffering without knowing that it may be because of their antibiotics? Disruptive research suggests this could be the case.

Scientists at Augusta University in Georgia, USA, conducted one of the largest studies on the psychiatric side effects of antibiotics like doxycycline.

They searched eight years of data from the U.S. Food and Drink Administration's Adverse Event Reporting System – a catalog of potentially harmful drug reactions reported by doctors and patients.

The researchers looked for cases where the main side effect was psychosis – defined as a "severe mental disorder in which thoughts and emotions lose touch with reality". For many, this means seeing things, hearing voices, and losing control of their thoughts.

The study found that out of more than 6,000 reports of side effects of all types from doxycycline, 91 related to psychosis or hallucinations. And doxycycline wasn't the only antibiotic that has been linked to sudden and severe psychiatric problems: at least 14 others showed an increased risk for these.

Included was a class of drugs called fluoroquinolones that Good Health previously highlighted for tendon damage, joint pain, and memory loss.

Fluoroquinolones such as ciprofloxacin and levofloxacin are commonly used for infections.

The US study also found 1,122 cases of psychosis in patients with fluoroquinolones – more than twice as many as with minocycline, a drug that is also commonly used for acne and is considered one of the safest antibiotics around.

The researchers said, "Our results suggest that psychosis is a potential adverse effect of antibiotic treatment and the risks vary by drug."

The worst was clarithromycin – an antibiotic for chest and ear infections. Of the 18,000 adverse events reported, approximately 700 were psychotic episodes.

However, the researchers admit they aren't sure why the drugs would cause such psychological distress. One theory suggests that certain drugs create complex interactions with chemicals in the brain called neurotransmitters that can have negative effects on the nervous system. Another reason is that the drugs increase levels of the stress hormone cortisol in the brain, which has a negative effect on behavior.

Becky was prescribed doxycycline daily this March to treat the severe acne she had had since she was a teenager. Previous treatments had failed. Within a few weeks, her mental health began to deteriorate.

"I felt very depressed and unhappy and initially blamed the coronavirus lockdown for this," says Becky. “I used to teach the children at home and couldn't see friends or family.

“I became more and more moody. I started disappearing for long walks – three hours each – and didn't sleep properly at night. Even when I did, I had really scary dreams.

“During the day, it was like everything that had ever happened to me was suddenly all I could focus on. I began to lose control of my thoughts and my mind raced. I would sob into my pillow.

"Tom had seen me with postnatal depression but said it was much, much worse."

Finally Tom insisted that she seek help. Becky qualified for ten free psychotherapy sessions at the NHS and her mental health has improved, but not entirely.

At no point did a health professional suggest that doxycycline, which she was taking in June, could be to blame. It wasn't until Becky heard of the coroner's conclusion in Alana Cutland's case that alarm bells rang.

And she is not alone. Good Health also spoke to a 25-year-old woman from north east England who had suicidal thoughts while taking the acne drug. She wants to remain anonymous as she did not tell her family how badly she was affected.

"I was treated with the drug (doxycycline) by my family doctor in 2018 and it worked wonders for my skin," she says. “But in the past 18 months my mental health has deteriorated a lot. I've never been as worried or suffering from mood swings as I do now. I can't stand to be alone I felt suicidal and called the Samaritan hotline. At some point I couldn't stop thinking about going into the forest and killing myself. "

She has now stopped taking the medication.

In no case is there any evidence that doxycycline is to blame. Professor David Healy, a psychiatrist consulted on the Alana Cutland case, first raised concerns about the possible harmful effects of doxycycline as a professor of psychiatry at Bangor University in 2013.

Professor Healy, now based at McMaster University in Ontario, Canada, says, “I know four or five people personally who have received doxycycline and have felt very concerned about it. In all cases, symptoms disappeared as soon as they stopped taking.

"In Alana Cutland's case, it was an extreme effect. Most doctors consider doxycycline benign, but for some people it may just be the wrong drug. The drug should have a carefully worded warning to inform people of the risks and the Stop taking it immediately if you have a mental health problem. It could save lives. "

Call the Samaritans free on 116 123.

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