Common Otolaryngologic Medications: Psychiatric Side Effects

Singing teachers may be the first ones to observe symptoms and signs of medical problems in their students; and they often serve as a student's primary resource and advisor on a variety of issues, including medical issues. Most singers consult an otolaryngologist at some time during their careers, often on the recommendation of their teachers. Many singers also experience periods of stress, agitation, and emotional lability. A singing teacher is often the first person called upon to help a singer understand and work through these problems and compensate for them. It is important for singing teachers to recognize that not all such problems are the result of a "high strung" personality, preperformance anxiety, or even intrinsic psychological problems. Some of the problems are iatrogenic (caused by medical treatment). In some cases, psychological disturbances may be caused by extremely common medications, prescribed often for singers by otolaryngologists and ordinarily tolerated well, without negative side effects. Consequently, it is helpful for singing teachers to be familiar with some of the psychiatric disturbances that can be caused by medications their students may be taking. The resulting psychological disturbances are sometimes indistinguishable from primary psychiatric disorders; and they can cause disturbing dysfunction in normal life activities, as well as interfere substantially with the ability to perform. Many medications may also have adverse effects on the voice by interfering with vocal fold lubrication and function, lung function and support for singing, or other bodily functions essential to singing; but these effects are not discussed in this article and may be reviewed in other literature. Certain medications routinely prescribed by otolaryngologists may have negative psychiatric side effects that can include mood disturbances, such as agitation, anxiety, depression, and mania; perceptual disturbances, such as hallucinations and delusions; cognitive disturbances, such as delirium and confusion; and behavioral disturbances, such as insomnia. The combination of some of the medications prescribed by otolaryngologists with previously prescribed psychotropic drugs (generally prescribed by a psychiatrist) may enhance or interfere with the therapeutic effects of one or the other medications. In addition to negative psychiatric side effects, adverse reactions such as cardiac arrhythmias and hypertension have also been seen. It should be noted that psychiatric symptoms manifesting at any time during the course of treatment are not always solely side effects of medication, but may be a manifestation of a coexisting or preexisting psychiatric disorder aggravated by the combination of medications a patient may be taking. The manifestations of drug-induced psychiatric disorders may be related to direct drug toxicity or interference with the brain's metabolism of the drug(s). The most common psychiatric symptomatology includes delirium (an acute reaction with fluctuating awareness of self and environment), confusion, disorientation, tremor, ataxia, and mania with behaviors such as increased activity, rapid speech, insomnia, and mood elevation. Psychiatric symptonis presenting during the course of treatment may also be related to the medical or psychiatric condition being treated. Anxiety disorders and panic attacks are known to occur in association with thyroid, parathyroid, adrenocortical disorders; Langhen's cell endocrinopath ies; collagen vascular disorders (such as systemic lupus erythematosus, rheumatoid arthritis, temporal arteritis, and periarteritis nodosa); and neurotological disorders such as multiple sclerosis and Ménière's disease. 2 Delusions (the perception that one's environment and circumstances seem unfamiliar) may also