Neuropsychiatric manifestations of cardiovascular drug therapy

Commonly used cardiovascular medications have neuropsychiatric effects, which can be either harmful or of therapeutic benefit to patients. For example, sedation and mental depression have been described with centrally acting antihypertensive drugs and beta-adrenergic drugs, and are related to their antiadrenergic actions. At the same time, because of these antiadrenergic actions, agents like clonidine have been used for treatment of opiate, alcohol, and nicotine withdrawal, and beta blockers have been used to treat performance anxiety and psychocardiac disorders. Antiarrhythmic drugs have been associated with delirium, and digitalis toxicity can be associated with hallucinations, mania, euphoria, and depression. Antiarrhythmic agents such as verapamil are used as adjunctive treatment for managing patients with bipolar disorders. Because neuropsychiatric disorders can be seen in patients with cardiovascular disease, it is important for the clinician to be aware of the possible relationships between these disorders and concurrent cardiovascular drug therapy. The neuropsychiatric actions of antihypertensive, antiarrhythmic, and hypolipidemic agents are discussed in this article.