Ephedrine has both alpha- and beta-
adrenergic activity, and both direct and indirect effects on receptors. Its stimulatory effects on the central nervous system are more prolonged, though less potent, than those of adrenalin. It raises blood pressure both by increasing cardiac output and inducing peripheral vasoconstriction. It is still commonly used as a
bronchodilator. However, since prolonged use leads to decreased effectiveness, patients tend to increase the dose themselves. The clinical picture of
ephedrine psychosis resembles that induced by
amphetamines: primarily a paranoid
psychosis with delusions of persecution and auditory and
visual hallucinations in a setting of unclouded consciousness. We present a 57-year-old woman who had been taking a usual dose of
ephedrine for
bronchial asthma (50 mg 3 times a day) for more than 30 years. When her husband died she developed depression, for which she tried to use
ephedrine as an antidepressive, increasing the dose to 500 to 1000 mg a day over the course of half a year. She developed paranoid
psychosis with delusions of persecution and
auditory hallucinations, despite a clear sensorium. Recovery was rapid after
ephedrine was gradually reduced to 200 mg a day and a small dose (200 mg) of the
neuroleptic thioridazine was added.