Psychiatric Adverse Effects From Hydroxychloroquine Use: A Systematic Review.

Objective: To conduct a systematic review of the available evidence on hydroxychloroquine (HCQ)-induced psychiatric side effects and their management.

Data sources: A literature search was conducted in PubMed, MEDLINE, PsycINFO, and Cochrane collaboration databases from 2000 to 2024 using the keywords "hydroxychloroquine" AND "psychiatry" OR "psychosis" OR "depression" OR "anxiety" OR "bipolar disorder" OR "delirium" OR "psychotic disorders" OR "psychiatric side effects" OR "psychiatric disorders."

Study selection: English-language articles with studies reporting HCQ-induced psychiatric/neuropsychiatric side effects were included. Duplicate records and studies reporting only chloroquine side effects were excluded.

Results: The review included 16 case reports, 8 original articles, and 3 review articles. HCQ was found to trigger symptoms of psychosis, depression, suicidal ideation, mania/hypomania, anxiety, sleep disturbances, and cognitive impairments. The onset of these psychiatric side effects varied, appearing shortly after starting the medication to a more extended period.

Conclusion: Based on the literature, HCQ may be associated with short-term psychiatric adverse effects. A psychiatric consultation for a thorough clinical and risk factor evaluation to differentiate a primary psychiatric disorder from a drug induced adverse effect would help guide the management. Dosage adjustments, discontinuing HCQ if feasible, and psychotropic medications like olanzapine or risperidone may be necessary when psychiatric side effects are secondary to HCQ. Further studies are needed to validate these findings.

Prim Care Companion CNS Disord 2025;27(3):24r03857.

Author affiliations are listed at the end of this article.