Psychotropic effects are those that alter the perception, behavior or mood. Such effects include hallucinations, psychosis and central nervous system depression or stimulation. Dextromethorphan (DM or DXM), a cough suppressant commonly found in cough medicine, has been shown to cause psychotropic effects when taken in high doses. Misuse or abuse of DXM causes symptoms that are dose-dependent, progressing to more serious levels at each new plateau.
Mild Stimulation
The first plateau of DXM overuse occurs at doses of 100 to 200 milligrams. At this stage, symptoms of mild stimulation begin to develop. DXM stimulates the central nervous system, causing hyperactivity or drowsiness, rapid heartbeat, skin rashes or blotchy skin, numbness or tingling in the fingers or toes, sweating, hot flashes, nausea and dizziness.
Euphoria and Hallucinations
When intake of DXM reaches 200 to 400 milligrams (the second plateau), symptoms such as altered sensory perceptions and shifts in mood begin to emerge. People may experience a general feeling of being inebriated or drunk, along with the sensation of euphoria or feeling "high." Speech starts to slur and short-term memory is affected. Mental performance and judgment are also impaired. Mild auditory, tactile or visual hallucinations, such as distortions of color, sound or touch, may emerge.
Motor Loss and Altered Visual Perceptions
The third plateau is reached when DXM doses are in the range of 300 to 600 milligrams. Doses this high result in the loss of motor coordination. Nystagmus (rapid eye movement) may also develop, along with other visual problems like blurred vision. Severe visual hallucinations can emerge, along with progressing sensory disturbances such as feelings of floating and altered time perception. Disorientation and confusion are common.
Some people may start to experience paranoia, irrational thoughts or delusions accompanied by severe anxiety or panic attacks.
Dissociation and Sedation
When levels of DXM consumption reach 500 to 1,500 milligrams, severe and potentially serious symptoms emerge. Individuals may begin to experience feelings of dissociation from their bodies, a dreamlike state in which people may lose a sense of connectedness to their thoughts, identity and physical self. This is sometimes referred to as an "out-of-body" experience.
Doses this high can lead to dextromethorphan poisoning, particularly in children. This has the potential to cause seizures, coma or respiratory depression (hypoventilation). Respiratory depression occurs when the rate or depth of breathing is not sufficient to perform the normal exchange of carbon dioxide and oxygen from the blood, thereby causing a buildup of carbon dioxide and increased acidity in the bloodstream.
