CRIMINAL MISCHIEF: Alice in Wonderland Syndrome [Episode 78]
- D. P. Lyle
- Apr 13
- 3 min read
Join Host DP Lyle, MD for a clever question from a crime writer and a discussion of this fascinating neurological syndrome. "What Drugs Might Cause Side Effects in My Character With Alice in Wonderland Syndrome?"
Q: I have a question about Alice in Wonderland Syndrome (AIWS)
My character is in his mid-30s. From what I've gathered from reading this syndrome, it is fairly common with children and with migraine sufferers and it is controllable. However, I want my character to have side-effects. In other words, even though his AIWS and migraines are under control, he is increasingly erratic. Insomnia, impotence, and irritability would all be a bonus. Could he be dosing himself with some type of herb that he doesn't realize would have these side-effects when combined with the medication prescribed for AIWS. Or is there a medication for AIWS that might cause these kinds of side-effects but be subtle enough in the beginning that the person becomes mentally unstable before he realizes something is wrong?
A: Alice in Wonderland Syndrome (AIWS), also known as Todd’s Syndrome,
is a neurologic condition that leads to disorientation as well as size and distance perception disturbances (micropsia, macropsia, pelopsia, teleopsia). Micropsia means things look smaller than they are, and macropsia that they appear larger. Pelopsia means they look closer, and teleopsia farther away. So, suffers of AIWS have perceptual distortions of size and distance. Much like Alice after she descended into the rabbit hole and consumed the food and drink she was offered. Or as Grace Slick and Jefferson Airplane sang: “One pill makes you larger, and one pill makes you small.”
These symptoms are often episodic and the sufferer is usually aware of these distortions, but simply can’t control them. Other symptoms might include poor coordination, sound and touch disturbances, and emotional instability. Rarer could a depersonalization syndrome. Here the person feels a disconnect from his own body and his environment. In some, alcohol consumption can magnify these symptoms.
AIWS is associated with migraines, tumors, head trauma, viral encephalitis, and some psychoactive drugs. Treatment mimics that of standard migraine therapy with various combinations of anticonvulsants, antidepressants, beta blockers, and calcium channel blockers. Both anticonvulsants (Dilantin, the benzodiazepines such as Valium and Xanax, and others) and antidepressants (the SSRIs like Lexpro and Prozac, the MAOIs like Marplan and Nardil, and the tricyclic antidepressants like Elavil and Tofranil, and others) have significant psychological side effects. These include insomnia, irritability, impotence, confusion, disorientation, delusions, hallucinations, and bizarre behaviors of all types–some aggressive and others depressive. Beta blockers can cause fatigue, sleepiness, and impotence. The calcium channel blockers have fewer side effects, at least on a psychiatric level.
As for herbs, almost anything that would cause psychiatric effects could have detrimental outcomes in your character. Cannabis, mushrooms, LSD, ecstasy, and other hallucinogens could easily make his symptoms worse and his behavior unpredictable.
Your sufferer could easily be placed on one of the anticonvulsants, one of the antidepressants, or a combination of two of these drugs and develop almost any of the above side effects, in any degree, and in any combination that you want. Their AWIS might improve, but the medication side effects could be debilitating and problematic. This would be particularly more likely with any of the psychoactive drugs I mentioned. Less so with beta blockers and calcium channel blockers. This should give you a great deal to work with.