Tuberculosis and mental illness share common risk factors including homelessness, HIV positive serology, alcohol/ substance abuse and migrant status leading to frequent co-morbidity. We sought to generate a comprehensive literature review that examines the complex relationship between tuberculosis and mental illness.

A literature search was conducted in MedLine, Ovid and Psychinfo, with further examination of the references of these articles. 316 articles were identified. It was not possible to conduct a formal meta-analysis due to the absence of randomised controlled data.

Rates of mental illness of up to 70% have been identified in tuberculosis patients. Medications used in the treatment of common mental illnesses may have significant interactions with anti-tuberculosis agents, especially isoniazid and increasingly linezolid. Many medications used in the treatment of tuberculosis can have significant adverse psychiatric effects; others such as rifampicin may reduce the effective doses of anti-psychotics by their enzyme-inducing actions. Mental illness and substance abuse may also affect treatment concordance, with consequences for public health.

Due to the common co-morbidity of mental illness and tuberculosis, it is important that both psychiatrists and physicians are aware of the potential for interactions between the drugs used to treat tuberculosis and psychiatric conditions.