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You start the game with unique disorders. As you treat these disorders with drugs, the drugs leave you vulnerable to getting additional disorders from other players. You win by treating yourself completely before anyone else.




There are four types of cards in the deck (we’ll talk about bonus cards later):







Separate all the Disorders from the deck. Shuffle them and deal out 4 per player face up in front of them. This is henceforth referred to as their Psyche. If you’re playing with 6+ people, deal out only 3 Disorder cards for their Psyche.

A Psyche can never hold 2 of the same Disorders, so if this happens, simply place the card on the bottom of the deck and deal out the next one.


Next, shuffle the remaining Disorders into the deck and deal out 4 cards per player face down. This is henceforth referred to as their Hand.


The rest of the deck becomes the draw pile. Discarded cards should be placed face up next to it (discard pile). Turns move clockwise. The player who had a nightmare most recently goes first.




Using the contents of your Hand, be the first to treat all the Disorders in your Psyche. You may keep playing until there’s one sick loser left.




Start your turn by drawing 2 cards. You can play up to 2 cards on your turn, but you’re not compelled to play anything if you don’t want to.


At the end of your turn, you cannot have more than 6 cards in your hand—place extra cards into the discard pile.




        1) Treat a Disorder in your Psyche: if you have a Drug that treats one of the Disorders in your Psyche, you can place it on top of that Disorder


        2) Give another player a Disorder: every Drug has a list of side effects written under “MAY CAUSE”.


When someone has a Drug on top of a Disorder card in their Psyche, they are vulnerable to receiving any of the Disorders from that list of side effects from other players. So, if you have a Disorder in your hand that another player is vulnerable to receiving, you can add that Disorder to their Psyche.


It’s important to point out that no Psyche can have 2 of the same Disorder. So even if someone is vulnerable to receiving a Disorder, once they’ve got it, they can’t get it again. This includes Disorders that are being treated with Drugs.


        3) Use a Therapy card: this is like a wild card. You use it by taking any Disorder from your Psyche and placing it, with the Therapy card, into the discard pile.


The only card that Therapy does not work on is Tremors. It’s also worth mentioning that there’s no Drug for Anorexia—you must treat this with Therapy. The only downside of treating a Disorder with Therapy is that the Disorder is no longer in your Psyche and that means that you could, in theory, get it again.


        4) Give someone an Episode: use this card to trigger any of the punishments listed on another player’s untreated Disorders.

Take a look at your opponents’ Disorders and read the punishments written on them. Once you’ve found the punishment you’d like to trigger, drop your Episode card onto that Disorder. The other player MUST comply. Discard the Episode card after use. You may laugh at their misery.


Once there no more cards in the draw pile, shuffle the discard pile and use that as the draw pile.




You may make deals with other players, but be sure to adhere to the following rules:


  1. You cannot put more than 2 cards into play on your turn.

  2. You cannot put any cards into play when it’s not your turn.

  3. You may give and receive cards when it’s not your turn as long as they’re not put into play.




Want to have 2 of the same Disorder in your Psyche? Want to use a Drug from your Hand to treat someone else’s Disorder? These are not officially allowed, but neither is collecting everyone’s taxes when you land on Free Parking! Your house, your rules.




On occasion, we will create bonus cards to make Side Effects even more zesty. Use them like a spice (as much or as little as you’d like). In the Kickstarter special edition, we included the following two:


Misdiagnosis: this card allows you to swap one of the Disorders from your Psyche with one from your Hand. One of the best parts of this card is that you get to keep the card you swapped out of your Psyche! Discard Misdiagnosis after use.


High Tolerance: this card forces another player to remove a Drug from their Psyche. You choose which one. Discard the Drug and the High Tolerance card after use.  




  • Pay attention to the punishments in your Psyche: this is absolutely essential to strategic gameplay. Read the punishments listed on the Disorders in your Psyche. Know what you’re vulnerable to. Play accordingly.

  • Beware of Madness: the punishment for Madness makes you discard all the Drugs on your Psyche. This can be devastating, especially if you’re close to winning. If you have an open Madness Disorder on your Psyche, wait until you can treat it, but don’t wait too long. Sometimes you just have to take a risk and start putting down Drugs so that you’re not too far behind other players.

  • Hoarding Drugs is not always best: there are many punishments that will make you give up cards. Refer back to strategy rule number 1. You may think that waiting to treat yourself is a good idea, but it really all depends on the Disorders in your Psyche.

  • Deprive others of what they desire: maybe that Gambling Addiction Drug doesn’t mean anything to you, but it’s the only card your opponent needs to win. Hang on to it.

  • Read up on the punishments of Disorders you’re vulnerable to: you may not have Impotence now, but it’s a side effect of a Drug you’re currently taking. Might be a good idea to see what kind of punishment it comes with.

  • Bargain: you’re allowed to make deals with others. Make someone an offer they can’t refuse.


©2017 Pillbox Games


Pillbox Games is an independent game company comprised of Jade Shames, Ben Bronstein, Jen Igartua, and Kat Thek.


More info at


Special thanks goes to Luke Koz, Sarah Tricker, Patrick Mahoney, Oliver Conant, Rob Ward, Andrew Maclarty, Lee Cahill, Marc Charisse, Kim Breslin, Jason Downey, Michael Wright, Calli Welsch, Thomas Palmer, Aimee Proctor, Brittany Blecher, Sarah Gully, Charlotte Buonomo, Sriracha, Godiva, and Darjeeling.


A brief word on the subject of mental illness: we fully support efforts to provide better advocacy and availability of mental health resources. The drugs and disorders featured in this game are all too real—this was done to add a touch of gravity to an otherwise lighthearted, parlor game. In doing so, we hope to facilitate open and honest communication about these issues.


For more information on mental health issues, including where to get help, here are a few useful resources:

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