Question:
Q. I am 25 years old and was diagnosed 3 years ago with bipolar disorder.
I take medications: Neurontin 100 mg and Seroquel 100 mg every day at
bedtime. I still recreationally use marijuana and drink alcohol. I have
spoken to my psychiatrist about this matter but he just says not to use
such drugs. I was hoping that you would be able to explain to me exactly
what are the effects of such usage on the body and brain regarding my
diagnosis and medications?
Answer:
You are raising an important question, but one that isn't easy to
answer scientifically--the kind of experiments that would be necessary to
measure such effects on the brain have not been done, to my knowledge. But
let's start with some basic facts: first of all, there is good evidence
that the use of alcohol, marijuana, and related drugs often worsens the
outcome in bipolar disorder.
For example, substance abuse may lead to mixed bipolar states (in which
features of both mania and depression are present), and contributes to
poor outcome in mania [Goldberg et al, J Clin Psychiatry. 1999
Nov;60(11):733-40). There is also some evidence that marijuana use can
lead to, or worsen, psychotic states, in some vulnerable individuals.
Furthermore, alcohol can cloud the patient's judgment, leading either to
impulsive actions (driving while intoxicated, violent behavior) or failure
to take appropriate medications.
While the precise effects of alcohol and marijuana on the brain are not
known, and have not been carefully studied in patients taking the
medications you mention, I would have several concerns. First, the
combination of alcohol or marijuana and Neurontin or Seroquel could cause
excessive drowsiness, impair coordination, and reduce reaction time--even
after many hours. This could put you at risk if you were driving or
performing some work-related task. Secondly, it's possible that marijuana
or alcohol could interfere with the therapeutic effects of Neurontin,
Seroquel, or both, leading to a mood swing (mania or depression). Third,
alcohol can interfere with sleep, which, in turn, can lead to a switch
into mania.
I think it's important that you talk to your doctor about what is behind
the recreational use you make of these agents. Some patients will use
alcohol or marijuana because they have not gotten complete relief from
their prescribed medications, and are self-medicating their residual mood
symptoms with these drugs. Other patients will use alcohol or street drugs
because they are trying to counteract side effects of their prescribed
medications, or simply because they want to feel normal. Some patients
with bipolar disorder have a hard time accepting that they have a serious
illness, and that alcohol and street drugs can destabilize their mood.
I would also encourage you to speak with your local chapter of the
National Depressive and Manic Depressive Association (NDMDA; call
800-826-3632). I think you will find that many folks with bipolar disorder
struggle with these same questions, and can give you the benefit of their
experience.
Finally, if you find that you can't stop yourself from using alcohol or
marijuana, I would encourage you to joint a 12-step program such as
Alcoholics Anonymous. If that type of program doesn't appeal to you, you
can discuss alternatives with your doctor. Good luck with your program! Cannabis (marijuana) has been shown to make Bipolar Disorder (and
Schizophrenia) worse.
Research found that cannabis abuse was associated with lengthening the
duration of manic episodes, and increasing the rate of noncompliance (not
taking) medication. Incidentily, the same research found that alcohol
abuse was associated with lengthening the duration of depressive episodes.
In fact, one study showed that some people became psychotic by just taking
cannabis. Here is the research supporting these findings. FROM A BIPOLAR former user of cannabis "I want to express my feelings regarding the use of Marijuana and being a
Bipolar person.
Before I even knew I had a mental illness, I smoked pot since I was about
17 years old. Not being an alcoholic, or even liking alcohol, pot seemed
to be the "medicine" for me. Even my ex-husband use to buy it for me, so
that I would be happy and cause him no trouble. I enjoy smoking pot, it is
soothing and it makes me feel happy and creative.
Unfortunately, I do realize that the feeling is just temporary. The only
time I would go back to smoking pot, is when I get off the meds, and
"believe" that I am "normal", that I do not have a mental illness.
I do not mix my meds with drugs or alcohol. When I make the committment to
get back on my medicine, to continue my treatment, and to keep my
appoiments with my Psychiatrist, is when I stay away from any substance,
which will interfere with my state of mind.
I know myself enough, to understand that if I smoke pot, and take my
medicine, I am only contributing to my own defeat. My medicine keeps me
balanced, keeps me calm and collected. I like myself better, and I am much
more productive and creative.
I am back on my meds, this is my first day in about 6 months. I know it is
going to take some time for me to feel the effect of the treatment, but I
am going to behave and be loyal to myself and my decision to get well
again.
I thought I was doing great, I had conquered my illness, I was "normal".
Well, I am not, I have made poor choices, I have made a lot of mistakes,
I have been self-destructive, such as using pot, to be "happy", knowing
it is not good for me. I became almost my worst enemy. I woke up, and now,
I am back on the road to recovery.
Using drugs or alcohol is not the answer. Mixing our medicine with
substances, it is totally irresponsible and self-destructive. I know it, I
am one who has done it all, and I end up being terribly confused, unhappy
and totally unreasonable.
I do not know that I will not fall into the trap again, but for now, I
want to be well, I want to be productive, I want to work again."
