Drug Interactions and Bipolar Disorder: Why Drug Use is Dangerous Under Treatment

Successful treatment of bipolar disorder largely depends upon finding the right combination of medication and therapy and adhering to it. Bipolar disorder is comorbid with drug abuse, meaning that people with a history of active bipolar disorder are at higher risk than the general population. This is partly a function of the disorder’s manic phases, in which the patient is likely to experience risk-seeking behavior, although the depressed phases may also play a role, as many people attempt to self-medicate depression with illicit drug use. At best, illicit drug use during treatment for bipolar disorder may make the treatment less effective. At worst, it might cause interaction effects that negatively affect the health of the user.

Bipolar Disorder and Drug Use

Bipolar disorder is a complicated disorder to treat even before introducing illicit drug use into the mix. Most people have different cycles, some with more prominent manic phases and others with longer depressive phases. The neurochemical mechanisms behind bipolar disorder aren’t fully understood and don’t seem to be the same across all cases, meaning that medication and therapy take some trial and error in every case. Additionally, the types of symptoms experienced by a patient with a mood disorder are likely to be affected significantly by illicit drug use of any kind. Even without treatment, or with therapy in lieu of medication, drug use can complicate bipolar disorder by increasing the severity of symptoms, both in manic and depressive phases of the cycle. People who are bipolar and abusing drugs are also at higher risk for risky behavior, including self-harm and suicidal behavior.

Common Drugs Used in Bipolar Treatment

The most common drugs that treat bipolar disorder include antipsychotics, anticonvulsants, antidepressants, and benzodiazepines. Benzodiazepines in particular have a high risk of addiction, which makes them a poor choice for people who have a history of drug abuse and an even worse choice for someone who is actively using illicit drugs during treatment. Antipsychotics, anticonvulsants, and antidepressants are all highly sensitive to drug interactions. Generally, using illicit drugs with any of these drug types will lead to a lack of improvement or a worsening of symptoms. Using illicit drugs with benzodiazepines may lead to addiction or dependence on either the treatment itself or the illicit drug. Most people with bipolar disorder take more than one medication to manage different aspects of their disorder, which increases the risk of drug interactions even more.

Interactions with Lithium

Although lithium is one of the most effective treatments for bipolar disorder, it’s also one of the most dangerous. People taking lithium need to be careful about regular blood testing to monitor lithium levels, which can become toxic if not monitored. Even over-the-counter medications can cause lithium levels to fluctuate, as can illegal drug use of any kind. If you’re taking lithium to treat bipolar disorder, be particularly careful about drinking alcohol, as it will contribute to dehydration and potential lithium toxicity. Drug or alcohol abuse while taking lithium can lead to severe side effects and potentially long-term health complications, including systemic damage and organ failure. Any drugs taken during lithium use, even over-the-counter or prescription, need to be monitored carefully by a healthcare professional.

Stopping Treatment in Favor of Drug Use

A common problem that complicates bipolar treatment is the lack of real treatment altogether. Many people living with bipolar disorder have a difficult time realizing that they need treatment, or may feel ashamed of their mood disorder because of a social stigma surrounding mental illness. Others may avoid treatment because it is too expensive and they lack health insurance, or because they truly feel they can treat it effectively on their own. Self-treating with illicit drugs is not an effective strategy, and can exacerbate the symptoms of bipolar disorder by adding the complications of drug addiction. Drug use can also alter neurotransmitter activity in the brain, either in terms of production or reuptake, which can make symptoms significantly worse and make it harder to effectively treat the disorder later. In any case, the complicated nature of bipolar disorder and the neurochemistry involved indicate that drug use is likely to turn into abuse in the presence of the disorder, and that there are fewer benefits than potential consequences.


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“Bipolar Disorder Medications and Interactions.” Drugs.com, n.d. Web. 15 Jan. 2013.
“Bipolar Disorder Supplements and Medication Interactions.” WebMD. WebMD. Web. 15 Jan. 2013.
“How Is Bipolar Disorder Treated?” NIMH RSS. N.p., n.d. Web. 15 Jan. 2013.
Staff, Mayo Clinic. “Bipolar Disorder: Treatments and Drugs.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 18 Jan. 2012. Web. 15 Jan. 2013.

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