Should an addict take psych meds?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drugs

Medications.
Photo courtesy of Pixabay.com

 

How safe is it for someone in recovery from drugs or alcohol to take psych meds?

Many recovering people are worried about the effects of taking psychiatric meds on their recovery. The recovery community has long been divided on this issue. Here is some background on the topic and my thoughts as a professional counselor.

Any decision to take, start or stop any medication should be talked over with your doctor. There can be side effects, withdrawal effects and the effects of the medication can change over time as your body adjusts to the effects. Never make sudden changes to meds without talking to your doctor.

Unfortunately, not all doctors are equally informed when it comes to the area of addiction and psychiatric medication. You need to be an informed consumer. Ask questions and talk these issues out with your doctor. Here are some things to consider in making your decision about taking psychiatric meds.

One long-standing belief in some recovery circles is that if you are taking medication then you are not clean, you are still using a drug to alter the way you feel. I think this is a bogus argument.

If you have a medical condition and there is a med that will help you, by all means, take that med. Diabetics need insulin and using that should in no way interfere with or compromise your sobriety.

Are you taking your meds AS PRESCRIBED!

This question is important. It is not should you take them but are you using them correctly.

Two med compliance issues arise for people in recovery. One they tend to play doctor and one day they take the med then the next day when they feel better they skip the meds. Most meds, and psychiatric meds are especially in this group; need to be taken every day. You need a certain level in your bloodstream to be effective. Taking them some days and not others can result in developing tolerance more rapidly, or can prevent building tolerance and can result in them not working correctly when you start taking them again.

Do not do the on and off thing with prescribed meds. Take them as prescribed.

Second problem – If one is good 30 should work better right?

If you find yourself boosting the dose, taking more than was prescribed, this is the dangerous path to addiction and problems. First, most psych meds do not work that way. More is not better. The correct dose is what you need and only you and your doctor working together can figure that one out. If taking more of most psych meds makes you feel better, then this may be more a placebo effect than the meds. Talk to your doctor and your counselors about those issues.

As a counselor what can I tell you about psych meds and their risk for recovering people? Here are my thoughts based on experience for whatever they are worth. If this gets you thinking for or against, please talk this over with your doctor.

There are four main categories (based on use not chemical formula) of psych meds, Antidepressants, Mood stabilizers (anti-mania), antipsychotics and Anti-anxiety meds.

Let’s look at these one at a time and let me tell you what clients who have taken them tell me about the effects they have had on their recovery. I will sneak in a few things from the effects of drugs and alcohol on the body and the brain class I teach. For more on this topic check either “Drug Use and Abuse, Maisto, Galizio and Connors” or “Uppers Downers and All Arounders, Inaba, and Cohen.” Any recent edition has good information.

1. Antidepressants.

These are NOT happy pills. They need to build up slowly over time and it can take 30 or 45 days to have an effect. You must take them every day as prescribed.

No self-respecting addict will take a pill today to feel better a month from now. No one in recovery has told me they had any problem with an antidepressant. If you don’t need them they just don’t do much and pass out of your system.

Occasionally someone will have sudden, week or ten days, response to an antidepressant this makes me think that the person may have bipolar disorder or that this is a medication-induced hypomanic episode. If that happens, talk it over with your doctor. This is rare in my experience though I suspect psychiatrists see this more than a recovery counselor hears about it.

Either way, I don’t worry about clients in substance abuse recovery taking an anti-depressant.

2. Mood stabilizers (anti-mania.)

Mood stabilizers are used to treat Bipolar and other mood instability problems. I am told they do not make you feel any particular way. They seem to just take the edge off.

Some of these have side effects that people find unpleasant. If you need them you need them if not you will not want to take them. Either way, there is not a lot of abuse potential for recovering people.

3. Anti-psychotics.

There are two main kinds of antipsychotics the older ones or typical and the newer atypical. Some of the older ones are very sedating and they tended to be overused in prisons and institutions to keep people “zombie out.” If you like being stoned and nodding out all the time then you may want to discuss with your doctor taking the newer atypical antipsychotics.

The newer atypical ones, no one has said they like how it feels enough to abuse it. Mostly they do not like the risk of weight gain that comes with these. If you take an antipsychotic invest some time in diet and exercise and try to keep the weight off.

All in all, antipsychotics do not seem to be a big issue for those who are in recovery.

Not taking an antipsychotic if you need one, is a major risk for relapse if you are in recovery.  Getting rid of or managing hallucinations or delusions are best done with prescribed medication and counseling, not street drugs.

4. Anti-anxiety meds.

This one seems to cause the most problems for people in recovery.

If you need them, you really need them, and prescribed meds are a whole lot better than alcohol or street drugs for managing anxiety.

The worry with this group of meds is that many, (probably most) are tranquilizers. People can and do abuse these. So if you are one of those “the more pills the better” people, you will need to have that hard talk with your doctor about the risks and benefits of these meds. Let that doctor know you are in substance abuse recovery and that you are concerned about the effects of meds on your recovery.

Also with anti-anxiety meds take them EXACTLY as prescribed. Do not take extras unless the doctor has said it is OK and if they are to be used when needed try to get through as many things as possible without “needing” to take them.

Anxiety disorders are a time when social supports may be absolutely essential to your recovery. Whenever possible reach for the phone and talk with your support system before you reach for a pill.

There you have it, my opinion on psych meds. Most help and have a low risk of abuse. If you need them, you need them and do not be afraid to take them as prescribed. If you find yourself abusing them, talk with everyone on your treatment team, the doctor and the therapist about these issues.

One last aside, those who do the best in recovery use every resource they can. Meds help but they will not do the whole job. You need a head change, a change in your way of thinking, and you need a good support system if you want to go the rest of the way in recovery.

Best wishes for your happy life.

David Joel Miller, LMFT, LPCC

Staying connected with David Joel Miller

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Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

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Do medications or drugs cause mania or Bipolar disorder?

By David Joel Miller MS, Licensed Therapist & Licensed Counselor.

Drugs.

Drugs.
Photo courtesy of Pixabay.

A connection between taking medication, abusing drugs and Bipolar Mania?

The question of connections between “drugs” and various mental illnesses is a huge concern.  We have known for a long time that there is a connection between some chemicals and Mania. The connection to Bipolar Disorders, formerly called Manic Depressive Disorder, is more problematic.

People seem to think that because a medication is prescribed by a doctor or can be purchased over the counter, it is safe. The huge increase in abuse of prescription medication has made us question that. Now there is evidence that not just street drugs but prescription medications may be setting off episodes of mania.

We all pretty much intuitively know what depression looks like. But Bipolar Disorder that is something else. The official definition of Bipolar disorder requires a lot more than just moodiness.

To get the diagnosis of bipolar you need to have had an episode of mania or hypomania. But the DSM excludes from diagnoses symptoms caused by drugs of abuse. For Bipolar Disorder this includes Bipolar symptoms that were caused by prescribed medications.

Do prescribed medications cause Mania or Hypomania? They sure do.

The creation of Manic symptoms by the taking of medications is so common that some researchers have proposed a separate “type” of Bipolar Disorder, Bipolar III, for those times when taking a medication causes manic symptoms (Akiskal 1999, 2003, Williams 2006.)

Here is the Bipolar medication dilemma.

Most people who get diagnosed with Bipolar Disorder have had one or more episodes of depression first. Then they have an episode of mania or hypomania and the diagnosis gets changed. Taking antidepressants is well known to result in propelling some people into a manic episode. This happens to about 10% of all people prescribed some antidepressants. Also if someone has EVER had an episode of mania or hypomania that risk of sudden switching increases to 20% (Breggin 2010.)

That drug or medication-induced mania is specifically excluded from the diagnosis under the DSM-4.

In practice, it has come to be common that a person who has a sudden extreme reaction to an antidepressant is a likely candidate for a Bipolar Diagnosis despite the DSM-4 exclusion.

If it was only antidepressants that created mania things would be simple. Lots of other drugs and medications can result in manic or near manic episodes.

There is a huge difference between someone being “maniacy” when under the influence or while withdrawing and those people who take a medication one time and are propelled into recurring bouts of mania or hypomania.

We see manic-like symptoms in people who use and abuse stimulants. Even excess of caffeine can create those sort of symptoms. But medications that we do not think of as stimulants can cause manic and hypomanic episodes.

Antibiotics have been shown to induce manic episodes. So have anti-anxiety meds and some over the counter medications. Other medications like steroids, both prescribed and abused have been suspected of creating this effect also. That connection remains uncertain.

So the question becomes, “Do prescribe medications create a manic episode?” It looks like the answer to that is yes, sometimes they do. Does that mean this is just an allergic reaction or side effect of that medication? This is iffier as some people have that response and others don’t.

Is it possible that people who have an undiagnosed Bipolar Disorder are likely to be propelled into a manic or hypomanic episode when they are exposed to a medication to which they are sensitive?  I am inclined to think so.

We also see a huge overlap between substance abuse disorders, especially alcohol abuse, and Bipolar Disorders. Does alcohol abuse cause a Bipolar condition? Are people with undiagnosed Bipolar Disorder more likely to abuse alcohol?

Does this medication-induced mania matter? Williams says it does and reports that the rate of suicide attempts by people who switch to mania as a result of taking an antidepressant is even higher than for those with Bipolar II.

But there is more

People with anxiety are sometimes treated with an antidepressant. They also can experience an episode of mania or hypomania.

All this points out to me that with all we know about Bipolar Disorder there is still a lot more we don’t know and a lot more research is needed in this area.

It also suggests that there may be multiple types of Bipolar or even several different disorders currently being lumped together under one name.

For more on Bipolar disorders see:

Hyperthymia and Bipolar Disorder

Do drugs cause mental illness?

Bipolar – Misdiagnosed or missing diagnosis?

Bipolar or Major Depression?

Bipolar doesn’t mean moody    

Or the category list to the right.

Anyone have the experience of taking or doing something and then having an episode of Mania which resulted in the diagnosis of Bipolar Disorder that you would care to share?

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. Do drugs cause mania?