Ask an Expert: Would a Mental Health Specialist Recommend Meth?

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Ask an Expert: Would a Mental Health Specialist Recommend Meth?

By Jeffrey Junig 12/06/16

Methamphetamine causes the exact same symptoms we see during untreated bipolar disorder.

Image: 
A doctor with wild hair holds his stethoscope against a wall.
But my doctor says...

Someone I know has recently been dealing with possible bipolar and psychosis diagnosis. They started smoking meth to deal with it. They told me they saw professionals who told them meth was helping until they could find something that worked for him. He explains to me that they agree that he should do it until then. Would a mental health specialist tell someone to continue drug use? 

Jeffrey T. Junig MD PhD: ​My first reaction to the question is whether the person we are discussi​ng​ truly has a diagnosis of bipolar disorder and psychosis.  To clarify, bipolar disorder is a mood disorder that used to be called "manic depressive disorder." A diagnosis of bipolar disorder requires an episode of mania, which consists of at least seven days of continuous symptoms. Those symptoms include racing thoughts, insomnia, increased goal-directed behavior, euphoria or anger, and poor judgement regarding spending, gambling, or sexual behaviors.

Manic episodes must last seven days to "count," but they typically last longer than seven days. Bipolar patients often have episodes of depression as well (which must last two weeks to count as a depressive episode), but mania is what triggers a diagnosis of bipolar disorder. Bipolar patients typically have 2-3 mood swings per year. Manic or depressive episodes can progress to psychosis, which is the term for having delusions and/or hallucinations.

I’m running through these criteria because laypersons (and even some psychiatrists) assign the "bipolar" label to people having short-term mood swings, i.e. mood changes daily or several times per day. Those symptoms are not bipolar disorder. Likewise, mood changes in response to a substance do not "count" as evidence for bipolar disorder.  

I’m always reluctant to diagnose bipolar disorder — a life-long condition that requires significant medication — to someone using substances. That concern is double in someone using methamphetamine. Methamphetamine causes the exact same symptoms we see during untreated bipolar disorder: episodes of psychomotor acceleration, mood elevation, insomnia, and euphoria or anger alternating with episodes of severe depression when the drug wears off. It is not possible to diagnose bipolar disorder in a person using methamphetamine for that reason. Methamphetamine use also causes symptoms of psychosis, including paranoid delusions and hallucinations. With bipolar disorder the hallucinations would typically be auditory; with methamphetamine the hallucinations​ would typically include "formication," a feeling that insects are crawling on the skin.

So to answer the question I first ask whether the person even HAS bipolar disorder? If he was using meth when diagnosed, probably not. People addicted to substances sometimes look to psychiatry to help with "symptoms" that are actually caused by their drug use. People on benzodiazepines who complain of depression or ADD also comes to mind.

If the person does have bipolar with psychosis, methamphetamine is the surest way to aggravate the mood disorder and worsen the psychosis. From a neurochemical perspective, methamphetamine causes the flood of excitatory neurotransmitters that aggravate mania. Methamphetamine also depletes nerve terminals of those excitatory transmitters, so that when the drug wears off, depression is almost guaranteed.

No, a healthcare professional who understands pharmacology, addiction, and basic neuroscience is not going to recommend methamphetamine use for treatment of bipolar disorder. The drug would only worsen things, but beyond that, recommending illegal drug use would be recognized as unprofessional by any doctor (except for marijuana, where doctors seem to have a range of opinions). And finally, the comment "until we find something that works for him" is likely either made up by your friend, or at best misheard—because there are many medications that effectively treat bipolar mania and psychosis. Those medications work well... unless the patient is using a drug like methamphetamine!

Jeffrey T Junig, MD, PhD, received his PhD in Neuroscience from the Center for Brain Research and MD with Honor from the University of Rochester School of Medicine and Dentistry. Full Bio. 

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