Mental Health Any drugs okay to use after a pychotic break?

[Jimmytheghost]

I had a rather serious pychotic break 7 months ago with delusions and paranoia. I have been on meds since then and have recently started to slowly come off them. I just went from 3mg to 2 and will be off them by March next year. I have had no symptoms for 7 months and feeling great I recovered really quickly. What are the chances of a relapse if I smoke weed every now and then once I'm off the medication? I have smoked twice in the last 7 months and I was fine but that was while I was on the meds so it probably helped. What about opiates I have heard that they do not cause psychosis? My doctor said any drug that increases dopamine has the ability to cause a relapse so that's why I'm a bit skeptical on opiates and weed. Alcohol causes a dopamine increase very slightly and I have drank nearly every weekend since my pychosis and the doctor said its okay to drink when off the medication. So what are your thoughts? Are my drug taking days over? Or is the occasional use of weed/opiates okay for me once I'm off the medication?

 

[ebola?]

Welcome to the board!
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Honestly, this territory is insufficiently explored, due to lacking research into how recreational drugs, psychiatric medications, and psychological symptoms interact (I mean, lacking even compared to our current, meager initial attempts at understanding neurology). Our understanding of the role played by exposure to trauma and subsequent ingrained responses to stressors reinvoking ingrained, unconscious responses thereto is sketchier still.

First, I think that we need additional information to provide valid predictions of potential risks.

What is your mental health history like in general? How about typical patterns of recreational drug use to date, in particular negative psychological reactions thereto, even if sporadic? Did your "psychotic break" correlate with any changes in drug intake?

I had a rather serious pychotic break 7 months ago with delusions and paranoia.

What precipitated these psychotic symptoms? How would you characterize their intensity and duration (and character, if you find such relevant)? How did you respond to the course of medication, particularly in terms of subsequent incidence of symptoms?

I have been on meds since then and have recently started to slowly come off them. I just went from 3mg to 2 and will be off them by March next year.

Ah. Which medication? What is the particular rationale for the chosen duration of treatment?

What are the chances of a relapse if I smoke weed every now and then once I'm off the medication?

Honestly, the only answer to this will be found in experimentation. People predisposed to psychotic symptoms when under duress respond to weed in a variety of ways, depending on a wide variety of factors, many idiosyncratic.

I have smoked twice in the last 7 months and I was fine but that was while I was on the meds so it probably helped.

Such is unclear. Maybe this was a singular incident related to some specific stressor. Maybe you will be predisposed to experiencing delusions and hallucinations cyclically and/or in response to future stressors, triggers, etc. irrespective of cannabis use. Maybe you were in a good place psychologically, resilient against any mental stress cannabis might place on you. Or maybe you are indeed predisposed to cannabis exacerbating such symptoms, depending on dose, but such was precluded by the neuroleptics in your system. This latter hypothesis seems less parsimonious to me than the others, but this is highly idiosyncratic.

My doctor said any drug that increases dopamine has the ability to cause a relapse

Either your doctor over-summarized to the point of inaccuracy or severely overextended the dubiously supported dopamine hypothesis for psychosis. Pretty much every non-psychedelic recreational drug increases dopaminergic function downstream, as does the pursuit and attainment of goals held to be desirable. Yes, high doses of directly dopaminergic agents, particularly when taken over long periods, tend to exacerbate symptoms in those actively delusional and/or hallucinating or predisposed, but not reliably so.

that's why I'm a bit skeptical on opiates and weed. Alcohol causes a dopamine increase very slightly and I have drank nearly every weekend since my pychosis and the doctor said its okay to drink when off the medication. So what are your thoughts?

All 3 of these compounds have quite indirect effects on dopaminergic function, cannabis's being the most subtle and furthest downstream, and opioids and gabanergics like alcohol have not been found to exacerbate psychotic symptoms (though their misuse can exacerbate mental instability in general). And while it has been established that high doses of comparatively directly acting dopaminergic agents tend toexacerbate frequency and severity of psychotic symptoms in those predisposed, a wide host of variable moderating factors render this tendency highly idiosyncratic. Furthermore, the notions that psychotic illnesses are nearly ubiquitously chronically recurrent and severe and caused by overactive dopaminergic transmission are poorly established.
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Sorry there's not a more satisfying answer here. . .if I were you, I'd tread cautiously (ie, infrequent, low doses in low-stress environments, bringing a good 'set' to the table)...if it turns out that this issue is recurrent, I would observe carefully for 'prodromal' symptoms that indicate heightened susceptibility to delusions and hallucinations when under stress, pharmacological or otherwise.

ebola

 

[AlphaMethylPhenyl]

Hmm not sure I agree on all of those points.

Alcohol has largely a sort of "shotgun" approach to neurotransmission. It's an NMDA antagonist, however weakly, which itself isn't good news for those who've been diagnosed with a psychotic disorder.

The basic issue here is that dopamine receptors are generally activated in one of four networks, and the same network that produces positive effects, is also the main one that leads to psychosis.

Even benzos can cause psychotic symptoms, though rarely.

If you think about it, getting high is a sort of psychotic phenomena itself.

 

[CfZrx]

IME even though opiates will relax even a guy who's psychotic, the inevitable withdrawals will completely make that same guy psychotic like never before.

 

[Pretty_Diamonds]

I would be more cautious with the weed, tbh. It can cause psychotic breaks and since you already had one... better safe than sorry.

I think alcohol and opiates are a safe bet, used in moderation of course.. like once every 1-2 weeks.. at the MAX

 

[YaleBoy]

Yeah I'm gonna say absolutely don't do that. What means more to you, keeping your sanity of getting fucked up? Think of how you felt during/after your psychotic break. You probably felt like you would give anything to just be normal again. Well how about taking yourself up on that offer and giving up drugs in exchange for the peace of mind that you're doing everything you can for your mental health?

 

[ebola?]

The basic issue here is that dopamine receptors are generally activated in one of four networks, and the same network that produces positive effects, is also the main one that leads to psychosis.

It is unclear that dopamine is the relevant mechanism here, both in terms of exacerbation of psychosis through problem-use of depressants and acutely or 'chronically' due to cannabis use. Yes, dopaminergic transmission is involved at some point in the presentation of organic psychosis, but this complex causal chain involves numerous other mechanisms and implements other key highly generalized functions.


ebola

 

[Drink_Tea_Love_Cat]

just found this thread but about to go to bed. So quick post to say hi... This is a very very difficult topic and there's certainly not a black and white answer.

I might have some opinions/advice/experience for you. I have had different types of episodes, and have been (recently in particular) taking drugs on and off.

so many variables to consider, especially when you consider drugs are more like tools than anything else - ie, you can use a knife to cut yourself or others, or you can cut up your food or hunt. You can use drugs in some ways to be productive, or you can really fuck yourself up permanently by accident. I will write more later, but will say - the number one thing I have learnt is to get in touch with your mind and body through meditation and academic reading etc, and to learn how to observe yourself objectively as well as learning how to control your feelings and moods as best as you can, or at least moderate them. It becomes more possible to come to terms with difficult paranoias and behaviours when you see them objectively and calmly. It's kind of like riding a wild beast. You can't force it to do anything, but you can guide it and work with it with practice. You can hope to make it your friend and for it to take you on adventures, but don't ride it too hard, or treat it badly or it will turn on you. You also, may never truly tame it. There is always the chance that, like some breeds of dogs, it will attack you.

Recently have specifically done some very very stupid and dangerous experiments. I almost would like to try to reverse engineer a social anxiety disorder that developed over time through drug use and a diazepam withdrawal. I am experimenting a bit with things such as -meditating on meth- ... or using a drug that scares me due to my history with it, and taking notes of the experience and of my mind set. Most of our relationships with drugs are linked to a lot of other things. e.g. my parents attitudes towards drugs led me to think of drugs as demons, and to attach horrible levels of guilt or fear to drug use.

So, I've already rambled a bit.... just don't take anything I say as advice or as valid/safe suggestions, just another crazy guy's experiences. Read my 2 or 3 other first posts for an understanding of where I'm coming from, if you think it's worth reading anything I have to say let me know and I'll try to elaborate more.

 

[TripMcnealy]

Agreed. Weed actually is actually a very common trigger for psychotic episodes and panic attacks; it's what caused my depersonalization/derealization aka the most frightening thing I've experienced in my life and took years to control. Have had full on flashbacks to the time and place where the first episode happened.

Some drugs may actually be beneficial, say colonapin or diazepam, depending on what meds you're on and how well you respond to them. I'd stay away from stimulants. Occasional low doses of opiates are ok but it is a very difficult to control, and there can be some.anxiety at high doses/next day.

Definitely stay sway from weed, speed, and pyschadelics.

 

[eatingt00thpaste]

I've had a psychotic disorder for just about as long as I've used drugs recreationally, and I think I'm pretty adept at knowing my triggers and knowing when enough is enough. So the advice I give will be heavily colored by my own experiences, which are in turn colored by my individual traumas, symptoms, physiology, tolerances, etc. Basically when you have a psychotic disorder you never know where your next trigger is coming from, so you'd best be prepared for any event.

So here's how I see it, based on the limited information you've provided: you're tapering off your antipsychotic but you want to continue to use recreational drugs? Can I just ask why the haste in tapering your AP if you're worried about a relapse? No judgement from me. I understand that these meds are not for the faint of heart. I would just like to understand your motive here.

If you would like to try using marijuana, for example, I would do it while you're still on a steady and effective dose of your antipsychotic. That just makes sense. Or any recreational drug, for that matter (that doesn't interact with any meds, of course). It just doesn't seem logically sound to alter multiple variables when trying to determine if you indeed have a chronic condition that must be managed with meds. In your shoes I would do the recreational drugs while on the meds, see how I react, and then decide my course of action re: tapering.

Here's a little bit of my background with this stuff:

I've been a long-term, multiple-time-a-day marijuana smoker since my late teens. My first psychotic break happened when I was 23 (I'm 32 now and haven't been hospitalized since 2014). I have taken several long breaks from weed with no change in symptoms. However, I find that when I'm hearing voices (which was about 75% of the time until this past summer - now I hear them only rarely), smoking weed really helps me cope. It calms my anxiety and helps me process difficult emotions. I find I'm able to journal better, communicate more effectively with my therapist, and have more useful insights into my voices' seemingly random jabbering than when I'm not stoned. Does that mean it's going to work that way for everyone on the psychotic spectrum? Nope. But it works that way for me, and, anecdotally, I have heard it from other members of support groups.

Alcohol, on the other hand, is a huge trigger for me. If I have more than a few drinks in a night I'll probably start hallucinating. Not so for many of my friends with similar disorders, though.

I have a personal dislike of opiates because of the way they usually make me feel physically, in addition to the losses of loved ones over the years to overdoses. But again, no judgement. They're just not for me.

I do an assortment of other classes of recreational drugs, though, with no ill effects as long as I keep my usage in check (which means checking in with a trusted loved one about my drug use) and an eye out for prodromal symptoms.

One thing that has helped me has been working on a Wellness Recovery Action Plan (WRAP) to pinpoint my prodromes and try to steer toward better habits when I notice problems arise. Here's a PDF with a basic WRAP outline. You can adjust it to suit your needs, of course. http://www.workingtogetherforrecovery.co.uk/Documents/Wellness Recovery Action Plan.pdf

With a WRAP, you can train yourself to notice small changes in mood and behavior that may signal an episode. Combined with journaling, this can prove to be an invaluable tool in figuring out which drugs, if any, are okay for you now, post-psychotic break.

I feel like everyone without a psychotic disorder has an opinion on whether we should be doing any recreational drugs at all, without knowing any of the actual theories or models of the neurology of psychosis. And it's often forgotten that we're still intelligent human beings who can make decisions for ourselves... it's taken for granted that everyone "deserves" access to potentially mind-opening experiences except those who deviate from a prescribed norm.

Psychosis isn't the end of the world. It's not even the end of a life. Yeah, things change and you learn to navigate differently, but I've had quite a few worse things happen to me than psychosis. That's not to say it's not scary sometimes, of course, but it does become manageable over time if you make an effort. And yes, recreational drugs can still be part of a person's life when they have a psychotic disorder. I would just make sure to have as much "safety netting" set up around you - a support system of loved ones, enough medication that there's no danger of running out should you become incapacitated briefly, self-care strategies that work for you, etc.

OP, should you return, I hope you're well and that symptoms have indeed been kept at bay. I would like to hear how you're getting on with meds and recreational drugs. Take care.