Opiates and Bipolar Disorder

Though opiates can have marked improvements on the symptoms of bipolar disorder, the risks of use are high.

An Overview

The phrase “emotional pain” isn’t merely poetic. Research shows that the pain of depression affects the same brain regions and prompts the same neurochemical response as physical pain. It makes sense, then, that people with mood disorders, including bipolar disorder, are often drawn to opiates. These drugs work in much the same way as endorphins, softening psychological and physical pain. However, unlike natural neurochemicals, opioid drugs have a host of side effects that ultimately make mood disorders worse.

The profound effect that opiates have on the brain means that combining opioids and bipolar disorder can lead to addiction and worse outcomes for the disorder, including more severe and frequent depressive episodes. Another unfortunate effect of mixing bipolar disorder and opiates is that these drugs can trigger manic or hypomanic episodes. Over time, these individuals may also develop opiate tolerance, dependence and addiction, which can be doubly dangerous if bipolar disorder is already present.

Using Opioid Analgesics in the Treatment of Bipolar Disorder

Research shows that opioids may reduce depression in some people with mood disorders. Not only does this parallel the way the brain uses natural opioids to alleviate emotional pain, but it also reflects the reason many people turn to opiates for off-label uses; opiates can have marked improvements on the symptoms of bipolar disorder. For some people, opiates provide a sense of relief they haven’t otherwise felt in years.

Unfortunately, even if the general risks of using opioids to improve mood were low, they would still be risky for people with bipolar disorder to use. Even standard antidepressant drugs like fluoxetine (Prozac) and sertraline (Zoloft) are not recommended for people with bipolar disorder because they can trigger mania. Research shows that opiates can do the same.

Aside from concerns specific to bipolar disorder, many clinicians avoid prescribing opioids for any condition because they believe the possibility of opioid addiction outweighs any potential clinical benefits. Fewer resist prescribing long-acting opiate agonists like buprenorphine (Suboxone) because the risks of prescribing these medications are much lower.

Opiate agonist therapy is being increasingly embraced as an option to treat co-occurring mood and opioid use disorders. Research shows that prescribing opiate agonists and mood stabilizers to people with dually diagnosed disorders yields better results than prescribing either type of drug alone.

Self-Medicating Bipolar Disorder with Opiates

As with any mental health condition, the symptoms of bipolar disorder manifest differently for different people. Some people with bipolar disorder experience increased creativity during the manic phases of the disorder. One of the challenges for people seeking recovery from bipolar disorder is to accept the loss of the positive aspects of manic or hypomanic episodes, which can include having more new ideas, increased drive to complete projects and greater determination to pursue projects.

For some people with bipolar disorder, opiates not only provide relief from depression but can also prolong or induce mania or hypomania. The ability to shift into a euphoric mood can be hard to resist. Unfortunately, the uplifting effects of opiates are always short-lived. Becoming dependent on opiates habituates the brain, causing it to produce fewer natural endorphins. As regular use progresses to addiction, periods of euphoria dwindle until they no longer occur. Over time, opiate use can actually make people more sensitive to pain and prone to depressive symptoms.

Co-Occurring Bipolar and Opiate Addiction Treatment

Fortunately, there are many options for successfully treating co-occurring bipolar disorder and opiate addiction. Research shows that integrated treatment is the most effective intervention for people with dually diagnosed disorders. People who address their substance use and mood disorders at the same time have better outcomes in recovery than people who treat each condition separately.

In integrated programs, clinicians provide different targeted treatments in cooperation with one another. They also communicate and collaborate on the development of treatment plans, which helps prevent progress in the treatment of one condition from causing setbacks in recovery from another.

For example, people who enter a opioid addiction treatment program that emphasizes abstinence may initially experience a worsening of opioid withdrawal symptoms as they stop using the substance that was helping to soften their psychological pain. By working with a therapist and psychiatrist to treat their underlying mood disorder, they can address these symptoms and prevent a recurrence of use.

Clients and providers alike vary on their opinions about using agonist medications like buprenorphine to help people recover from opiate addiction. To some, these medications are a life-saving innovation that helps promote better overall outcomes; to others, the risk of complications outweigh the benefits. Integrated programs with multidisciplinary treatment teams are often better equipped to assess when such interventions are appropriate and provide them as needed.

Fortunately, there is hope. This cycle can be broken with the right treatment that addresses both opiate addiction and bipolar disorder. The Recovery Village operates facilities across the United States that provide integrated treatment of co-occurring mental health disorders and addiction. If you’re not sure whether your opiate use has progressed to addiction, you can read more about the effects of opiates here or take a quiz. You can also learn more about bipolar disorder here if you are curious about how it is diagnosed and treated. If you know you have bipolar disorder and have become addicted to opiates, contact a representative from The Recovery Village today.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Stephanie Hairston, MSW

Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more