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 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 substance abuse treatment program that emphasizes abstinence may initially experience a worsening of 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.
Key Points: Opiates and Bipolar Disorder
- The brain responds to emotional pain by releasing endorphins, which are natural opioids produced by the human body
- By soothing sadness, opiate drugs can temporarily relieve the depressive symptoms associated with bipolar disorder
- However, using opiate drugs to boost mood comes with adverse long-term effects and is ultimately counterproductive
- Opiate use can lead to addiction, trigger dangerous episodes of severe mania or worsen depressive symptoms over time
- As the brain becomes more dependent on opiate drugs, it becomes more sensitive to pain and prone to chemical imbalances linked with depression
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.
Fisher, Nicole. “Rejection And Physical Pain Are The Same To Your Brain.” Forbes, December 25, 2015. Accessed March 19, 2019.
Kelly, Thomas. “Integrated Treatment of Substance Use and Psychiatric Disorders.” National Center for Biotechnology Information, August 26, 2013. Accessed March 19, 2019.
National Center for Biotechnology Information. “Toward a unitary perspective on the bipolar spectrum and substance abuse: opiate addiction as a paradigm.” July 2006. Accessed March 19, 2019.
Schaffer, Charles. “Mood-Elevating Effects of Opioid Analgesics in Patients With Bipolar Disorder.” The Journal of Neuropsychiatry, October 1, 2007. Accessed March 19, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.