Q. I am 25 years old and was diagnosed 3 years ago with bipolar disorder. I take medications: Neurontin 100 mg and Seroquel 100 mg every day at bedtime. I still recreationally use marijuana and drink alcohol. I have spoken to my psychiatrist about this matter but he just says not to use such drugs. I was hoping that you would be able to explain to me exactly what are the effects of such usage on the body and brain regarding my diagnosis and medications?

A. You are raising an important question, but one that isn't easy to answer scientifically--the kind of experiments that would be necessary to measure such effects on the brain have not been done, to my knowledge. But let's start with some basic facts: first of all, there is good evidence that the use of alcohol, marijuana, and related drugs often worsens the outcome in bipolar disorder.

For example, substance abuse may lead to mixed bipolar states (in which features of both mania and depression are present), and contributes to poor outcome in mania [Goldberg et al, J Clin Psychiatry. 1999 Nov;60(11):733-40). There is also some evidence that marijuana use can lead to, or worsen, psychotic states, in some vulnerable individuals. Furthermore, alcohol can cloud the patient's judgment, leading either to impulsive actions (driving while intoxicated, violent behavior) or failure to take appropriate medications.

While the precise effects of alcohol and marijuana on the brain are not known, and have not been carefully studied in patients taking the medications you mention, I would have several concerns. First, the combination of alcohol or marijuana and Neurontin or Seroquel could cause excessive drowsiness, impair coordination, and reduce reaction time--even after many hours. This could put you at risk if you were driving or performing some work-related task. Secondly, it's possible that marijuana or alcohol could interfere with the therapeutic effects of Neurontin, Seroquel, or both, leading to a mood swing (mania or depression). Third, alcohol can interfere with sleep, which, in turn, can lead to a switch into mania.

I think it's important that you talk to your doctor about what is behind the recreational use you make of these agents. Some patients will use alcohol or marijuana because they have not gotten complete relief from their prescribed medications, and are self-medicating their residual mood symptoms with these drugs. Other patients will use alcohol or street drugs because they are trying to counteract side effects of their prescribed medications, or simply because they want to feel normal. Some patients with bipolar disorder have a hard time accepting that they have a serious illness, and that alcohol and street drugs can destabilize their mood.

I would also encourage you to speak with your local chapter of the National Depressive and Manic Depressive Association (NDMDA; call 800-826-3632). I think you will find that many folks with bipolar disorder struggle with these same questions, and can give you the benefit of their experience. Finally, if you find that you can't stop yourself from using alcohol or marijuana, I would encourage you to joint a 12-step program such as Alcoholics Anonymous. If that type of program doesn't appeal to you, you can discuss alternatives with your doctor. Good luck with your program!

Other Resources

• More Questions on Bipolar Disorders

August 2002

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