"Just say no" (now with a scarier argument)

September 25, 2008 3:57 PM

My doctor just complained to me that every weekend one of his patients whom he prescribes concerta has a psychotic episode from smoking marijuana. What would cause this to happen? Are some people more vulnerable to this side effect than others?

I have been taking concerta for about half a year and this is the first I've heard about any serious side effects involving marijuana. I have never had any adverse reactions myself and am doing some of my own research to verify the seriousness of this. At the very least I want to try and understand the chemistry behind such a severe effect.

posted by Pseudology to health & fitness (15 comments total)

As someone who has used both concerta and marijuana regularly and concurrently, I can tell you that it depends on the person. Marijuana and concerta alone, in my limited layperson understanding, could both potentiate a psychotic episode on their own in the "right" person. It's not too surprising that it happened with a combination, but it's certainly not typical.
posted by sunshinesky at 4:13 PM on September 25, 2008 [1 favorite]

More to the point, why the hell is your doctor telling you about another patient? That's even more messed up that him (apparently?) not knowing what's going on with said patient.
posted by sunshinesky at 5:10 PM on September 25, 2008

More to the point, why the hell is your doctor telling you about another patient? That's even more messed up that him (apparently?) not knowing what's going on with said patient.

As long as the conversation doesn't involve personally identifiable information, I'm pretty sure that discussing medically-relevant case histories of other patients is ok.
posted by deadmessenger at 5:13 PM on September 25, 2008 [3 favorites]

What would cause this to happen?

Every weekend? The other patient is an idiot or they like it.
posted by fshgrl at 6:03 PM on September 25, 2008

errr, I think he meant a different patient each weekend. So far this whole thing reeks of bullshit. The only thing I can dig up is marijuana induced psychosis which is more likely to happen if used with an amphetamine (I think methylphenidate qualifies). This would only affect me if I was prone to psychotic episodes which isn't very likely. If I'm not prone to psychosis then the chances of me developing this complication are almost nil.
posted by Pseudology at 6:46 PM on September 25, 2008

It's certainly possible, because those who are prone to psychosis can have it "triggered" by just about anything.

But people love to invent negative effects for pot. This sounds a bit like, "people who smoke marijuana and shoot themselves in the head tend to die immediately afterward!"
posted by drjimmy11 at 7:00 PM on September 25, 2008 [1 favorite]

I'm not a doctor, but my own very limited independent research leads me to believe thats a load of shit. A different person every week? I highly doubt that.
posted by CitrusFreak12 at 8:56 PM on September 25, 2008

Psychotic episode is a bit vague coming outside a formal diagnosis. There was this New Zealand birth cohort longitudinal study where researchers surveyed pot use (among other things) and also mental health. Their 10 question checklist for psychosis included some seemingly benign phenomena (such as "you think differently than other people"), and if you ticked 2/3, then you had had a psychotic episode, as per that study.

Delusions and hallucinations are prototypical symptoms of psychosis, and the former is probably routine during cannabis intoxication. Remember, the stronger psychedelics, like LSD, were initially considered models for schizophrenia as they were supposedly psychotomimetic i.e. inducing psychosis. Hardly surprising that, for some people, acute cannabis effects follow the same mold. The key thing to worry about is prolonged psychosis that sustains long after the smoking, not during the acute episode.
posted by daksya at 9:00 PM on September 25, 2008 [1 favorite]

Interesting question; thanks for asking it.

I think the answer is possibly to be found in the pineal gland.

The pineal gland secretes melatonin, certainly, and DMT (dimethyl tryptamine, a hallucinogen), I would say probably.

The pineal gland has norepinephrine receptors which, when activated, cause it to secrete more melatonin. Concerta, a time release form of ritalin, is a norepinephrine agonist, meaning that it enhances the effects of norepinephrine or acts in its stead.

So Concerta would likely normally cause the pineal gland to produce more melatonin. However, cannabinoids block a pineal enzyme critical for the production of melatonin, and thereby attenuate the pineal output of melatonin.

I would guess that this can have the effect, in turn, of causing pineal output of DMT to increase markedly, either because the reaction pathway which produces DMT no longer has to compete with the pathway producing melatonin for critical substrates, or because there is a feedback loop in operation which monitors the output of melatonin and keeps the (already very active because of the Concerta) pineal churning away when insufficient melatonin is detected.

The DMT then causes hallucinations and other effects which look like psychosis to your doctor.

But they are not psychosis if this is true, they are essentially waking dreams. And, as the lives of narcoleptics tend to demonstrate, probably pose dangers which are generally controllable.
posted by jamjam at 9:39 PM on September 25, 2008 [4 favorites]

I have a friend who isn't a Concerta user, but using pot produces a very debilitating paranoid response. I'm talking curled-up in a fetal ball.

I seriously doubt the doctor has done any serious study to see if there is a link between Concerta and pot.
posted by Thorzdad at 5:12 AM on September 26, 2008 [1 favorite]

Everyone is different - maybe that person has a chemical imbalance which is magnified with pot.

Another possibility which can happen is that the pot was laced with another, harder substance. In my reckless youth, I found plenty of weed that had psychoactive additives.
posted by JJ86 at 6:04 AM on September 26, 2008

So, it sounds like he's just trying to keep you from smoking pot. Still seems a bit quackish to me, on top of BS.

JJ86, I've never come across laced pot that wasn't made so deliberately and right before smoking it. You don't just get a bag a weed with coke sprinkled on it. Imagine how expensive that would be for the dealer? It is very possible to receive a laced joint unknowingly from a friend, but not at this kind of frequency. Remember that pot is a psychoactive substance on it's own, and potency/effects vary quite a bit.
posted by sunshinesky at 8:04 AM on September 26, 2008 [1 favorite]

Find a new doctor. This doctor is a liar and a scaremonger.

I'm sure that one of his patients who was taking Concerta had a psychotic episode after smoking pot for some reason (coincidence, pot triggered psychotic episode, combination of pot and Concerta triggered psychotic episode).

But for him to blow this up into a REEFER MADNESS SCENARIO OF DOOM implies that he's a shitty doctor.
posted by Sidhedevil at 8:54 AM on September 26, 2008

I'm glad to find out this is bullshit. Both through my own research and with the help of Mefi. The only shitty part is that now I have to lie about my blazing habits. I hope he doesn't drug test me cause as far as I know he's one of the only doctors who perscribes it here (always complains about the medical college breathing down his neck).
posted by Pseudology at 9:38 AM on September 26, 2008

oh I forgot. The standing theory I have right now is that, for the reasons mentioned by Jamjam methylphenidate, or any other drug that causes your body to produce more norepinephrine, amplifies THC. This would create a stronger high which would in turn be more likely to trigger psychosis if I was predisposed to it.
posted by Pseudology at 9:42 AM on September 26, 2008