How do I talk to my friend, productively, about his drug use and mental state?

August 28, 2006 7:22 PM

Friend in trouble: bipolar, taking Zoloft, smoking huge amount of marijuana which exacerbates his mania. He's acting crazy. I'm far away -- how can I help? Especially, how can I support his girlfriend, and convince him to accept treatment and quit the pot? Other advice about treatment for bipolar disorder?

I recently saw a good friend for the first time in years -- call him Andy. He was acting amped-up and strange: talking nonstop, repetitively, and often inappropriately; running around; bursting into tears; driving recklessly, etc. He looked exhausted and hadn't slept in days, but kept insisting he was better than he has been in years. I adore Andy and the good parts of his personality are still there, but were masked by this nutso behavior.

Now his longtime girlfriend -- call her Sara -- tells me he is "pre-disposed to bipolar" but is not medicated for that; he's taking Zoloft; and smokes marijuana every other day, or more recently, a couple of times a day. When I saw him he couldn't stop talking about marijuana, even with people who clearly weren't interested or would disapprove (eg older people in the church). She says his no-sleep nonstop-chat behavior has been going for a couple of weeks.

Sara has finally snapped, and insisted that Andy get some psychiatric care. He still insists he doesn't need it, and when he comes back from the doctor, he quotes the doctor as saying things like "Andy doesn't need meds. And pot is completely safe, so Andy should be able to smoke as often as he wants." Uh huh.

I've gotten some quite paranoid and angry emails from him about how everyone is blaming the pot and interfering in his life, and how we should all leave him alone, and if we don't like pot it's just because we don't see how good it is. Even saying something like "I'm worried about you because you seem really overtired" gets an angry and defiant response. So telling him directly how his behavior looks seems like a doomed approach.

I'm worried because if he doesn't get treatment and stays manic I think he will not be able to keep his job, and his very nice girlfriend (whose apartment he lives in) is understandably at the end of her rope. I would hate to see them break up -- because they're a good match, and also because if they broke up there wouldn't be a stable, sane person looking after him.

I live far away. How can I help? How should I talk to him about this? (Esp about how his behavior looks to me, or about quitting the pot.) What advice or resources can I give her? What do you know about manic behavior, or the combination of bipolar disorder and marijuana, or how to snap out of a dependence on marijuana?

For the record: I'm not against pot in general, but it seems to be doing Andy in particular a world of bad. And I know that I can't make an addict quit. But I want to do what I can to help, or at least not make things worse.

posted by LobsterMitten to health & fitness (14 comments total)

whoa. this sounds really bad. his girlfriend should probably start looking into involuntary commitment, if possible and feasable. he sounds out of control. don't know what you might be able to say to him other then try to be non confrontational and supportive.
posted by lester at 7:46 PM on August 28, 2006

Maybe his girlfriend could suggest to him that the events of the past few weeks are making her feel crazy, and she needs him to support her, and go with her to a shrink to talk about the past month (like couples therapy). It sounds like this would be the truth, and not a deception (although a truth with an ulterior motive), and maybe if he is together with her at a therapist's office he can take the steps to leave this pattern.
posted by extrabox at 8:01 PM on August 28, 2006

From the very first words of your question: "...bipolar, taking Zoloft..."

Well, there's your problem right there, most likely. Bipolar people who are treated as if they have unipolar depression are at grave risk for getting crazy-manic. While Zoloft is sometimes given to bipolar people in addition to other meds, on its own, as you say Andy is taking it, it may be as big a problem as the pot. He's probably self-medicating with the pot so he can try to slow his brain down a bit from the inappropriate dizzying highs he's feeling from the Zoloft. No wonder he's defensive about his pot use; he probably feels like it's keeping him sane! So maybe in your conversations with him, you can leave off talking about the pot altogether, and mention that the Zoloft seems to be really screwing him up.

Now, neither you nor Sara are equipped to play doctor for him; he needs an independent psych evaluation. I, too, am not a doctor, but I think he needs to be checked into a hospital, weaned off the Zoloft, and put on appropriate bipolar meds. It will take at least two weeks, because the dosages need to be raised very slowly and many blood tests done to make sure he's not having a bad reaction to the new meds. He'll probably be put on good ole Lithium (which is actually a kind of salt) plus either an SSRI and/or low-dose anti-psychotic, or one of the new bipolar drugs like Lamictal, which were originally developed for epilepsy but which work well for bipolar with few side effects.

Does Andy have health insurance? Barring that, does he have parents or a family who Sara can call, explain the situation, and ask for emergency money to pay for hospitalization until he's stabilized?

I wish your friend a speedy recovery, but more realistically, I wish him slow and steady progress and I wish him a good and kind doctor who's up-to-date on the latest treatment options.

On a personal note: about two weeks ago, while going about my hobby for genealogy, I found out that the bipolar disorder that afflicts one of my relatives is apparently not an isolated incident. Though it skips generations, it's been carried on that side of my family probably at least since 1853. Fun. Thank you for caring about your friend.
posted by Asparagirl at 8:25 PM on August 28, 2006

Which is more important, how he's feeling or how much he resembles the person you want him to be?
posted by trevyn at 8:25 PM on August 28, 2006

Unless he is threatening to hurt himself or others you won't be able to commit him.

Who prescribed him the Zoloft? That's who you need to call. And as a bipolar who formerly took zoloft, that's rocket fuel-and worse than the pot, believe it or not.
posted by konolia at 8:26 PM on August 28, 2006

Ah, asparagirl nailed it.
posted by konolia at 8:28 PM on August 28, 2006

I have a lot of experience in this regard.

My friend was bi-polar, had (has) a very bad and well-documented case, who took up drinking once upon a time, which is worse than weed in these cases as far as I know.

For my friend, it was a relatively quick descent and he totally disintegrated one night. People watched him fall apart slowly over a few weeks beforehand. Tried to talk to him. Reason with him, etc.

One night it all came to a head. I ended taking care of him that night as he flipped out and other friends tried to find doctors. He became totally uncontrollable and incoherant until he tried to kill another friend of mine with a broken bottle and was hauled off in a ambulance later that night.

Good times. Good times.

This is an extreme case. Unfortunately, there is little you can do. It can be hard to involuntarily commit someone, especially if they are acting relatively normal. And sometimes it is hard to get them out. If she needs to, his girl friend should not hesitate to just call the police. Especially if he starts making no sense or becomes violent. She should be careful.

If you get him commited, I suggest you and her rigourously check up on him at the hospital, etc. When our friend was at the hospital, I swear they would have left him there forever if someone hadn't fought for him. They didn't know his name or that he was there at one point. That's NYC for you.

At any rate, my best advice is to call his parents if he is on good terms with them. Ask for help. They probably know him better than anyone and you can collectively work for the best solution. Having suffered severe mental illness myself, it is very possible that they do not know how bad the situation is, but would be more than willing to help if they did.
posted by milarepa at 8:30 PM on August 28, 2006

trevyn, there's a kind of situation where that question would be appropriate. This isn't it. If a person feels euphoric in the end stages of drowning, your question would be off-base for similar reasons.

asparagirl and konolia: thank you! I just called Sara to tell her this. That is great to know. (In her observation the Zoloft was usually okay and things got worse the more pot he smoked, hence my original approach in asking the question.)

milarepa: That's horrible; I'm so sorry. We're not quite to the violent stage, but at this point it almost wouldn't surprise me. And yes, his parents are involved, though I don't know them at all so I don't know what their take will be.


I think a semi-voluntary committal is the main option on the table now. The question is, as we go through this process, when he communicates with me, what's a helpful approach?
posted by LobsterMitten at 8:54 PM on August 28, 2006

Look into Lamictal
posted by idledebonair at 9:08 PM on August 28, 2006

Antidepressants can unmask manic symptoms in a bipolar. That's why they have specific medications for folks on bipolar. The pot probably isn't doing anything.

The boy sounds like he is a little lithium-deficient. Somebody take away his credit cards. Trust me on that. Give him something creative to do to burn off that mania. Let him paint your house or build something. Harness that unbridled energy and sleep-independence.
posted by i_am_a_Jedi at 4:53 AM on August 29, 2006

The doctor who prescribed 'Andy' Zoloft (or any SSRI) almost certainly should not be practicing medicine. It is rule fucking number one with bipolar people unless there is some massive extenuating circumstance. I've been in a situation far worse than Andy (being a severe type I, my encounter with an SSRI knocked me into psychosis) because of that kind of incompetence, and it always enrages me to see this sort of shit is still ongoing.

Get Andy off it (and get him a different doctor), and onto a real bipolar drug. In response to idledebonair: Lamictal is an excellent new medication for treating bipolar that I'm currently taking with amazingly positive results (although you have to go up on it really slowly in order to avoid developing a potentially fatal rash), but that said it's always a bad idea to randomly assign people medications based on what somebody else is telling you over the Internet.

As far as the pot goes, it's hard to say. Sometimes you read things like this. But IIRC cannabis operates by dopamine and not serotonin, so an SSRI (selective serotonin reuptake inhibitor) like Zoloft shouldn't be compounding the problem. Personally I've heard reams (several hundred accounts) of anecdotal evidence in both directions as regards using marijuana by itself for self-medicating lighter amounts of bipolar disorder.

In any case, your first order of business is to have Sara talk to whomever gave him Zoloft, and unless he has DAMN good reason for doing so, get Andy off it and away from that doctor. Hopefully this should solve the immediate problem, after which you can look into longterm prevention via some of the usual bipolar drugs and reducing his pot intake. If you want my personal experience, side effects from least nasty to worst has gone in the following order: Lamictal, Depakote, Trileptal. Most people would tack Lithium onto the very end of that list, which is why I never took it.
posted by Ryvar at 8:21 AM on August 29, 2006

Thank you all! If anyone else has more to add, I will still be reading this thread and grateful to hear it.
posted by LobsterMitten at 10:32 AM on August 29, 2006

Other SSRIs to be wary of: Prozac, Effexor, Celexa - I experienced hypomania with all of them. The effect was so subtle though, that no one caught on to the fact that I was bipolar type II for quite some time. I also self-medicated with marijuana. I literally could not get anything done without it - sober, my mind was such a muddled mess that I couldn't even get it together to get dressed before noon. High, not only could I get dressed, but dinner was cooked, house was cleaned, bills were paid. Pot was quite literally the only way I could function. I've been on Lamictal now for several years and it has made a big difference. I have also been (mostly) pot-free for the past 14 months. The weirdest thing was how pot affected me after I got on Lamictal - instead of being super-productive, I felt foggy-brained and unmotivated. It pretty much most all of it's allure to me after that.

Best of luck in helping your friend get his life back together.
posted by echolalia67 at 6:38 PM on August 29, 2006

I've experienced an episode of mania that ended up with psychosis. My pot use at the time was low-level and infrequent, but I remember it feeling really amazingly good every time. Most of what was wrong with me was brought on by work-related stress, cultural isolation (I was working in Berlin, and I speak bugger-all German) and self-perpetuating sleep deprivation.

Mania to the point of full-blown psychosis felt incredibly good in general; I absolutely did not believe there was anything wrong with me - I was having wave after wave of what felt like pure insight into the fundamental nature of reality, and the inside of me was an exciting and wonderful and exhilarating place to be while the outside went inexorably out of whack. I ended up being arrested for getting naked at Changi airport.

If your friend could use a reality check from a stranger with no motivation to nag him, my email's in my profile.

If not, sedate him and get him to psych ward, stat!
posted by flabdablet at 5:33 AM on August 30, 2006