CBD Is Not A Cure-All: Here's What You Should Know about CBD and Pharmaceutical Drug Interactions
Danielle Simone Brand | Civilized | with Dr. Bill Code, POR medical advisor May 2019
Recent news about CBD’s interactions with pharmaceutical drugs has been making waves inside and outside the cannabis sphere, causing naysayers to wag their fingers about the potential dangers of this, or other cannabinoids. Juxtaposed against the CBD craze, with many advocates painting the compound as a panacea for everything from PMS to epilepsy, consumers or the canna-curious are left wondering about how to separate helpful cautions from fear-mongering.
Let’s tease out the specifics of this issue.
What’s CBD Good For?
CBD, or cannabidiol, is a highly therapeutic, non-psychoactive compound found in cannabis. It’s been studied as a successful anti-epileptic, while a CBD-based pharmaceutical called Epidiolex is gaining market share for kids with intractable epilepsy. In a related pathway, CBD is known to calm the nervous system for those suffering from muscle spasms associated with Parkinson’s and ALS, and is generally known as a muscle relaxant.
For more everyday symptoms like anxiety, insomnia, and inflammation, CBD is being used regularly by seven percent of Americans to tame stress, get a better night’s sleep, and help the body heal itself. As a topical ointment, it helps with sore muscles, headaches, and run-of-the-mill pain.
CBD is sold in numerous forms, including oils, tinctures, capsules, gummies, and even flower. Derived from hemp or marijuana (the former having less than .3 percent THC), CBD ss also infused into various foods and drinks available everywhere from dispensaries to coffee shops.
With the 2018 Farm Bill having effectively legalized CBD nationwide, along with its ever-increasing availability and market share, it’s no wonder that more and more people are learning about, buying, and consuming CBD. And with this flurry of new ways people are using CBD, come new concerns—and a need for more robust research.
What Are the Potential Side Effects of CBD Alone?
Depending on the dosage, and the variations between each person’s endocannabinoid system (ECS), CBD is sometimes associated with tiredness, diarrhea, and appetite changes. Not everyone tolerates CBD well, but those who do often report dramatic improvements in the quality of their physical and mental health.
What are the Potential Interactions with Pharmaceutical Drugs?
More than half of American adults take at least one prescription drug, and many of them — particularly seniors — are prescribed a cocktail of daily meds. We know that pharmaceuticals can interact with one another, as well as with other substances.
Take grapefruit, for instance: a healthy and seemingly harmless food that nonetheless affects a group of liver enzymes in the human body, and thereby alters the way drugs are metabolized. Consuming grapefruit or grapefruit juice can augment the effects, or prolong the presence of, certain drugs in the body — which means that the drugs either may not work as intended or may present more severe side effects. That’s why a significant number of prescription meds carry a warning against consuming grapefruit.
Broadly speaking, CBD is thought to work in the same way. The liver enzymes concerned are in a group called Cytochrome P450 which are known to process drugs and toxins, including those found in about 60 percent of pharmaceutical meds. Because, in simple terms, CBD “occupies” those enzymes for a period of time, the cannabinoid taken alongside prescription meds can interfere with the drugs’ effects.
“Unfortunately, the very busy enzymes are the ones that deal with CBD (but not THC), so adding CBD can overload the capacity of those enzymes," Dr. Jordan Tishler, a medical marijuana doctor in Massachusetts, wrote in an email to Civilized. "Oddly this can cause increases or decreases in the medication levels. It’s somewhat unpredictable.”
However, according to Rosalia Yoon, PhD., research scientist at Apollo Cannabis Clinics, most of the information about CBD and drug interactions comes from molecular and animal studies. Others cite case studies to show that CBD has interfered with certain drugs’ actions, but clinical research is somewhat sparse, owing to a few factors: Primarily, federal prohibition has historically made it hard for researchers to get projects approved and funded, and secondly, people metabolize cannabinoids, including CBD, differently — so one person’s adverse dose may be another’s optimal dose.
Which Drugs Are Affected?
According to Dr. Tishler, there are a number of medications that CBD could affect, including benzodiazepines, blood thinners, cardiac medications, seizure drugs, and immunosuppressants used in the case of organ transplants. “Many of these medications need very specific levels," he said, in order to work safely and well.
Blood Thinners CBD can augment and prolong the effects of warfarin, prescribed as a blood thinner, as well as those of ibuprofen. The risks of over-bleeding grow with the simultaneous use of CBD and these drugs.
Sedatives Because CBD and THC both carry sedative properties on their own, combining them with sedating benzodiazepines like Xanax, Klonopin, Valium, and Atavan could boost the effects of those drugs in a potentially dangerous way.
Anti-Seizure Meds CBD is known as an antiepileptic in its own right. However, it must be closely monitored if combined with pharmaceutical anti-seizure meds because it can change the concentrations of the other drugs in the body, rendering the drugs less — not more — effective in preventing seizures.
Chemotherapy Drugs CBD use alongside chemotherapy treatments can result in higher concentrations of the drugs for longer periods — which isn’t necessarily a good thing. In cancer treatment, the ratios and dosages are highly regulated for optimum effect and minimum toxicity.
However, CBD and THC are both known to alleviate pain from cancer and to slow the growth of cancer cells, so if well monitored, they can both potentially play a role in treatment.
At Which Dosages Does CBD Affect Other Drugs’ Performance?
The extent to which CBD affects the performance of these kinds of drugs is not entirely clear, nor is it evident what concentrations are risky. According to a report by Project CBD, it’s possible that lower doses of the cannabinoid (less than 100 milligrams) would not have much effect. For perspective, a fairly standard dose of CBD is somewhere in the range of 30 milligrams, though people can and do take much larger amounts for therapeutic purposes. Some cite the fact that, because CBD isn’t psychoactive on its own, people sometimes ingest very large servings without knowing.
When Could CBD Interactions Actually Be a Good Thing?
According to Dr. Bill Code, a physician who works with medical marijuana in Canada and author of Solving the Brain Puzzle, CBD can augment the effectiveness of painkillers like OxyContin by four to ten times, which means that pain patients seeking to taper off meds can reduce their dose without dipping into the pain zone. As long as this augmenting action of CBD is known and monitored, the cannabinoid can be instrumental in reducing pharmaceutical dependence.
Dr. Code told Civilized that if a patient adds a large amount of CBD to an existing painkilling regimen, “that’s a tiny bit risky,” because the CBD slows the breakdown of the narcotic. “So that’s why, when you’re doing this reduction of the narcotic, it’s better to have some THC in there, too,” he said. In fact, for pain relief — including the use of cannabis in conjunction with opioids — Dr. Code will often recommend a 4:1 ration of THC to CBD because the THC will not interfere with the liver’s processes the way cannabidiol does.
How Dangerous Is It?
It depends on whom you ask.
Yoon emphasized how limited the data currently is on CBD-drug interactions, but also cited a 2016 study by Ethan Russo, which found CBD to be, “safe and well tolerated in humans, even in complex drug regimens with opioids, tricyclic antidepressants, and anticonvulsants.” However, she said, because potential harm is present, it’s vital to work with a knowledgeable practitioner when seeking to combine certain classes of meds and CBD. The risk is particularly strong, she said, for the elderly, and for those with compromised liver or kidney function.
Dr. Tishler advises that patients taking the aforementioned drugs avoid products high in CBD. However, he added, trace amounts found in flower or many vape products are not likely to cause harm.
According to the report from Project CBD, the risks are on part with “mis-dosing the other drug(s) that a patient is taking.” The dangers likely increase with higher doses of CBD (particularly isolates, as opposed to full-spectrum compounds) taken in combination with a pharmaceutical “that has a very narrow window between its therapeutic and toxic levels.”
A patient's metabolism may also play a role: The slower one's metabolism, the longer the effects of the cannabinoid (or another drug) will last in the body, which could influence a patient's level of risk when taking multiple substances at once. Do the Types of CBD and Modes of Consumption Matter?
In short, yes. Whole-plant CBD extracts in this case are safer because, with the entourage effect attributed to the mix of THC, CBD, and other plant compounds, a patient may need fewer milligrams of the product to achieve the desired effect. It’s perhaps counterintuitive that products containing some THC may actually be safer than CBD isolates and single-molecule CBD extracts for those taking prescription meds—but, according to experts on the subject, it’s because THC does not have the same effect on the liver enzymes that CBD does.
Inhaling cannabis also poses less risk for drug interactions than orally consuming it because of differences in the liver’s metabolizing process for the two routes. Timing may also matter. Though research on this subject is still in its infancy, there’s some evidence to suggest that consuming CBD several hours after taking a pharmaceutical may reduce its potential interactions. Read original article...
Can Cannabis Replace Wellbutrin
Danielle Simone Brand | Civilized | with Dr. Bill Code, POR medical advisor April 2019
Depression can hit at any time of life and brings with it feelings of sorrow, hopelessness, a lack of self-worth, and irritability that can make it all but impossible to live well. One in six Americans regularly fills prescriptions for psychiatric medications, and the majority of those prescriptions are for antidepressants. Wellbutrin is one of the more popular antidepressants today because it produces results for many who take it and doesn’t usually cause sexual side effects like loss of libido and erectile dysfunction. It’s an NDRI (norepinephrine-dopamine reuptake inhibitor) that is sometimes prescribed alone, and sometimes alongside other meds.
But Wellbutrin is not risk-free. Common side effects include drowsiness, headaches, agitation, aggression, nausea, insomnia, or constipation. Allergic reactions, irregular heartbeat, and seizures are three of the less common, but more serious, potential side effects. And like many other antidepressants, Wellbutrin occasionally causes an uptick in suicidal thoughts.
Wellbutrin also doesn’t work for everyone. Google “Wellbutrin reviews” and you’ll find detailed accounts of how the drug sometimes fails those in dire need of relief. And for some who do experience reprieve from their depressive symptoms, the side effects can make it a difficult choice to remain on the medication.
Still, the drug helps people. James, a Wellbutrin user (who prefers to withhold his real name because the stigma associated with his mental health condition could jeopardize his job), told Civilized that comparing his state of mind before and after he started on Wellbutrin was like “night and day.”
A long-time cannabis user, the 42-year-old started smoking a lot more weed when he went through a rough patch in his career and relationship a couple years ago. He was on psychiatric medications other than Wellbutrin at the time, but found that adding large doses of THC into the mix "dramatically" exacerbated his mental health problems. "It degraded reality because there was just too much going on in my head," he told Civilized. James's psychiatrist advised him to quit weed for a period of time while his body adjusted to the new regimen of meds that included Wellbutrin.
Today, James takes a combination of three psychiatric medications including Wellbutrin, another antidepressant, and a mood stabilizer. “My meds are what keeps me on a steady track,” he said, though after a break of almost two years, he also enjoys cannabis again to help him relax on weekends and process occasional feelings of being overwhelmed. “I think, in the right amounts, marijuana can help,” he said. “It shifts my outlook, makes me feel lighter and more appreciative for what I have. A little weed while doing something cool can give you a breakthrough. But If you’re clinically depressed, you probably shouldn’t be smoking a ton.”
Depression can be caused by a wide variety of factors, from genetics to stressful life events. Even physical ailments, like chronic pain, can come with "a very strong overtone of depression," says Dr. Bill Code, an anesthesiologist, integrative medicine specialist, and author of Solving the Brain Puzzle, who has treated more than 2,000 people with chronic pain. He’s seen a number of patients eventually able to come off not only their pain medication, but their antidepressants, too, using medical cannabis. “Many, many people — but not all — can get off antidepressants by tapering,” Dr. Code told Civilized. But in cases of very deep depression, he says pharmaceuticals may be still be the most effective. Does Cannabis Work as an Antidepressant?
Depression is a serious condition, and this information is not meant to sway anyone toward or against Wellbutrin, nor does this constitute medical advice. But, because there are people who enjoy cannabis and would prefer to live without antidepressants, it’s a question worth asking.
Dr. Code says yes, there is evidence that cannabis can relieve depression, though — as in most things related to the plant — more research is in order. Most of the studies Dr. Code references come from outside North America; Italy and Israel have led the way in clinical research on medical cannabis.
The endocannabinoid system (ECS) appears naturally in the human body and regulates homeostasis, including the functions of mood, sleep, appetite, pain, inflammation, memory, and reproduction. The ECS works through an extensive network of CB1 receptors located in the nervous system and CB2 receptors located in the immune system, major organs, and GI tract. The fact that we have an ECS, according to researchers, helps us understand how and why cannabis acts therapeutically on the human body.
Anandamide — from the Sanskrit word Ananda, or bliss — is an endogenous cannabinoid, meaning that it’s produced naturally by the body and causes a feeling of euphoria. THC, said Dr. Code, has a major effect on the CB1 receptors, and works a lot like anandamide. CBD also works on a number of receptors, including some that affect depression and pain. Additionally, CBD acts secondarily through other mechanisms on the body’s CB2 receptors. Another way to think of it, says Dr. Code, is that, “cannabis has beneficial effects on the body because it’s mimicking the body’s own systems.”
Even beyond cannabinoids, terpenes (aromatic compounds) found in cannabis can have a dramatic impact on inflammation in the body, including in the brain. “‘The brain on fire’ is the short way of talking about depression,” said Dr. Code. Thus, if we can dial down inflammation, we may see an abatement in depression symptoms.
Alpha-pinene, known to reduce inflammation, promote clear thinking, and moderate the effects of too much THC, is potentially one of the most useful terpenes for depression. D-limonene, identified by its citrusy, uplifting, scent, is associated with clean thinking and bright thoughts, said Dr. Code.
“Historically, in depression the imbalance was hypothesized to be from serotonin, dopamine, and norepinephrine deficiency states and medications such as SSRIs, SNRIs and NDRIs are used to reverse this imbalance," Dr. Zinia Thomas, a psychiatrist in St. Louis who regularly recommends medical marijuana, told Civilized. "CBD and THC are also seen to be able to ‘bind’ or sit in and activate the release of serotonin, dopamine and endorphins which then create a bliss-like state, free of anxiety and pain.” Dosages, Strains, and Delivery Methods
According to Dr. Code, everything depends on the individual patient’s diagnosis, experience with cannabis, and the sensitivity of their endocannabinoid system. “The secret is to start small and work your way up over a period of days or weeks,” he said. Dr. Code often works with a 1:1 ratio of THC to CBD because he’s had good results with it for mood issues, as well as pain relief. “Many recreational strains will have 10:1 or 20:1 or even 30:1 THC to CBD," he cautioned, “That’s not going to be therapeutic [for most people with psychiatric diagnoses].”
Dr. Code recommends that patients explore different terpene profiles that may be beneficial to their particular makeup. The good part about experimenting with cannabis medicine, he said, is the low risk of side effects. As long as patients and practitioners stay mindful of the THC to CBD ratios, and avoid an excess of THC (which is individually determined), they’re not likely to run into major complications from cannabis.
Dr. Thomas tends to recommend a cautious ratio of 20 parts CBD to one part THC. Each delivery method has its own pros and cons. Edibles will last longer, but will take 60 to 90 minutes to relieve symptoms. Tinctures and oils can allow for accurate micro-dosing. CBD vape pens, said Dr. Thomas, “can offer instant, yet short lived, effects and are especially useful for panic or severe anxiety symptoms [that can go along with depression].” She also occasionally recommends strains like Sour Diesel, Gorilla Glue #4, GSC, and Tangerine Dream for their potentially antidepressant and anti-anxiety effects. CBD Can Help People Ease off Wellbutrin
The Stoner Mom, a blogger who has written about her experience getting off antidepressants with the use of CBD, wrote that once she quit the meds, her anxiety skyrocketed and depression loomed. In addition, she experienced “brain zaps”—a well-known withdrawal symptom of certain antidepressant drugs which are often described as sudden and uncomfortable sensations like electric jolts in the brain. She felt confused, disoriented, and overall extremely low. She wrote that CBD was instrumental in getting though that period.
After about eight weeks, her withdrawal symptoms stabilized, and the Stoner Mom now takes a large dose of CBD — 100 mg daily — to support her mental health without pharmaceuticals.
In addition to the mood-stabilizing and mood-boosting benefits of CBD, its anticonvulsant properties can be particularly helpful when weaning off Wellbutrin. Dr. Thomas told Civilized, “just as we can see videos of childhood seizures ceasing in seconds to minutes after CBD oil is administered, that is what happens to the nerves that are withdrawing from Wellbutrin—they’re calmed.”
It should be noted, however, that CBD can affect how the body processes certain pharmaceutical drugs through its action on a liver enzyme and thereby augment the actions of the drug. It’s always best to work with a practitioner well versed in cannabis medicine when mixing CBD or other cannabinoids with pharmaceuticals or considering a reduction in meds. Don’t Do It Alone
Dr. Thomas observed that many patients, “start to taper off antidepressants on their own and inform the physician after their great success.” But, she doesn’t necessarily recommend that approach. She and Dr. Code both emphasized the importance of seeking qualified help if you believe you’re ready to reduce antidepressants like Wellbutrin. And as with most things health-related, good nutrition, quality sleep, exercise, and stress reduction techniques like yoga,meditation, and time outdoors should all be part of the picture, too. Read original article...
5 Things That Can Happen To Your Body When Taking Acetaminophen Or Ibuprofen
by Lindsay E. Mack with Dr. Bill Code, POR medical advisor
Most people don't think twice before taking a pain reliever for a headache or other common pain. But in some cases, there are a few creepy things that can happen to your body when you take Advil or Tylenol. Although these medications are generally safe and widely used, there are a few ways they can adversely affect the body.
First, though, it's important to understand what these common drugs actually are, underneath the brand names. "Tylenol is the brand name for acetaminophen. Advil or Motrin is the brand names for ibuprofen," says Dr. Geralyn Frandsen, Assistant Director of the Online Nursing Program at Maryville University. It's important to keep this in mind, because going by the brand name alone may make it easier to accidentally overdose, potentially worsening adverse symptoms.
That said, this isn't meant to scare you away from over-the-counter pain relievers forever. Millions of people take them all the time to manage pain symptoms, and they are deemed safe by the FDA. Really, there are a lot of ways people can use these medications safely and responsibly. "You have to be informed about the best type of pain reliever to take depending on your pain and at the same time, be in the know about its side effects," says Dr. Robert Segal, co-founder of LabFinder. As Dr. Segal further explains, NSAIDs (non-steroidal anti-inflammatory drugs) help ease pain, reduce fever, and decrease inflammation. However, not all drugs have these same effects. "Acetaminophen helps to reduce pain and fever, but it does not affect or help with inflammation," says Dr. Segal. If you don't know which type of pain reliever is best for your particular situation, then definitely contact your healthcare provider for advice.
1. Numbs your Emotions Can these medications affect your emotional state? "Many people don’t know this but studies have shown that acetaminophen, the active ingredient in Tylenol, can actually numb your emotional response to both positive and negative stimulants," says Dr. Niket Sonpal, NYC Internist and Gastroenterologist, and Adjunct Professor at Touro College. For instance, people who had taken the medication were shown to have lower-than-average responses to both positive and negative imagery, according to a study in Psychological Science. It seemed to blunt their emotional responses overall.
2. Turns you Yellow Granted, this is a very rare response, and not one you're likely to experience the next time you take an Advil. "Jaundice is a slight yellowing of the skin and whites of the eyes. High levels of bilirubin could cause this condition. When the liver doesn’t cleanse the bilirubin out fast enough the skin turns a little yellow," says Dr. Sonpal. "High levels of acetaminophen can cause this side effect but it is rare." And if you do take on a yellow tone, stop taking the medication and see your doctor.
3. Increases Risk for Heart Disease For some people, these medications may be damaging to the body. "Advil increases your cardiovascular risk as do all NSAID’s," says Dr. Bill Code. If you're concerned about heart disease, then speak with your doctor to find more heart-friendly pain medications.
4. Results in Stomach Issues Some of these pain relievers appear to be rough on the stomach, to say the least. "It also affects blood flow to certain organs as the kidney and GI tract," says Dr. Tarek Hassanein, director of the Southern California Liver Centers. "Accordingly, overuse of Advil and its family of NASIDS could lead to GI ulcerations particularly the stomach and results in gut bleeding, occasionally severe." If you're concerned about potential stomach issues, then definitely discuss this medication with your doctor. A different type of pain reliever may be your best bet.
5. Injures the Liver Dosage amounts can be critical information. "The recommended maximum dose of acetaminophen in 24 hours is 3,250 mg," says Dr. Frandsen. "Liver injury is associated with doses of 4,000 mg per day." Drinking alcohol alongside these doses can worsen the effects. In general, if this or any other medication is giving you cause for concern, discuss its effects with your doctor at once. Although these medications are generally safe when taken in lower doses, it's always a good idea to mention these drugs to your medical professionals.
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How to Get Off Prescription Drugs
Tips for stopping your meds safely, plus three success stories
By Teresa Carr and Ginger Skinner | Consumer Reports 2017
Whether you plan to stop taking a drug or just lower the dose, Consumer Reports’ medical director, Orly Avitzur, M.D., advises that you talk with your doctor about how to wean yourself.
That’s because abruptly quitting drugs can often trigger serious problems. For example, stopping many antidepressants, anti-anxiety drugs, heartburn meds, and sleeping pills can worsen the symptoms the medication was meant to treat.
And if you’ve been taking opioids such as OxyContin, Percocet, or Vicodin for more than a couple of weeks, going cold turkey can trigger withdrawal symptoms including anxiety, muscle aches, nausea, vomiting, diarrhea, and sleeplessness.
When making a plan to stop, here are some steps to take:
Come up with a clear timeline for reducing your dose.
Schedule follow-up appointments to monitor your progress.
Ask about temporary effects you can expect that aren’t cause for concern—and serious ones that you should be alert to and that warrant a call to your doctor.
Discuss nondrug options you can try. For example, adding 30 minutes of physical activity daily may help control your blood pressure, or trying acupuncture, massage, spinal manipulation, cognitive behavior therapy, or yoga may help manage pain.
And don’t become discouraged if you need to modify your plan, Avitzur says.
“There’s no one-size-fits-all approach to stopping a drug,” she explains. “You may need to slow your taper or even pause it for a while. It may take some trial and error to find what works best for you.”
For examples of why you might want to cut back on your drugs—and how to do it—here are stories from three people who successfully reduced their need for prescription drugs.
Case 1 – Glenn B. 32, Minnesota
What he took: The stimulants Ritalin, Adderall, and Vyvanse to treat ADHD, and then four antidepressants to treat the side effects of the stimulants.
Why he wanted to stop: Soon after Bitzan was diagnosed with ADHD at age 13, his psychiatrists prescribed progressively higher doses of a stimulant to treat the condition, he says. When that triggered sleeplessness, anxiety, a racing heart, and shaking hands, doctors prescribed a series of antidepressants to counter the stimulant. But instead of calming him, they “just dampened my emotions,” Bitzan says. Then one day, while taking a test as an ultrasound technician student, Bitzan’s shaky hands caused him to fail the exam. “I’d never been so devastated in my life,” he says. “I knew I had to get off the medication.”
How he did it: Bitzan entered a prescription-drug-withdrawal program called Point of Return, which took five months. Being medication-free has changed his life, he says. “My sleep is much improved; I have a stable job,” he says. “I’m much happier.” Read original article
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When Happy Meds Lead to Depressing Debt
Reckless Spending: A Side Effect of Antidepressant Use
Can antidepressant use spur financial flights of fancy?
Millions suffering from severe depression, anxiety or bipolar disorder find relief with antidepressant medications. Yet while these ameliorants can dramatically improve the way patients feel and function, they may also cause an unexpected and financially devastating reaction: irrational shopping sprees, atypical gambling jaunts and reckless investments. The Centers for Disease Control and Prevention reports that about 11 percent of people living in the U.S. age 12 and over are currently prescribed antidepressants. If you or a loved one is among them, be alert to unusually compulsive or risky financial behavior -- and know what preventive steps to take if the urge is coming on. Meds affect financial choices The number of antidepressant drugs on the market today is vast, from selective serotonin re-uptake inhibitors (SSRIs) with such trade names as Lexapro, Prozac, Paxil, and Zoloft, to serotonin-norepinephrine reuptake inhibitors (SNRIs) including Effexor and Cymbalta. According to San Diego, Calif.- based psychiatrist David Reiss, any antidepressant and stimulant can trigger hypomania, a psychological state that makes a person feel euphoric. And while a patient may gain such positive effects as being super-confident, creative and outgoing, it can also cause extremely poor judgment concerning money. Reiss sees many patients through the California Workers Compensation system who have experienced depression due to their injuries and are treated with antidepressants. Among this group, he has noticed a spike in gambling. "I am now much more aware to listen for and more closely ask how they are spending their time," says Reiss. "Perhaps 20 percent of the time, people who are limited in their activity by physical impairment and finances will tell me that they go once a week or once a month to local casinos," he says. As a result, they can't meet their expenses and assume losses that their disability income cannot support. Many are surprised by what they've done after the euphoria passes, and are shocked and dismayed when they see their credit card bills. "This often triggers guilt and depression," says Reiss. Grandiose self-perception is also a feature of hypomania, and it too can lead to daredevil actions. "They think they can walk into a casino and win a million dollars," says Soroya Bacchus, a psychiatrist practicing in Los Angeles. "When you're hypomanic, you can do a lot of things mere mortals can't. Or you think you can, anyway." Shopping till they're dropping Besides unrealistic and obsessive betting, the Diagnostic and Stastical Manual of Mental Disorders states that hypomania also may result in "unrestrained buying sprees" and "foolish business investments." That was true for Wendy Honeycutt of Bellview, Texas. She had been prescribed antidepressants to help cope after a series of tragic events, including the death of her young son. While medicated, she began to spend and charge recklessly. "My needs were being met by grabbing a credit card," says Honeycutt. "I ended up with closets full of crap. When you're on those drugs you don't care. They cause you to be selfish. It doesn't allow you to see yourself though a proper perspective. You have a craving for something, but it was more in the purchase. I would order stuff on eBay and Amazon and days later it came in the mail, and I didn't remember buying it. By the time it came I didn't want it anymore." After Honeycutt ceased her medication, she was nearly $25,000 in debt. Sterling, Va., resident Elisa-Ruth Nelson was only on antidepressants for nine months, and during that time was compelled to not just acquire things, but credit cards, especially retail accounts. "They were pretty!" says Nelson, "I amassed so many of them. The Limited, Macy's, Bloomingdales ... I just did what I wanted. I bought St. John suits and Louis Vuitton. Whatever was in the window, I bought it. If the sales girl said I looked good -- I bought it." When she went off the drugs, says Nelson, "Miraculously, it was over." Debt remained, though, and like Honeycutt, Nelson is using a credit counseling agency's repayment plan to deal with it. Stories like Honeycutt's and Nelson's are not at all uncommon, says Alesandra Rain, founder of Point of Return, a nonprofit that helps people find a natural way to address their psychological needs. In fact, she too went on bizarre spending sprees when she was on antidepressants. "I bought an entire wardrobe of sundresses and I only wear jeans!" says Rain. "I can't wear heels, yet I bought an entire collection of three-, four-, five-inch heels. With SSRIs, there is no turn-off switch. I bought a t-shirt folder -- not one, but three! It was crazy." Today, Rain and her organization help others identify the side effects associated with antidepressants. "I hear it all the time -- impulsively buying cars, trading stocks, selling in the stock market," says Rain. "One man who owned a $50 million company was making terrible decisions -- his CEO was trying to talk him out of them -- and it put the company into bankruptcy." Treat the ailment and remain solvent If you believe a friend or relative has antidepressant-induced hypomania and is spending, charging or gambling detrimentally, don't just rip away the credit cards. "It will escalate the mood, and if they're bipolar, you risk a bad reaction," says Bacchus. "Ask if you can take them to the doctor. Even the emergency room. They are equipped to handle these situations." Rain suggests sitting down with the person and calmly asking, "Do you know how much you've changed?" Don't make them wrong. Instead say, "I looked it up and overspending and gambling is a side-effect of the drugs. It must be so uncomfortable for you." Offering hard evidence can be beneficial, says Laurie Campbell of Cronton, Ohio. Campbell had been prescribed Paxil for irritable bowel syndrome, and says her spending was so out of control she drained her 401(k) because of it. "If someone has a loved one going through this and you know they were prescribed something because they were depressed, print out the information that is out there," she says. "Be firm and say, 'You don't see what is going on with you, but here's what has happened in the last six months before taking this drug.' Do the tough love thing. It might have helped me," says Campbell. And if you identify the problem in yourself? Tell your prescribing doctor that your spending habits have changed and ask if it could be medication-related. A change may be in order. You may also be able to control your own financial actions before or during a hypomanic state. For example: - Inform trusted friends and family members about the issue. Ask that they tell you if you're sounding or acting unusual, and if they would be willing to talk to you before you make large purchases. - Unsubscribe from your favorite retailers' email advertisements. - Avoid places where you tend to overspend. For example, if you're a "shoe person," do not even enter a shoe store. - Redirect your energy. Write, garden, clean or contact old friends. Use this time in a positive way until the episode has passed.
The bottom line: Any change in antidepressant use has the potential to send some people into a hypomanic episode. It could be just starting the medication, changing the dosage, discontinuing it or even adding something to the mix such as an extra cup of coffee. If you fear the drugs are causing you to make foolish or dangerous financial choices, let your doctor and caring family members know immediately.<