You know how a disorder – like bipolar disorder or PTSD – can make you so miserable…even make you want to self-medicate?  

Doing so is rarely a good idea, though it may seem at the time that it helps.  But that’s for another post. Anyway, you know how self-medicating often accompanies these disorders, and we’ve assumed that the self-medicating is driven by the symptoms of the disorder: the ups, the downs, the agitation and rage, the misery… If the symptoms were to go away, there would be no need for self-medicating. Right? Doesn’t that seem logical? Well, a recent study says no…in fact, self-medicating with opioids… or even using prescribed opioids may lead to PTSD!

Mood Swings in Bipolar Disorder Make You Want to Self-Medicate

Take bipolar disorder, for example. You feel yourself swinging up, up, up until you’re confident, then agitated, shooting words like a machine gun, and feeling more energy than you can manage… you just want to feel normal, you know?  So you start drinking beers as fast as you can to slow down… and…well, it’s not an exact science.

You end up drinking way too many until you’re frankly drunk…but there’s still energy you have to manage, somehow. You may want to jump in a car and head down the freeway… but thankfully, you can’t find your keys.

OR… your mood starts plunging and plunging.  Way too fast… and before too long you want to scream and cry. You feel so hopeless, and disgust and self hatred take over your mind… and it feels like you have fire ants on your brain. 

You need something to help you feel better. So you reach for something that helps you feel like you’re at a party. Then, after awhile, you’re a mixed up ball of horrific and frustrating feelings…and you decide to go for something different that will help you chill.

This is a dangerous and destructive path, but it’s tragically common. This is self-medicating.

And, unfortunately, you may not even realize that use of opioids may lead to PTSD.

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Meet Zach. He served two tours in Afghanistan. He wanted to go back for a third, but his family needed him at home. (At least that’s what he told himself.)

Zach never talked about it, but he’d gotten high with friends off and on in high school. He had joined the Marines for the hard work and discipline, to get himself back on track.

Now this.

Anyway, he had rehab. Who was he kidding? There was no way he could go back. He figured he was nervous about going home after all that happened…

The truth is, Zach got through the first tour fine. Then, on the second tour, he and some fellow marines were helping some children carry water to their homes.

He and Rex were heading in the same direction when a little girl approached them with eyes as big as saucers. Rex naturally reached for the child and at that moment she detonated. The child had been wrapped in home-made explosives under her clothing.

Rex blew apart, as did both children. Zach lost his right arm and his ear. Such an inhuman thing to do. The scene was tattooed in Zach’s memory and he couldn’t escape from it. Children’s body parts, his friend and marine brother’s hands, leg, organs, everywhere.

Rage Begins… and Panic

Rage burned within him that anyone would stoop to the evil of murdering children that way just to get rid of a marine or two.

When he got home, he wasn’t the help to his family he wanted to be. He had trouble holding a job… any sudden startle stirred up the fight in him and sent him into a cold sweat at the same time. Like the wait staff dropping a dish. The clatter sounded like that explosion inside his head. His only thought in moments like that was to tear apart the reprobate who did this to these little kids. And stole his friend.

Zach was seething all the time. Going through surgeries for his arm stump and ear reconstruction. Jumpy, easily provoked, irritable…and at times terrified. His marriage was deteriorating. His children afraid of him.

He talked to a buddy about getting his hands on something to calm him down… he hated being like this.

Something had to give…then his wife learned about a “new” treatment for PTSD…

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Researchers Asked, Can Use of Opioids Lead to PTSD?

So…  it turns out this self-medicating road goes both ways. A new study released in December 2019 demonstrated that heavy opioid use over time before a traumatic event influences us to be traumatized by the event… basically it alerts us to be so fearful of that experience that we can develop PTSD as a result.

We’re talking about Post Traumatic Stress Disorder, or PTSD. And like bipolar disorder, PTSD has an established reputation as a disorder that is quite often co-morbid (meaning you have more than one illness at the same time) with substance use disorder.

In fact, 40% of people diagnosed with PTSD also struggle with substance use disorder (SUD) …meaning they may have addictions, or they may regularly use a substance that masks or combats the way they feel…until it doesn’t. 

Now get this: almost 35% of people who struggle with an opioid use disorder also suffer from PTSD. Sound familiar?  

PTSD <=> SUD

  40% <=> 35%

A bit of a coincidence you think..? Maybe, but more likely this two way street of comorbidity with PTSD and substance use disorder does cause us to stop and think….can opioid use play a role in the development of PTSD?

Laboratory Animals Develop PTSD after Opioid Use

This study I mentioned was just published in Neuropsychopharmacology last month, by a team at UCLA led by Zachary T. Pennington. Their carefully planned study involved laboratory animals and demonstrated how the use of opioids during a time that preceded a trauma increased fear learning.  Or, to be more clear… use of opioids may lead to PTSD.  

Interestingly, in cases where the opioid use occurred after the traumatic experience, there was no lasting fear or PTSD reaction.

The team used an upsetting/frightening stimulus to create a traumatic experience for the animals and noted their reaction to it. Then after creating the condition of “withdrawal” from opioids using morphine and naltrexone (a medicine used to block the effects of opioids) they placed the animals in an environment where only a mild stimulus was used, and saw that the animals reacted strongly in fear — basically they froze in place — as though it was the original severe experience.

Sounds a lot like PTSD, doesn’t it?

Remember Zach? The guy who is a combat veteran with PTSD freezes when someone pats him cheerfully on the back to greet him. It’s all he can do to avoid turning and fighting that person to the ground. Why? Because it feels like he’s being assaulted, and all those horrific memories flood him as if they’re happening right now.

Researchers also gave control animals (the ones who don’t receive opioids so they can be compared to the ones who do) saline injections instead of morphine, and then followed with the traumatic experience. Those animals experienced far less fear and anxiety reactions compared to the ones who had been given morphine prior to the traumatic experience.

Stress Enhanced Fear Learning (SEFL)

They call this approach “stress-enhanced-fear-learning” (SEFL) and it’s a model for us of PTSD and how it ca develop. 

And this demonstration shows us that people who’ve used opioids, whether they were prescribed — or obtained illegally — could be vulnerable to PTSD from traumatic experiences in the future. The resilience necessary to quickly recover from trauma seems to be drastically reduced in those who are exposed to opioids.

The media is full of the dangers of the opioid crisis, but this is one we didn’t see coming. Use of opioids at a particularly vulnerable time can lead to PTSD …or at least that’s what this study seems to tell us.

Still, the researchers emphasize that there’s a difference between fear learning and fear expression. Fear learning is the process we go through where we’re frightened by something unpleasant that we don’t want to experience again…and by it we learn to be cautious and recognize danger.  (This is a good thing.) The amygdala is the primary place in the brain where fear is processed and stored. Some types of fears are then sent to the hippocampus for further storing.  But that’s not the point.

Fear expression is what we do and how we look when we feel fear. Fighting or running are expressions of fear. Freezing can be an expression of fear, too.

Fear expression is our response to the fear we feel.

The way we express fear has nothing to do with the learning process we go through to establish a fearful memory. But the process we go through to learn the fear has a lot to do with whether we quickly recover from it, or whether it turns into a fearful memory that becomes traumatic every time we think of it…and that’s the story of PTSD.

What we didn’t know before this study, is that using opioids may make you really vulnerable to PTSD, so avoiding them if you can is better for your overall wellbeing going forward. 

Because use of opioids may lead to PTSD…

Of course, since this is the first study that has identified the role opioids may play in the development of PTSD, there are lots more studies needed. We’d like to see studies that test the development of PTSD if the opioids were used 6 months ago, a year ago, 2 years ago…?  

In this laboratory setting, with lab animals — not human beings — it had only been a week.

And because this study focused on the reactions of lab animals, we don’t yet know how the results would look in human subjects. In addition, we can’t know without more research, what this means for people who already take opiates for pain.

It’s certainly true that none of us knows when we might experience something traumatic. It can happen to anyone… at any time. An assault, a vehicle collision, a catastrophic illness, a vicious divorce.

The study demonstrated this phenomenon only in cases where the animal had previously had the opioid before experiencing the trauma. When the opioid was administered after the trauma there was no PTSD reaction.

So… of course we’d like to avoid opioids as much as possible for unexpected surgeries, accidents, and injuries just in case of trauma in the future…? At the same time, we don’t know enough yet to be alarmed.

This is how it works with new discoveries. Tiny pieces of information eek out…one bit at a time. And so we look forward to what else can be learned about this PTSD – Opioid connection.

Still, we’re excited about an effective treatment for PTSD if it does develop, and for certain substance use disorders, as well.

IV ketamine treatment has demonstrated what it can do for both of those, both in studies and in real world practice.

At Innovative Psychiatry, we use novel and advanced treatments for disorders that haven’t responded to traditional medicines and treatments. IV ketamine treatment reigns proudly at the top of that list. 

And we’re always thrilled and amazed to see how effective ketamine can be in reversing a cluster of disorders all at once. By treating PTSD and depression with IV ketamine, we often see phobias disappear, too. By treating suicidal thoughts with ketamine, which can be utterly life-saving…we often see depression lift, and PTSD with it.

There’s nothing magical about ketamine. It’s just a man-made molecule that happens to work in a surprising number of ways. But when you’ve been tormented by the traumatic flashbacks of PTSD, disrupting your life and your family, and then those terrifying visuals and experiences subside with ketamine infusions, it sure can seem like it’s magic. And it thrills your family just as much as it does you…when they see your new-found peace and resilience.
If use of opioids leads to PTSD for you, IV ketamine treatment can help you achieve remission like this relaxed guy on the beach.

If you suffer from fear and the fearful memories that disrupt you life, your career, and your relationships — or if you’ve been diagnosed with PTSD but treatments haven’t helped, you owe it to yourself and the people you love to reach out for the freedom you can enjoy after IV ketamine treatment.

Your life can change through the extraordinary effects of IV ketamine treatment. 

Expect around 6 -8 infusions or so… and be patient if you don’t immediately feel better after the first one. Give it a little time and a few more infusions…

On average, it’s common for people to experience ketamine’s benefits after the 3rd infusion. But that’s an average and individual experiences vary.

You do your part, we’ll do our part…and we’ll also eagerly embrace collaboration with the healthcare team who knows you well.

You can have a better life. You really can. Find out how you can enjoy the resilience to snap back after something goes wrong. Reach out for help to get better with IV ketamine treatment. We’re here to walk you through it, and to help it go smoothly. You’ll be in a quiet, comfortable room, with lights turned low for your infusions. And you can bring soft music to play, if you like. A blanket to keep you warm and secure.

This is your chance to emerge better, balanced, and joyful. This is your opportunity to restore hope.

We look forward to talking with you. Call us.

Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

To the restoration of your best self in 2020, 

Lori Calabrese, M.D.

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