Cocaine and mental health

• cocaine use can result in a whole range of psychological and psychiatric problems. It can cause marked changes in moods and behaviour. It can also exacerbate an underlying psychiatric problem
• patients can become frankly psychotic on cocaine
• anxiety and depression
  • marked increase in anxiety and irritability, especially when withdrawing after a session of use
  • reduction in dopamine and serotonin can cause anxiety and chemical depression
  • can lead to self harming, suicidal ideation and suicide
  • crack could be taken to self-medicate underlying depression, but may also precipitate mania and intensify the depression
  • care must be taken with antidepressants and only used if underlying depression confirmed
• fear, paranoid ideation and cocaine-induced psychosis
  • excited/agitated delirium can result after a bout of heavy use. The time it lasts varies between patients and consists of agitated and bizarre behaviour, hyperthermia and extreme paranoia
  • tactile hallucinations are characteristic of stimulant use – the ‘cocaine bug’ – this may cause obsessive skin-picking
• cocaine used to modify mood in schizophrenia, bipolar disorders, personality disorders and unrecognised ADHD
  • schizophrenia
    • can worsen the condition or act to modify mood, especially against the unwanted effects of the major tranquillisers or against the negative symptoms of schizophrenia
  • bipolar disorders
    • increased amounts taken during manic phase, but also used to self-medicate against depression
  • personality disorders
    • used to manage abnormal mood states.
  • Attention Deficit Hyperactivity Disorder (ADHD)
    • cocaine may be used by people with undiagnosed or diagnosed ADHD to increase attention span and concentration
  • eating disorders
    • associated with anorexia nervosa, as it acts and can be used as an appetite suppressant
  • other addictions
    • patient can develop an opiate, alcohol or benzodiazepine problem when these drugs are used as relaxants after a bout of cocaine use

Reference:

• (1) RCGP (2004). Guidance for working with cocaine and crack users in primary care