MENTAL HEALTH

Psychosis

Heavy psychostimulant use or long term use can produce a psychosis that is similar to a non-drug induced psychosis. Lack of sleep (and food) can contribute to these symptoms, however, they usually disappear within a few days of stopping your drug use.

Symptoms of psychosis may include:

• hallucinations (hearing or seeing things that aren't there)
• paranoid delusions (thinking that people are talking about you or plotting to harm you)
• extreme feelings of jealousy
• uncontrolled violent behaviour

• drug-related psychotic symptoms in the past
• a diagnosis of mental illness including schizophrenia, paranoid disorder, brief reactive psychosis or mood disorder with psychotic features
• a family history of serious mental illness

• reduce or stop use
• don't inject
• don't use potent forms such as crystal meth or ice

Reducing your drug use will also help prevent mental health problems that are starting to appear from developing into full-blown psychosis.

If you are experiencing signs of paranoia, having a break and getting a few good nights sleep can stop it progressing to psychosis.

High rates of psychological problems, especially depression and anxiety, are also associated with psychostimulant use. Other symptoms experienced can include panic attacks, hallucinations and violent outbursts. These symptoms can occur during intoxication, the 'crash' following use, and withdrawal.

Depression

Depression is a common mental health problem. Depression affects about one million people in Australia each year and occurs in people of all ages and backgrounds. It is particularly common amongst people who use or have used amphetamines.

Symptoms of Depression
Depression has both psychological and physical aspects. Depression is not just when we feel sad but when someone experiences a range of symptoms for at least a two-week period.

The main psychological symptoms of depression are:

• Low or flat mood (feeling sad)
• Finding it difficult to enjoy what you normally find enjoyable
• Feeling guilty or worthless
• Reduced motivation
• Feeling like there is no hope

The physical symptoms of depression include:

• Change in sleep patterns – sleeping too much or sleeping too little
• Change in sex drive – decreased or absent
• Poor concentration and memory
• Fatigue and low energy
• Feeling restless or agitated
• Reduced ability to tolerate physical pain

Depression saps energy and self-esteem, and interferes with a person’s ability to get help. They might think they are not worth the effort. Often, people who are depressed believe they are not capable enough to do anything to help their situation. Importantly, a range of treatments like psychological therapy and anti-depressant medications are effective in treating depression.

Causes of depression
A range of factors can lead to depression such as a chemical imbalance of our brains or grieving over the loss of another. Stress is a major factor, either over a long period of time, or extreme stress in a short period of time. Using drugs and alcohol can result in a person becoming depressed, or exacerbate existing feelings of depression. This is because of their side effects of these substances and because abusing drugs can interfere with how a person manages tasks of everyday life.

Depression and amphetamines (speed or ice) use
Often, people with depression will turn to drugs like speed to help with their depression – perhaps to change and improve their negative thoughts and feelings, or cope with their physical symptoms. However the use of speed to improve mood is only effective in the short term. In other people, depression is developed after using amphetamines or other drugs. The important point is that either problem can make the other worse and lead to bigger trouble.

How amphetamines cause depression
Amphetamines work by trigging the release of dopamine and adrenaline in the brain and body. The release of these chemicals leads to short-term feelings of satisfaction, wellbeing, relief, increased attention, lots of energy etc.

The problem is that when the effects of amphetamines wear off, it leaves a person with the opposite feelings – radical mood swings, depression, lack of energy, confusion, total exhaustion, uncontrolled violence etc. The greater the stimulation effects when using amphetamines, the greater the negative or rebound effects will be.

Because amphetamine unnaturally releases dopamine and adrenaline it is essentially ‘borrowing’ from the energy reserves of the brain and body rather than creating new energy for you to use. That’s why you get the rebound effects after taking speed.

If you use amphetamines over long period of time, the amphetamines start to change the way certain processes in the brain work. People can start to feel depressed because the amount of dopamine in their brain is lower than before. When taking amphetamines the amount of dopamine and other chemicals released is also lower, so people find that they need to use more amphetamines to achieve the same ‘high’.

Side effects of using amphetamines

Frequent use of amphetamines can cause the following negative side effects:

• Feeling flat or depressed
• Feelings of tension and anxiety – eg. high blood pressure and rapid, irregular heartbeat
• Hallucinations, paranoia and delusional thoughts (psychosis)
• Sleep problems – in particular difficulty getting to sleep and staying asleep
• Reduced appetite, which makes it less likely to eat properly, making you run down and more likely to get infections
• Heavy amphetamine users may also become violent for no apparent reason.
  

Mood and anxiety disorders

In the case of methamphetamine, both intoxication and withdrawal states have many similarities with mood and anxiety disorders.

A disturbance in mood after methamphetamine use, which is considered to be in excess of the symptoms usually associated with use of the drug, and which is of sufficient severity to warrant clinical attention has been recognised as a diagnostic category in the DSM-IV.

Methamphetamine-induced mood disorder is characterised by a prominent and persistent disturbance in mood, which has developed during or within one month of methamphetamine intoxication or withdrawal. The disturbance in mood can be characterised by either depressed, irritable, elevated or expansive mood or a markedly diminished interest or pleasure in most activities.

Methamphetamine-induced anxiety disorder, similarly, is characterised by prominent anxiety, panic attacks, obsessions or compulsive behaviours, which are of sufficient severity to impair usual occupational, social or other important areas of functioning and which developed during or within one month of methamphetamine intoxication or withdrawal.

A more complex issue for treatment of mood and anxiety disorders in methamphetamine users is in relation to individuals who have a pre-existing disorder, which requires longer-term mental health intervention. It is clinically relevant to ascertain whether an individual has a pre-existing mood or anxiety disorder which has influenced their methamphetamine use, (e.g. an individual who uses ice when they experience a major depressive episode) or whether the mood or anxiety disorder occurs as a result of methamphetamine use (e.g. an individual who suffers from a manic episode after a methamphetamine binge).

These two diagnostic pictures differ from the case where both the methamphetamine use and mood or anxiety disorder coexist and are chronic, and interact in a cyclical fashion to sustain both disorders.

The assessment of the potential interactions between methamphetamine and mood or anxiety disorders is essential in treatment planning and relapse prevention. Researchers have found the best predictors of psychological comorbidity in methamphetamine users were frequency of use, injecting rather than swallowing or snorting, and pre-existing psychological symptoms. Other risk factors include a family history of mood or anxiety disorders.