Illicit Drugs

"Many paths of pleasure in the brain employ dopamine messengers [neurotransmitters] in their reinforcement. When we find ourselves partial to some experience, it is the dopamine system that reinforces the feeling and determines that we will seek it again. Many addictive drugs, likewise, alter dopamine in the brain and stimulate this reward system, sometimes producing manic-like behavior. The "buzz" described by those taking amphetamines (speed), or the "rush" of snorting cocaine, is the subjective "high" of the sudden increase of brain dopamine activity that these drugs stimulate."

"Cocaine is one of the most powerful dopamine-enhancing drugs. It achieves its effect at the synapse by blocking the transporter of the neuron's recycling system for dopamine, thus dramatically increasing the amount of dopamine available to stimulate neurotransmission. Through this mechanism, cocaine precipitates a transient state of hypomania—with euphoria, sleeplessness, and increased energy—in virtually all who take it. Furthermore, in individuals of bipolar temperament it will commonly precipitate a sustained manic episode ... In contrast to many other drugs of addiction, where tolerance occurs, the craving for cocaine increases with chronic use, making it one of the most dangerous of the addictions."

"Natural opioid [from opium] peptides are released as messengers in the brain under stressful conditions and physical injury. Appropriately named endorphins (meaning "internal morphine"), these "internal pain pills" help explain opiate addiction. Morphine and heoin, drugs of the opiate family, have a very high affinity for the brain receptors through which the endorphins operate."

Peter C. Whybrow, "A Mood Apart."



"In the mania of manic depression [bipolar disorder], it is the dopamine system, aided and abetted by norepinephrine, that becomes dominant. [Dopamine and norepinephrine are neurotransmitters in the brain.] ... A close cousin of dopamine, the norepinephrine messenger system is the vigilant watchdog of the brain, with special duties under conditions of stress, including the responsibility of tuning the brain's sensitivity to incoming stimuli. Frederick K. Goodwin ... has suggested that the norepinephrine system is responsible for the intrusive curiosity, grandiosity, and euphoria of early mania. ... However as mania escalates, dopamine neurotransmission becomes dominant with intense agitation, disorganized activity, confusion, and psychotic perception. Increased dopamine sensitivity may also explain why those in the throes of mania, like people high on cocaine, have increased energy and unusual strength."

Peter C. Whybrow, "A Mood Apart."


Sound of Sirens

Life is absurd, a life with occasional visits to the Funny Farm, doubly so. Your basket weaver meets many paradoxes. Whereas some people take illicit drugs to experience a "high," we take drugs to avoid experiencing another high.


"Hypomania is a milder form of mania that has similar but less severe symptoms and causes less impairment. During a hypomanic episode, the person may have an elevated mood, feel better than usual, and be more productive. These episodes often feel good and the person may not recognize that anything is wrong. The desire to experience hypomania may even cause some people with bipolar disorder to stop their medication. However, hypomania can rarely be maintained indefinitely, and it is often followed by an escalation to mania or a crash to depression."

"Treatment of Bipolar Disorder 2004: Guide for Patients and Families"
Expert Consensus Guideline Series


The problem is that the initial stages of a manic episode are extremely enjoyable—like the siren's call, almost irresistible. All of the senses are heightened, colors are brighter, ideas abound, creativity is enhanced, there is a boundless energy and a diminution of inhibitions; nothing seems beyond one's grasp. It is very tempting to succumb to the siren's call—to linger in this stage and attempt to make it persist, perhaps by discarding our medication. We are unlikely to be successful; mania or depression will follow. Who among us, when feeling like this for the first or second time, is going to respond by reaching for the medicine cabinet? But this is exactly the response we have to teach ourselves.

Much of the world is engaged in the pursuit of happiness. We basket weavers are pursued by happiness. We avoid it like the plague it is, we run from it, we reach for the medicine bottle, we make a doctor's appointment. Now there's a paradox.

Of course I exaggerate. There is a difference between honest happiness and the beginning of a manic episode. But it is a subtle one. It is a continuum, with ill-defined boundaries. It takes experience, and the inevitable errors of judgment, before one gets a sense of the lay of the land. And even then, there is always the question, "Is this happy, or is it too happy?"

There is only one way to learn—the hard way. How else are we going to learn to distrust the mounting pleasure at the onset of mania if we have not yet visited the inevitable Dark Side to follow? I found the only way to teach myself to suspect the beginning of a manic episode, and reach for the tablets, was to remember the pains of recovering from the last one. Even then it took me half a dozen episodes before I could do so with any resolve. Maybe I'm a slow learner.

I'm sorry, you can't go home until you're better.