Cocaine, Bipolar Disorder, Antisocial
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Cocaine, or bipolar disorder? Antisocial?  Will it go away? (Tim)

Q: My 36 year old brother-in-law is in a high manic state after years of cocaine abuse. He has been off of the cocaine and under psychiatric care for 3 weeks. He is taking Depakote, zyphrexia, and Chloryl Hydrate. We think he may be bi-polar but his doctor is not ready to pronounce this yet. He was in drug rehab. but was too disruptive due to his Manic state and was kicked out. His anger at those who love him most is almost unbearable and running us all into the ground. His behavior is strongly sociopathic. Can we expect his sociopathic tendencies to lessen when his manic state is under control or is his hate and anger all due to the effects of the drug abuse? In your answer, please "assume" that he has no legitimate reasons to be angry with his loved ones.

Dear Tim --
You are right to wonder about bipolar versus (or in addition to!) cocaine. At this point it could be either, and maybe cocaine is a more hopeful answer still.  But pretty soon, and I would have done it a while back, but I'm pretty aggressive this way as doc's go, he should have a trial of mood stabilizers.  Most of us use Depakote as the first step in this circumstance, but you have to watch out for weight gain bumming a person out before they've hardly gotten to see what it might do.  If his liver tests check out all right, there's pretty low risk -- i.e. the risk of using it, and finding out later one was wrong about the "diagnosis", is low enough to justify going ahead at this point, or at least soon.

Will the antisocial stuff go away?  Surely you would be hoping for a yes, and I think a lot might change, but I should caution you not to be too hopeful, and instead let the "proof be in the pudding" -- i.e. believe it when you see it and it stays true for a while.  However, that said, many of us who work with the serious mood disorders are coming to think that what looks like "personality disorder" can be part of the mood problem, and thus "treatable".  Since drugs like cocaine can really mess up your emotional maturation process, sometimes when the overdrive behaviors have settled down, there is still a lot of "growing up" to do, and sometimes people have trouble with that even when their mood is stable.  So, cross your fingers very gently, in such a way that you can still go on with your own life effectively while you wait to see what happens.

Dr. Phelps

Published November, 2000

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