Expert: Ivan Goldberg, M.D. - 2/11/2008

Question
Dr. Goldberg,
In the spring of 2007, I began to smoke marijuana heavily after a long
moratorium. I was on Celexa for anxiety (caused by pot some years earlier)
and so I doubled the dose to 40mg.  The plan was to quit drinking then.  
WHen I tried I suffered long lasting (months) and ultimately acute mania.  I
was put on lithium and rispiridal until Littium got therapeutic.  Then I
suffered depression and now am on ciplarex.  There is a family history of
depression (not sure about bi-polar).  Is there anyway this was just a perfect
storm (increased SSRI, pot. booze) that would not count toward bi-polar
diagnosis?

Answer
Hi Peter

It is hard for me to say anything definite based on the information you provide. I have seen many patients with stories similar to yours. When staying away from marijuana and other substances of abuse, about 80 of them turned out to eventually have spontaneous bipolar mood swings while 20 never had another episode. For those who developed mood swings, long-term lithium was generally effective,

I am sorry that I cannot be more specific about your situation.

Best regards . . .
Ivan
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