The news of Demi Lovato’s alleged heroin overdose came as a shock to her many fans and other celebrities around the world. It is well-known that she suffers from mental illness and substance abuse but had reportedly been in recovery – then she recently wrote a song about relapse in her substance abuse.
Although I have not treated Demi Lovato, her struggles with bipolar disorder were public knowledge. Generally speaking, co-morbid substance abuse is common with bipolar disorder, with patients turning to alcohol, cocaine and heroin. This can lead to nonresponse, noncompliance with treatment, relapse and difficulty achieving remission. Curing substance abuse isn’t possible until the bipolar disorder is properly treated.
With bipolar disorder in particular, one must grasp a few simple facts about the condition to help understand why substance abuse can happen. A bipolar patient suffers from periods of depression, mania and mixed states. Most patients spend two-thirds of their time in the depressive stage but ironically enough, typical antidepressants don’t work well for bipolar patients and are not FDA-approved to treat bipolar depression. This leaves many turning to recreational drugs like cocaine and heroin.
There are approximately 800,000 heroin addicts in America right now. Heroin binds with the opioid receptors of the brain, overflowing them with dopamine, one of the feel-good neurotransmitters, giving the patient an unbelievable high. This high or sense of euphoria is very short lived, lasting only a few minutes and then leaving the person feeling sleepy. Getting that high again requires taking more and more of the drug, which sadly leads to many overdoses. One can imagine bipolar patients in the depressed state look forward to these highs.
Demi Lovato is one of the lucky ones if she pulls through. Many heroin overdoses are fatal, and she is lucky she received the right emergency care as quickly as she did. This needs to serve as a teaching moment for everyone. There are three takeaways:
1. Patients and their families need to better understand bipolar disorder. Most patients with bipolar disorder are initially misdiagnosed. In fact, it can take up to 10 years to get the right diagnosis. This is a difficult psychiatric illness to treat because of the highs and lows experienced by the patient. There are currently only three FDA-approved medications – Latuda, Seroquel and Symbyax – but friends and loved ones need to be on the lookout for signs of alcohol and illicit drug use. Close and careful monitoring of the patient is a must even after remission is achieved.
2. Heroin is extremely dangerous and addictive. It doesn’t take much to get hooked. Overdoses are common and withdrawing brings about many unpleasant side effects. Avoiding heroin is a must for anyone, especially those with bipolar disorder and other mental health conditions.
3. Anyone, despite fame, money or anything else, can struggle with mental illness, and we need to get rid of the stigma immediately. There are plenty of celebrities who have struggled with and recovered from bipolar disorder, substance abuse and other mental illness. Please understand that you are not alone and there should never be any guilt or shame in seeking professional treatment. The only way to get better is to get help. Sadly, it seems every time there is a celebrity story involving mental illness, the subject is brought into the limelight but quickly disappears. Mental health is something that must become part of the public conversation all the time.
Prakash Masand M.D. is a psychiatrist and the founder of the Centers of Psychiatric Excellence (COPE), copepsychiatry.com.