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Mixing Bipolar and Codeine

I had dental surgery last Thursday and as fun as that was, managing the pain since has been ever more so. It got me to thinking that mixing bipolar and codeine likely isn’t the best idea.

What Is Codeine?

Codeine is an opioid medication and can naturally be derived from opium and a form of morphine. It is primarily used as a pain medication but can be used for a myriad of other things such as suppressing preterm labor contractions and is on the list of essential medications as assessed by the World Health Organization.

Many people take codeine in the form of Tylenol #3s which contains codeine, acetaminophen and caffeine (caffeine speeds the absorption of the other drugs and helps to combat their sedating effects).

As with all opioids, codeine can be addictive and should not be used in people with addiction disorders (typically).

Codeine and Bipolar Medications

Codeine is a common painkiller but if you have bipolar disorder, should you take codeine? Learn more about bipolar and codeine here.I will be the first one to say that I didn’t check the interaction list or seriously question anyone before taking this stuff. This was my bad but, in my defense, it’s sort of something that healthcare professionals should have been asking me about (I.e., What other medications are you taking?). But they didn’t. And when I went to pick up the prescription I was on sedative medication so it certainly didn’t occur to me to mount a major query offensive (walking was challenging at that point).

But, having looked it up, I can tell you that codeine/acetaminophen and even codeine alone has over 200 “significant” interactions and many “serious” (use alternative) interactions. And yes, some of these are codeine and bipolar/psych med interactions.

I’ve looked through the list and many of the “significant” interactions are either an increase in sedating effects (most antipsychotics and benzodiazepines, some antidepressants) or an increasing of potency (several antidepressants) both of which require close monitoring (according to Medscape). Here’s a sampling:

  • Bupropion (Wellbutrin) – increases level of effect of codeine by effecting hepatic enzyme CYP206 metabolism. Significant interaction possible.
  • Desvenlafaxine (Pristiq) – inhibits CYP206, with higher desvenlafaxine dosages (i.e., 400 mg) decrease the CYP206 substrate dose by up to 50%, no dosage adjustment needed with desvenlafxine dosages < 100 mg.
  • Quetiapine (Seroquel) – both increase sedation. Potential for interaction, monitor.

See all the drug interactions for codeine here.

Codeine and Bipolar Disorder Interactions

There is not really any research on codeine and bipolar disorder except two case studies I found wherein codeine (and accompanying medications) was likely responsible for inducing mania.

Note that the adverse effects reported for codeine include:

  • A false feeling of wellbeing
  • Paradoxical central nervous system stimulation (as opposed to sedation, which is typical)
  • Restlessness

And I, personally, found I had a paradoxical reaction making sleep actually more difficult rather than easier, which is what it should be on an opioid medication.

(As an interesting side note, the opioid oxycodone has also been known to cause mania in bipolar individuals and has also been tried as an adjunctive treatment in bipolar depression.)

Bipolar and Codeine

All of this is to say that it’s not very fun for me to be on yet another medication in conjunction with all the psychiatric medications I currently take. It feels rather like all the meds have gotten together to throw a kegger in my brain. I’d avoid the experience again, if I could.

And, of course, I should have done this research and discussed it with my doctor long before going on the medication. This isn’t always possible, of course, but it was in my case and I should have done it. Feel free to learn from my error here and do your due diligence.

(It’s also worth noting that not all interactions are going to be known and that we, as a bipolar population, are special and our reactions may simply be unusual. That’s why closely monitoring your bipolar symptoms and psychiatric wellbeing in general while going on any medication – prescription or over-the-counter – is critical.)

Image: “TYLENOL3”. Licensed under GFDL via Wikipedia.

You can find Natasha Tracy on Facebook or Google+ or @Natasha_Tracy on Twitter or at Bipolar Burble, her blog.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

17 thoughts on “Mixing Bipolar and Codeine”

  1. There are so many things that come up that point me to a diagnosis, but I didn’t know for so long. One of my first experiences was with codeine cough syrup when I was 16/17. I took it and was spacey and couldn’t sleep. I stayed up all night finishing a school project for two days. Didn’t know what I was experiencing. I had bad reactions/non compliance with anti depressants starting at around 21. Often made me feel High. Every time I’ve tried Vicodin, I have a similar reaction to it as the codeine. Couldn’t sleep, feeling very spacey and loving everyone and everything.

  2. I have not considered myself bipolar. I just realized that when I take pain meds after surgery or anything with codeine, I go through hypo and hyper manic. Then a few weeks later go into anxiety and some depression. Not suicide but every little thing in life looks way too big to handle. I had brain surgery over 6 years ago. Every surgery but one since I have gone through this manic situation. It took till this week with being on cough meds with codeine to realize what was happening. I refuse CODIENE for now on. The only other times I have had this manic situation is two times in over three years because of extreme stress and/or hurt. I hope this helps someone! Send me a message if you need me.

  3. Well this is a no-brainer. If you have actually been diagnosed with bipolar disorder of any kind by a licensed trained psychologist not a common practicing doctor and you are functioning and dealing with your disorder you already know to mention any medication that you’re taking with any new prescription that you’re given by anyone. It is not the doctor’s responsibility to inquire it is our responsibility to notify. That’s why every advertisement for new medications State specifically talk to your doctor before starting this new medication about the effects they can have on any medication you are currently taking. Any type of Narcotics can cause adverse reactions in people with bipolar disorder. Either it triggers the Mania or it triggers even worse the depression because most opiates are downers. Do your research take control of your health be smart and demand questions and answers. I should know I was born with the disorder 5th generation and we’re all functioning working raised families run businesses finished school went on to college etcetera etcetera etcetera it does not have to be a disorder that you become disabled by it. you can live with it and control it just like diabetes.

  4. Every medication effects every person differently. I have never had a negative reaction to codeine. In fact I use it in a medication combo for migraine treatment. However, I did have a mania reaction to gabapentin which hardly ever happens to anyone. It’s all a matter of how your brain and your body react to the medication in conjunction with your other medications.

  5. Thank you for writing about this, Natasha. I wish I had seen it sooner! I have BP-I, and a few months ago was prescribed a cough medication with codeine. I got hypomanic and couldn’t figure out why until my pdoc asked me what I’d been prescribed for my cough. I had never heard of this connection before—and frankly had doubts if that was the real cause—until hearing about it today from someone else on PatientsLikeMe, and then reading this article.

  6. “Note that the adverse effects reported for codeine include:

    A false feeling of wellbeing
    Paradoxical central nervous system stimulation (as opposed to sedation, which is typical)

    Reminds me of when my cat got spayed. I don’t know the name of the pain medication they gave her after her surgery, but it was supposed to have a sedating effect, and she had a paradoxical reaction. She was wired – racing around clumsily playing with everything, her pupils enormous. It was kind of funny to watch. I wonder if she had a feeling of euphoria, too? She did seem pretty happy.

    Recently, our older cat got the same med while recovering from frostbite, and she had a normal reaction – super-sleepy and cuddly.

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