Q:  Mood Disorder Meds & Methadone

I have been on 50mg of methadone/day for the last 18 months.  This is treatment for the 2 years I snorted heroin.  I still say I feel normal on heroin but have not used it during the last 18 months.  I have trouble sleeping and low motivation on methadone.  I never felt good when I tried cocaine or marijauna.

I have recently been diagnosed as bi-polar and would like to know if it is ok to start any medications for mood disorders while on methadone?


Dear Nancy -- 
Okay to start, as long as your psych-doc thinks it's okay. We used to hold off if people were actively using, e.g. alcohol, and tell people to get clean and sober for a few months and then we'd treat whatever mood symptoms that remained, if any. This was what I was taught in my residency, loosely, about 15 years ago, although many of us went ahead and started mood treatments anyway without waiting that long. Now there's at least one good study showing good outcomes in people with bipolar disorder and alcohol use if the treatment is started even while people in the study were still actively drinking.^Salloum So the thinking has really changed, almost all the other way around, now: treat the symptoms and hope that doing so might actually help the person stay clean. That doesn't always work, unfortunately, but sometimes I think it helps quite a bit. In your case, of course, it's up to you and your doc' to decide when to start. Good luck with that. 

Dr. Phelps 

Published May, 2006