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Cocaine and mental health

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • cocaine use can result in a whole range of psychological and psychiatric problems. It can cause marked changes in moods and behaviour. It can also exacerbate an underlying psychiatric problem
  • patients can become frankly psychotic on cocaine
  • anxiety and depression
    • marked increase in anxiety and irritability, especially when withdrawing after a session of use
    • reduction in dopamine and serotonin can cause anxiety and chemical depression
    • can lead to self harming, suicidal ideation and suicide
    • crack could be taken to self-medicate underlying depression, but may also precipitate mania and intensify the depression
    • care must be taken with antidepressants and only used if underlying depression confirmed
  • fear, paranoid ideation and cocaine-induced psychosis
    • excited/agitated delirium can result after a bout of heavy use. The time it lasts varies between patients and consists of agitated and bizarre behaviour, hyperthermia and extreme paranoia
    • tactile hallucinations are characteristic of stimulant use – the ‘cocaine bug’ – this may cause obsessive skin-picking
  • cocaine used to modify mood in schizophrenia, bipolar disorders, personality disorders and unrecognised ADHD
    • schizophrenia
      • can worsen the condition or act to modify mood, especially against the unwanted effects of the major tranquillisers or against the negative symptoms of schizophrenia
    • bipolar disorders
      • increased amounts taken during manic phase, but also used to self-medicate against depression
    • personality disorders
      • used to manage abnormal mood states.
    • Attention Deficit Hyperactivity Disorder (ADHD)
      • cocaine may be used by people with undiagnosed or diagnosed ADHD to increase attention span and concentration
    • eating disorders
      • associated with anorexia nervosa, as it acts and can be used as an appetite suppressant
    • other addictions
      • patient can develop an opiate, alcohol or benzodiazepine problem when these drugs are used as relaxants after a bout of cocaine use


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