Could Medication Produce a Drug Abuse Problem?

Reader’s Question

My husband was prescribed Paxil for premature ejacualation (not depression or anxiety) and shortly thereafter he started abusing drugs. He was stealing my painkillers that I am on for my back problems. He said that he could not control it. When he couldn’t get the pain killers, he was snorting Sudafed. Since I caught him, I have locked up all medications, including his Paxil. Now that he’s been off of the Paxil, he says that he does not have any cravings or thoughts of abusing anything. In fact, he says that he can’t believe how much clearer his thinking and emotions are. He started going to outpatient therapy recently. Years ago, he was an alcoholic and has not drunk in 6 years. Could the Paxil have caused this behavior? Could it have caused the compulsions and contributed to his already addictive personality? He is not normally the type of person to risk his family. The lying and hiding and stealing has close to destroyed us.

Our Consulting Clinical Psychologist’s Reply

I’m not aware that Paxil can produce compulsive drug abuse. However, we have evidence in the professional literature of something very close. Paxil is a Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant. Antidepressant medications in this class have been known to produce hypomania — a lesser degree of mania. Hypomania includes symptoms of inflated self-esteem, decreased need for sleep, talkativeness, racing thoughts, poor attention span, “flighty” behaviors and thinking, increased sexual behavior, physical hyperactivity, elated mood, and excessive involvement in pleasurable and/or high-risk behavior (this is where your husband comes in). That last symptom may include spending sprees, get-rich-quick schemes, sexual misbehavior, gambling, and anything that is considered pleasurable.

Hypomanic behavior can be very damaging and often produces marital problems, financial difficulties, and even problems with the law. Several years ago I had a hypomanic patient purchase 44 copies of the same outfit. In her mind, she would wear the outfit around the community, look so “hot” that everyone would want the same outfit, then supply them the outfit in their size from the trunk of her automobile — pay off her maxed-out credit card — and have a profit. It didn’t end up the way she planned.

If he has returned to a normal state of behavior, I would continue the therapy approach to treatment. If an antidepressant is needed, I would have a serious conversation with the physician about his possible response to medications and the need to monitor his mood. There is such a thing as being Too Happy.