Bath Salts Addiction And Mental Health Problems

Ashley Rooks, M.S., LASAC

  1. Bath Salts Effects on The Brain
  2. Bath Salts and Psychosis
  3. Serotonin Toxicity
  4. Sources

Bath Salts Effects

Bath salts are a synthetic derivative of the naturally-occurring stimulant cathinone; they are a ‘legal’ alternative to stimulants like meth, ecstasy and cocaine.

Like cocaine and ecstasy, bath salts produce stimulatory effects, increasing euphoria and alertness at low doses. But prolonged use can cause adverse effects like agitation, paranoia, hallucinations and suicidal behavior.

Bath Salts Effects

Bath salts are relatively easy to purchase due to difficulties in regulating market availability and sales. Manufacturers thwart regulations by re-formulating products and labeling them “not safe for human consumption.”

Bath salts use is very common amongst adolescents and young adults between the ages of 13 and 25. This is a sensitive developmental period during which continuous use can result in stunted neurocognitive and emotional growth.

Bath Salts Effects on The Brain

Bath salts exert their influence by mainly altering two neurotransmitters in the brain: dopamine and serotonin.

  • Dopamine is responsible for regulating the brain’s reward mechanisms; when dopamine is released in a normal state—at normal levels—it is reabsorbed.

    • However, in bath salt users the amount of dopamine released is so great that reabsorption becomes difficult and this can adversely alter the brain’s regulatory mechanisms.

The National Institute on Drug Abuse states that bath salts are ten times more potent than cocaine in affecting dopamine release and reuptake.  Also, users may abuse other substances in combination with bath salts, further compromising dopamine reuptake.

According to research, when the reuptake of dopamine is inhibited, it remains trapped in the synapse, leading to a hyperdopaminergic state that can cause:

  • Violent behavior.
  • Delirium.
  • Agitation.

aggression-from-substance-abuse

Increased concentrations of dopamine can result in reward dysregulation.

  • The things that you once found pleasurable—like hobbies or social events—no longer produce the same pleasure or rewarding feeling.
  • The substance, instead, becomes the focus of reward and pleasure.
  • A lack of ability to find pleasure in everyday activities, like work, relationships, or personal hobbies, can increase your vulnerability to feelings of hopelessness, depression and isolation.

It is important to consider that a person may have started using bath salts to escape symptoms of a mental illness. This means it is imperative that both the co-occurring drug use and mental illness are treated to achieve the best recovery outcome. Please call 1-888-993-3112Who Answers? to find a program that's right for you.

Bath Salts and Psychosis

Over time the amphetamine-like effects of bath salts can lead to insomnia, paranoia, and hallucinations. Hallucinatory effects are thought to be caused by an increase in the neurotransmitter serotonin, which can lead serotonin toxicity and precipitating symptoms of psychosis.

Bath salts-induced psychosis can be very pronounced, with users experiencing:

    • Paranoia
    • Visual and auditory hallucinations.
    • Delusions.

    This paranoid delusional state usually remits after supportive treatment, with symptoms resolving anywhere from a day—to one week—after ingestion.

If symptoms are not resolved within one or more weeks after last use, the user should be evaluated to determine if placement in an inpatient psychiatric facility is appropriate.

In 2009, poison control centers received zero calls reporting bath salt toxicity but in 2011, they received 6156 calls. This increase is correlated with the increase in emergency room admissions for bath salts intoxication.

Problem with detecting psychosis

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Many variations of bath salts cannot be detected in urine.

  • This makes it difficult for medical personnel to identify the difference between substance-induced psychosis and another mental health concern, unless the patient is honest about their drug use.

To date, there is no antidote for bath salts toxicity, so appropriate diagnosis is important in order to properly treat a patient for bath salts-related psychosis.

Serotonin Toxicity

Serotonin toxicity, otherwise known as serotonin syndrome, is a cluster of symptoms caused by the increased biological activity of serotonin.

Like dopamine, the release and reuptake of serotonin occurs naturally in the brain. Excessive serotonin release induced by drugs such as bath salts, can lead to excessive nerve cell activity, causing serotonin syndrome.

Symptoms of serotonin syndrome can be lethal and include:

  • Confusion.
  • Headaches.
  • Changes in blood pressure.
  • Increased heart rate.

  • Diarrhea.
  • Tremors.
  • Seizures.
  • Unconsciousness.

Short-term effects of serotonin can be resolved with supportive care and abstinence from bath salts.

  • However, prolonged bath salts abuse increases the risk of repeated serotonin toxicity and subsequently, the development of more serious symptoms that may be resistant to treatment with antipsychotic drugs.

You will typically be hospitalized for observation and treatment of serotonin syndrome.

  • Benzodiazepines, such as Ativan, can be used to treat agitation and prevent seizures.
  • It is critical to maintain hydration so you may be given IV fluids.

Sources

Karch, S.B. (2015). Cathinone neurotoxicity (“The 3Ms”). Current Neuropharmacology 13(1), 21-25.

National Institute on Drug Abuse. (2012). DrugFacts: Synthetic Cathinones (“Bath Salts”). Retrieved from http://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts

Watterson, L.R. & Olive, M.F. (2014). Synthetic cathinones and their rewarding and reinforcing effects in rodents. Advanced Topics in Neuroscience. Published online, doi: 10.1155/2014/209875

Weaver, M.F., Hopper, J.A. & Gunderson, E.W. (2015). Designer drugs: Assessment and management. Addiction Science and Clinical Practice, 10(1), 8. WebMD Feature. (2013). Bath Salts Drug Trend: Expert Q&A. Retrieved from http://www.webmd.com/mental-health/addiction/features/bath-salts-drug-dangers