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Is Codeine a Depressant, Stimulant, or Hallucinogen?

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Codeine is a depressant medication, reducing pain and the urge to cough, and it is widely used in cough syrup and tablet painkillers. Codeine is less powerful than other opiate painkillers, but just like heroin, a person who takes too much codeine can develop life-threatening respiratory depression that slows down breathing and causes death.

All depressant drugs (or “downers”) are psychoactive medications that temporarily slow down the normal activity of the brain. They can decrease pain, relax muscles, cause sleepiness, prevent seizures, and calm people who are anxious or suffering panic attacks.

Stimulants, on the other hand, have the opposite effect of depressants like codeine. Stimulants temporarily increase brain activity, elevate mood, boost energy levels, raise blood pressure, make the heart beat faster, and produce feelings of well-being and alertness.

Despite their many benefits, depressant drugs like codeine have a high risk of a painkiller addiction, as well as numerous physical and psychological side effects. They should only be used exactly as prescribed by a doctor – and never for the “self-medication” of depression or other mental illnesses.

What Happens When I Stop Taking Codeine?

Codeine changes the way the brain interprets pain signals. The brain gradually stops making natural painkillers when a person takes codeine for more than a few days. If a person suddenly stops taking codeine, they go into withdrawal and experience feelings of depression and intense cravings for more codeine. There is also a risk of long-term changes in the brain that make it extremely difficult to feel normal or stop taking codeine without a specialized treatment plan.

How Does Codeine Depress the Central Nervous System?

The body converts codeine into morphine through the liver. Morphine is then absorbed into the bloodstream and passes through the blood-brain barrier, where it acts in the central nervous system (CNS). The CNS involves the brain and spinal cord and it controls most of the body’s functions.

Codeine is an opiate that activates opioid receptors in the brain just like other opiates, including heroin and morphine. It does not interfere with nerve signals to the brain, but it changes how the brain interprets pain signals. It blocks pain receptors in the brain and mimics the actions of feel-good chemicals called endorphins which are the body’s natural painkillers.

Does Codeine Cause Respiratory Depression?

Yes. Codeine slows down activity in the brain, which can also slow down breathing. Specifically, it slows down the subconscious breathing that is controlled by the brain-stem, forcing a person to breathe manually or risk not breathing at all. This is called respiratory depression, or “hypoventilation,” in which breathing is too slow.

During a normal breathing cycle, a person inhales oxygen and exhales carbon dioxide. If the person is breathing too slowly, the body does not get enough oxygen to the tissues and vital organs. Furthermore, levels of carbon dioxide increase, which poisons the bloodstream. As the condition progresses, a person can become dangerously impaired.

In terms of how this feels physically, a person who is suffering from respiratory depression will be completely focused on their breathing rate. They will feel like they are forced to breathe manually because they might forget to breathe — but they will also feel extremely sleepy.

Uncontrollable tiredness usually develops with respiratory depression. In cases of codeine overdoses, a person can easily fall asleep and suffocate because their breathing gradually decreases until it stops. The person may develop bluish-colored lips, fingernails, or skin. The most severe level of respiratory depression can cause seizures, extreme confusion, unconsciousness, coma, and even death.

What are the Depressant Effects of Codeine?

The short-term effects of depressant medications like codeine may include slowed brain function, slowed heart-rate, slowed breathing, lower blood pressure, nausea, poor concentration (“brain fogginess”), confusion, sleepiness, dizziness, slurred speech, disorientation, blurred vision, lack of muscle coordination, and difficulty urinating.

What are the Long-Term Effects of Depressant Drugs?

The long-term use of CNS depressants like codeine can cause psychological problems including depression, paranoia, irritability, suicidal thoughts, memory problems, and poor judgement. It is also very common for heavy users to develop long-term problems with fatigue, sexual dysfunction, and trouble sleeping through the night.

Long-term use of depressants can negatively impact nearly every area of a person’s health. Codeine abusers may gain a lot of weight or develop diabetes, liver damage, kidney problems, or heart rhythm problems. The risk increases when codeine is abused with alcohol.

As a person develops a tolerance to codeine and becomes dependent on a daily dose of the drug to function normally and avoid withdrawal, they are more likely to experience long-term cravings, severe anxiety, or panic attacks if they are unable to get more codeine.

What is Tolerance?

Tolerance to depressants like codeine can develop within as little as 3 days, in which the body requires larger and larger doses of codeine to get the same effect. Tolerance to codeine can be managed in the short-term, but it can become a serious long-term problem as the body becomes physically dependent on codeine to function normally.

If the body does not get codeine, the person will start experiencing the unpleasant physical symptoms of withdrawal. It is very easy to become psychologically addicted to codeine as a result of continuously increasing the dose to avoid going through withdrawal. If the user continues to take more and more codeine, they can reach a dangerous level where they are at risk of overdose, coma, and even death.

What Happens When Codeine is Combined with Other Depressants?

The FDA warns against combining codeine with other depressants, such as alcohol, opiate and opioid painkillers, benzodiazepines, barbiturates, or tranquilizers. The combined effects can severely slow down brain activity and cause a person to stop breathing and die.

Benzodiazepines, also called “benzos,” are depressant drugs for anxiety, panic attacks, seizures, insomnia, muscle relaxants, and anesthesia before surgery. Some popular benzodiazepines include Xanax (alprazolam), Valium (diazepam), and Klonipin (clonazepam).

Patients who combine codeine with alcohol, benzodiazepines, or other CNS depressant medications, should seek emergency medical attention immediately if they (or someone they are caring for) experiences the following symptoms of a dangerous overdose.

What are the Signs of CNS depressant overdose?

  • Unusual dizziness
  • Light-headedness
  • Extreme sleepiness
  • Slowed or difficult breathing
  • Unresponsiveness
  • Person does not answer or react normally
  • Can’t wake the person up

What About Breastfeeding Mothers?

Codeine is sometimes prescribed to women for pain after a caesarean section (C-section). The problem is that breastfeeding women who use codeine can pass the medication to their baby in their breast milk. This can cause respiratory depression or a deadly overdose in the baby.

Studies show that about 24% of nursing babies will experience symptoms of CNS depression if their mother is taking codeine. Babies are far more vulnerable to the effects of codeine than the mother, so even low doses of codeine in breast milk can potentially cause death.

Codeine is converted into morphine in the body. In babies who died after breastfeeding when the mother was taking codeine, morphine levels were generally much higher in the baby’s body than what was typical. This is because some babies are genetically “ultra-rapid metabolizers” of codeine, which means they metabolize codeine into morphine too efficiently, leading to severe respiratory depression.

These babies naturally convert a dose of codeine into morphine much faster and more completely than an average person because they were born with two active copies of the CYP2D6 gene. Even women who are “poor metabolizers” of codeine – meaning they have non-functional CYP2D6 genes – can have a baby who is an ultra-rapid metabolizer because the baby was born with active CYP2D6 genes. The prevalence of this CYP2D6 gene varies widely around the world. It has been estimated to occur in 0.5-1% of Chinese and Japanese people, 0.5-1% of Hispanics, 1-10% of Caucasians, 3% of African Americans, and 16-28% of North Africans, Ethiopians, and Arab populations.

Why is Codeine Risky for Children?

When a child is an ultra-rapid metabolizer of codeine, the mother may not be aware of the risk. The child is significantly more likely to experience respiratory depression or death if they are given a dose of codeine or breastfed by a woman who is using codeine. This is why the U.S. Food and Drug Administration (FDA) does not recommend giving codeine to children under 12 years old. The symptoms of a codeine overdose in a breastfed infant may include unusual sleepiness (more than 4 hours at a time), trouble breastfeeding, limpness, or abnormal breathing that is slow, noisy, labored, or seems difficult.

Why do Some People with Depression Use Codeine?

Physical pain is a common symptom of depression, which is why some people with depression take codeine or other painkillers. People who are in pain may also develop persistent depression as a result of not being able to sleep, eat, or do other activities they previously enjoyed.

Can Codeine Abuse Cause Depression?

Yes, it can. Depression is also a side effect of long-term codeine abuse, especially as a person is going through withdrawal. But even after the physical symptoms of withdrawal are over, depression may remain. This is because it takes the brain a long time to return to normal function.

What Does Codeine do to the Brain?

As the brain develops a tolerance to codeine and becomes physically dependent, it requires higher doses to achieve the same effects. The brain also stops making its own feel-good chemicals like dopamine and endorphins. When a person stops taking codeine, their dopamine and endorphin levels may not return to normal for weeks or even months.

What is Depression?

Depression is a common but serious mood disorder that is characterized by imbalances of “feel-good” chemicals in the brain. It causes persistent feelings of extreme sadness, guilt, worthlessness, emptiness, and thoughts of death or suicide in some cases. People who are depressed may also suffer from anxiety, fatigue, social withdrawal, increased sleepiness or insomnia, and weight changes.

Is Codeine an Antidepressant?

Codeine is sometimes abused by people who are depressed to self-medicate, but codeine is not an antidepressant. Instead, it makes the brain care less about painful or unpleasant feelings, resulting in a pleasant apathy. The problem is that codeine only temporarily treats the symptoms of depression — not the underlying cause. Codeine can also worsen depression by negatively changing how the brain works.

What is the Risk of Using Codeine?

Instead of trying to use codeine as an antidepressant on your own, it is best to talk to your doctor about how you are feeling. It is essential to get treatment for the underlying mental illness besides just the illegal drug use. Codeine is highly addictive and using it to control the symptoms of depression can lead to far worse problems.

People who become addicted to codeine will do whatever it takes to get more of the drug. They crave the feel-good effects so powerfully that they completely lose control over their usage. Over time, as the person continues to take higher and higher doses of codeine, the brain changes the way it normally functions.

What Happens When I Stop Using Codeine?

Discontinuing the use of codeine will cause the person to go into withdrawal which can involve severe depression and even suicidal thoughts or behavior. People with major depressive disorders who use codeine to self-medicate will likely experience even more severe depression when they go through withdrawal. They may be at risk of attempting suicide. This is why specialized drug treatment plans are often necessary for people with depression who are trying to recover from codeine addiction.

Can Codeine Make Depression Worse?

Depression is often misdiagnosed. If a person is addicted to codeine, many of the symptoms of codeine abuse can mimic and hide the symptoms of depression. To make matters worse, people who are depressed – especially if they are also suffering from physical pain – are more likely to visit a general doctor to get a prescription for painkillers instead of a psychiatrist or a psychologist. This can delay a proper diagnosis and treatment for depression.

If you plan on taking codeine for pain, make sure that you speak with your doctor and lay out a safe treatment plan that avoids too much codeine and results in a codeine addiction.

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