I just saw my little brother over thanksgiving weekend, I haven't seen him since his wedding in may of this year. At his wedding, he looked healthy, he had actually gained a little weight. When I saw him this weekend, I did not recognize him literally I had to look twice, his head was shaved, his eyes were bulging and he had lost like 50 or so pounds since I saw him last, he was shaking like crazy and when I asked him if he was OK, he said he had permanent shakes from taking his bi polar med limictal, he said he had since stopped taking it and was not taking any meds for it at all, I was suspicious because he just started taking that like a yr. and a half ago and was telling me how well it was working, he was doing so well. Now he seems depressed and withdrwn and I can't get over how bad he looks, his wife had told me a while back that he had used cocaine a few times before they got married but he stopped when she got pregnant. He also said he lost weight because he had a tooth absess for a while and just got his teeth fixed. I am worried are these signs of cocaine use?

Yes. Also symptoms of Heroin and meth use. I don't know what your brother has been doing, so I can't tell you for sure. But yes. In fact, the possible drug use could have been what caused the abcess. This I don't know for sure, since I don't know him. It definitely sounds like it, it doesn't sound like he is a stranger to drugs. I would talk with him. And his wife. If you find something out, have an intervention. It may work, it may not. But it is worth a try.

Cocaine addiction happens fast and it's a hard on to get over, Hopefully you all can get him some help, Here are some of the symptoms; Stuffy, runny nose, and nose bleeds,
Anxiety, increased energy, tremors, shakes, hyperactivity, dilated pupils, talking rapidly, increase energy, mood swings, weight loss, due to loss of appetite, neglect of body and hygiene, cold sweats, insomnia, social withdrawal from family and friends.

All very good signs that he could be "using".

I know he smoked pot a lot, he says he quit that but pot would have the opposite effect of a stimulant, he has all the signs, my older brother says we should give him the benefit of the doubt when he says he could not eat because of the absess, I told him I think he is lying, I knew from the moment I saw him something was wrong.

It may be true that he could not eat because of the abcess, those things are PAINFUL!! But the abcess could very well have been cause by drug use. It could have also been caused by poor dental care... I don't know... Talk to him, and tell him you won't judge him. He just has to tell you the truth.

I'm afraid he will take offense or lie to me, he does not know his wife told me he was using back in April, how do you confront someone about that you know? He does have bad oral hygiene, he never brushes his teeth, I think that is why the absess happened. The shaking is what tipped me off to something being wrong, he never did that before.

You are right if you bring it up to him he will deny it.
My neighbor goes to rehab approximately every 1 and 1/2 years because he loses so much weight and his system gets so crazy he has to go. He looks horrible before he goes and he stays long enough to get the drugs out of him so that he can come back and start all over. When he comes home he looks so healthy and has a sparkle in his eyes and is gaining weight. Within a month he starts back and goes down hill and starts looking like a skeleton again. Same with some other guys I know, I can tell when they have been off their drugs for a while cause their skin and eyes have a glow they don't when they are getting high. Then they start again and don't have a healthy look again.

Abscessed tooth wouldn't make you that bad off.
Shaking usually means they are in withdrawal between their 'fixes'
My ex husband use to get miserable and shaky and I thought it was cause he was all highed up then one day I realized it was the opposite.

Hi,

I don't envy your situation and I'm sorry you and your family--and your brother--are going through this.

I've worked with literally thousands of addicts as well as family members, and while every situation is unique, family red flags are frequently correct. However, not knowing the details of your brother's history and situation, it would be extremely irresponsible to make an assertion that he is or is not using.

Having said that, whether he is Bipolar I or II, marijuana plays a major factor in medication regulation complications, and many docs will refuse to prescribe until the patient is abstaining from marijuana for a certain period.

Maybe he did do just that, and the meds were able to be adjusted for both manic and depressive cycles (docs have to determine how deep and how frequent those swings are, and which one may be dominant as well--it's complex!). If he did start using marijuana again, either because the meds needed adjusting or because he was feeling too "flat" on the meds, that would throw the meds off and send him into a state of spiraling imbalance.

People with bipolar disorder are often very creative, fascinating, and sensitive people. One of the most difficult challenges, I've heard time and again, is the reduction in that creativity when on meds. For some, this leads to temporarily going off meds to have that feeling again, only to find themselves trying to readjust on their own when things get out of balance.

Being OFF meds for many bipolar people is like being on drugs in a way--extreme swings of euphoria followed by mania (usually accompanied by very poor decision making and impulsiveness that can be life-threatening) followed by a crash, sometimes into life-threatening depression. Their "norm" is a very similar experience to that of a drug addict, and taking meds is like being "clean."

This is all speculation, as your brother's drug or bipolar history and severity are unknown to us, and it's all very complex, actually. I can only encourage you to speak with an addictions specialist one-on-one (not online!).

Many outpatient addiction treatment centers have psychiatrists who specialize medication regulation for people who are "dual-diagnosis" clients in the General Mental Health system--people who have co-occurring challenges of chemical imbalance/mental illness (as defined in DSM-IV) and addiction. Educating yourself about this may help you not only feel you can have an informed dialogue with your brother (for example. if he says he has shakes from not taking his meds, a conversation with a treating psychiatrist may reveal that, in such cases, shaking would not be due to that particular medication, etc.), but may help you and your family make a decision as to whether you feel confident intervening on his behalf.

Now, if you made it to the bottom of this post (congratulations!)...

Hazelden has a good general pdf available on bipolar and addiction:

http://www.hazelden.org/web/public/d...mh_bipolar.pdf

If you want qualified online help from a psychiatrist, you might try here:

Is it bipolar or addiction? - Mental Health

Best of luck to you.