I am on Ritalin. Would the use of other drugs such as marijuana and alcohol cause me to get paranoid and have insomnia? Sometimes I feel depressed after I have mixed all of these things, and my mind races and I can't calm myself down.

J.S.

I certainly wouldn't recommend mixing any prescription drug -- but particularly any psychiatric drug -- with marijuana, alcohol or any drug not prescribed or approved by your physician. (That includes over-the-counter drugs and herbal remedies.)

As you may know, Ritalin is a stimulant with an action similar to cocaine and amphetamines (speed). Alcohol is a central nervous system depressant (or sedative), as is marijuana. There are many possible ill effects from mixing prescription medication, recreational drugs and alcohol. Not to mention whatever might be bothering someone in the first place to lead them to use (and continue using) recreational drugs despite negative consequences.

Insomnia and nervousness are possible side effects of Ritalin. Alcohol can increase any pre-existing sleep problems, particularly middle insomnia (awakening in the middle of the night and being unable to get back to sleep), due to the brain's tendency to fight alcohol's sedating effects. Anxiety and paranoia have been associated with marijuana use.

If one of my clients were experiencing the problems you describe, I'd recommend that the person should stop smoking marijuana, drinking alcohol and taking any recreational drugs, and should report his or her paranoia and insomnia to the physician who prescribed the Ritalin. I'd also explore the possibility of the person having a substance abuse problem that might need to be an additional focus of treatment.

In your case, I'd recommend talking with your physician about what you're experiencing, and also exploring your drug use in therapy. Good luck.