By David Joel Miller MS, Licensed Therapist & Licensed Counselor.
A connection between taking medication, abusing drugs, and Bipolar Mania?
The question of connections between “drugs” and various mental illnesses is a huge concern. We have known for a long time that there is a connection between some chemicals and Mania. The connection to Bipolar Disorders, formerly called Manic Depressive Disorder, is more problematic.
People seem to think that because a medication is prescribed by a doctor or can be purchased over the counter, it is safe. The huge increase in abuse of prescription medication has made us question that. Now there is evidence that not just street drugs but prescription medications may be setting off episodes of mania.
We all pretty much intuitively know what depression looks like. But Bipolar Disorder that is something else. The official definition of Bipolar disorder requires a lot more than just moodiness.
To get the diagnosis of bipolar you need to have had an episode of mania or hypomania. But the DSM excludes from diagnoses symptoms caused by drugs of abuse. For Bipolar Disorder this includes Bipolar symptoms that were caused by prescribed medications.
Do prescribed medications cause Mania or Hypomania? They sure do.
The creation of Manic symptoms by the taking of medications is so common that some researchers have proposed a separate “type” of Bipolar Disorder, Bipolar III, for those times when taking a medication causes manic symptoms (Akiskal 1999, 2003, Williams 2006.)
Here is the Bipolar medication dilemma.
Most people who get diagnosed with Bipolar Disorder have had one or more episodes of depression first. Then they have an episode of mania or hypomania and the diagnosis gets changed. Taking antidepressants is well known to result in propelling some people into a manic episode. This happens to about 10% of all people prescribed some antidepressants. Also if someone has EVER had an episode of mania or hypomania that risk of sudden switching increases to 20% (Breggin 2010.)
That drug or medication-induced mania is specifically excluded from the diagnosis under the DSM-4.
In practice, it has come to be common that a person who has a sudden extreme reaction to an antidepressant is a likely candidate for a Bipolar Diagnosis despite the DSM-4 exclusion.
If it was only antidepressants that created mania things would be simple. Lots of other drugs and medications can result in manic or near manic episodes.
There is a huge difference between someone being “maniacy” when under the influence or while withdrawing and those people who take a medication one time and are propelled into recurring bouts of mania or hypomania.
We see manic-like symptoms in people who use and abuse stimulants. Even excess of caffeine can create those sorts of symptoms. But medications that we do not think of as stimulants can cause manic and hypomanic episodes.
Antibiotics have been shown to induce manic episodes. So have anti-anxiety meds and some over the counter medications. Other medications like steroids, both prescribed and abused have been suspected of creating this effect also. That connection remains uncertain.
So the question becomes, “Do prescribe medications create a manic episode?” It looks like the answer to that is yes, sometimes they do. Does that mean this is just an allergic reaction or side effect of that medication? This is iffier as some people have that response and others don’t.
Is it possible that people who have an undiagnosed Bipolar Disorder are likely to be propelled into a manic or hypomanic episode when they are exposed to a medication to which they are sensitive? I am inclined to think so.
We also see a huge overlap between substance abuse disorders, especially alcohol abuse, and Bipolar Disorders. Does alcohol abuse cause a Bipolar condition? Are people with undiagnosed Bipolar Disorder more likely to abuse alcohol?
Does this medication-induced mania matter? Williams says it does and reports that the rate of suicide attempts by people who switch to mania as a result of taking an antidepressant is even higher than for those with Bipolar II.
But there is more
People with anxiety are sometimes treated with an antidepressant. They also can experience an episode of mania or hypomania.
All this points out to me that with all we know about Bipolar Disorder there is still a lot more we don’t know and a lot more research is needed in this area.
It also suggests that there may be multiple types of Bipolar or even several different disorders currently being lumped together under one name.
For more on Bipolar disorders see:
Hyperthymia and Bipolar Disorder
Do drugs cause mental illness?
Bipolar – Misdiagnosed or missing diagnosis?
Or the category list to the right.
Anyone have the experience of taking or doing something and then having an episode of Mania which resulted in the diagnosis of Bipolar Disorder that you would care to share?
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I was diagnosed with depression and PTSD about age 30 and began taking an anti-depressant. I was concerned about the drug because of stories about it causing mania and a bipolar mother in my family history. I was able to make positive changes in my life on the antidepressant, but never showed signs of mania. I had an on/off again history of substance abuse with some long periods of clean time. At age 47 I began to abuse some illegal drugs again when I was going through a painful divorce. The substance abuse continued and I had a suicide attempt at age 48 (was still on antidepressants). I took an overdose of benzodiazepines and an opioid pain killer. When I woke a couple days later in the hospital, I was still “high” on the benzos and pain pills. When I learned I was being sent to a psych hospital due to an involuntary commitment from a family member, I became angry and combative. I wanted to go to a facility of my choice and that was taken away from me. I was still under the influence of the meds I had overdosed on. As a result of my behavior at the local hospital before I was transported to the psych facility, I received a tentative diagnosis of bipolar. On the day I was transported to the psych hospital I felt “normal” again and was ready to go anywhere except where I was being held under lock and key. Three days later, I was released from the psych hospital with no changes in meds and a promise to follow up with outpatient therapy for my depression and substance abuse. It was only at the outpatient treatment facility I learned from a Dr. I had been given the label of bipolar because of the episode. However, he let me know he did not agree with the diagnosis because he felt it took more than one encounter with a patient to make that judgment. To make a long story short, I have never been treated with any psych med other than an antidepressant and have not had another manic episode, drug induced or otherwise (it took a couple years, but I’m now clean of all illegal substances). So is bipolar over-diagnosed?
Thanks for your comment. Yes I think bipolar is way overdosed. If it is induced by medications or street drugs that should not count towards the diagnosis. I tend to think it comes in varying degrees of intensity. The DSM lists type one and type two. There is a milder similar condition called Cyclothymia. Some mild forms can be managed without meds but when under stress or on street drugs anyone, mentally ill or not can become overwhelmed. Relationship problems, financial issues and drugs send way more poel to the mental hospital than acute episodes of a mental illness. If you have concerns that you might be rehospitalized consider having a written plan on what hospital you prefer here you do not want to go and you med history and preferences. You can find more info on this under W.R.A.P. Or Wellness and Recovery Action plan. http://www.amazon.com/gp/product/0963136615/ref=as_li_tl?ie=UTF8&camp=211189&creative=373489&creativeASIN=0963136615&link_code=as3&tag=counselorssoa-20&linkId=XFI6YHJPT672YCYO
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Great post. My father had bipolar II and for years I wondered if I was bipolar as well, or just a product of my environment. I was and still can be very high strung and anxious. I was first given Paxil years ago to control my depression – after 5 days I was literally hallucinating! I wondered if it had anything to do with my weed addiction and my frequent use of LSD and magic mushrooms. Years later, I began taking Celexa (or citalopram) for the anxiety. This one worked well for me, but my preference to dealing with any mental issues was marijuana. I wondered if they conflicted at all. I saw psychiatrists, psychologists and counsellors – all who said they were certain I wasn’t bipolar, but coaxed me into thinking it was more my personality and the way I grew up. Once I got pregnant, I quit smoking weed on a daily basis and I stopped taking citalopram. I started reading a lot about my pursuit to happiness and taking up yoga frequently. This has helped me stabilize and everyone around me seems to have noticed. Sometimes drugs are not the answer – even prescription ones. It’s tough because everyone is different and even if the symptoms are similar, the reactions to treatment could be very diverse.