By David Joel Miller.
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 sort 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:
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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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books