Do medications or drugs cause mania or Bipolar disorder?

By David Joel Miller MS, Licensed Therapist & Licensed Counselor.

Drugs.

Drugs.
Photo courtesy of Pixabay.

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:

Hyperthymia and Bipolar Disorder

Do drugs cause mental illness?

Bipolar – Misdiagnosed or missing diagnosis?

Bipolar or Major Depression?

Bipolar doesn’t mean moody    

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?

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

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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 my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. Do drugs cause mania?

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What is Mania?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

How is mania related to Manic Depressive Disorder?

Manic Episode or mania, as it is commonly known, is a mood episode, not a diagnosis. Mood episodes are used to decide which Mood Disorder a person has. For all practical purposes mania and its milder cousin hypomania are only associated with one of the forms of Bipolar Disorder.

Having an episode of mania or hypomania is the defining symptom that distinguishes Bipolar Disorders from Depressive Disorders. The connection is so strong that for a long time what we now know as Bipolar Disorder was known as Manic-Depressive Disorder. Changing the name has confused a lot of people. I still see clients who say they have been diagnosed with Bipolar Disorder and Manic Depressive Disorder. Sometimes they also tell me they have Depression.

Once you have Mania or Hypomania we forget the Major Depressive Disorder diagnosis and use the Bipolar label only.

A Manic Episode is marked by a period of time of at least a week, or less if you get so bad you end up in the hospital before the week is out, where you have a really high, expansive or elevated mood. This is not just a little happy or full of energy but a way “off the hook” period of time. Mania is not a good time. A little may feel like fun in the beginning. People with Bipolar Disorder may like a little mania but full-fledged mania is frightening.

Typically people who are manic have grand schemes to do things. These ideas make sense to them but they sound impossible to most other people. This is not the person who thinks they can sail around the world or invent an internet program. There have always been visionaries who plan to do great things and don’t get appreciated. These are people who try to run for president, cure cancer and beat the house in Vegas – all in one week.

They have decreased need for sleep, sometimes getting by on three hours of sleep a night and they try to do everything until they crash. This looks like a person on Methamphetamine but they don’t need drugs to be like this. Most people who get only a few hours of sleep may be able to function, but they will be tired and drag all day until they can sleep again. The person with mania can go days on little or no sleep and they feel fine. But the longer they are manic the crazier they act and sound.

Fully manic people talk a lot, pressured speech, the sort that erupts rather than is said. This is not normal conversation. They know what they are talking about by not many other people can follow them. Because their mind is racing they become angry and irritable when other people cannot keep up.

In full on mania they become very goal oriented, taking on lots of projects, rushing to do many things, but not always finishing anything. They have difficulty staying on one project, jump from task to task and sometimes get stuck on something that to others looks meaningless or insignificant.

Since they know what they have in mind they think of themselves as brilliant and important, they become full of self-importance until the manic episode ends at which point they may become depressed and regret all they have done or said. This differs from narcissism in that the episodes of grandiosity go away leaving them ashamed or embarrassed.

A common characteristic of a manic episode is getting over involved in things that are pleasurable. They may gamble, do drugs or drink to excess. There is a huge overlap between alcoholism and manic or hypomanic episodes. During manic episodes, they may have excessive, unsatisfiable urges for sex and engage in sex with partners they don’t know.

Someone who is experiencing a manic episode may become so impaired that they have hallucinations. These hallucinations will go away when the mania ends, unlike psychotic hallucinations that are more long-term. It is also possible to have a “mixed episode” where the person is both manic and depressed at the same time.

If someone has these kinds of symptoms we reserve judgment as long as they are able to work, have friends and are not upset about the episode. If it starts to affect functioning then the diagnosis is given. If someone is doing drugs or has a medical problem that is causing these symptoms then we don’t think that is mania and recommend they stop the drugs or get the medical problem treated.

If you have ever had a Manic Episode I would recommend you talk with a doctor, psychiatrist or other mental health professional. Treated early you still can have a productive life. The longer you wait to go for treatment the more the risks that while manic you will do something you can’t take back and the mania will likely get worse each time you have an episode.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.