Substance/Medication-Induced Bipolar or Related Disorder
Substance/Medication Induced Bipolar or Related Disorder
Substances, medications, and even toxins can cause symptoms that mimic those of bipolar disorder. Substance/medication-induced bipolar disorder is a diagnostic term used when symptoms of bipolar disorder are determined to be caused by the use of a substance or medication. The difference between a substance/medication-induced bipolar disorder and bipolar disorder that is independent of substance use lies in knowing whether a substance or medication was the cause of the symptoms or the symptoms pre-dated the use of the substance or medication. The condition is considered to be substance-induced when, after the substance is discontinued and a period of time elapses, the individual does not display new symptoms of bipolar disorder.
Because individuals suffering from either mania or depression tend to overuse substances, it is essential to determine the origin of the problem. This determination is made when a professional mental health provider observes whether the symptoms persist after the individual has abstained from the substance/medication for a sufficient period of time. In some cases, an individual may, indeed, suffer from a bipolar or related disorder and may self medicate their untreated symptoms by abusing a substance. This further complicates the clinical course of the disorder and makes diagnostic accuracy even more challenging.
Teasing out whether the bipolar symptoms are substance-induced or stem from an endogenous bipolar disorder tends to be a complex equation that is best solved when a client and mental health professional partner together for diagnosis and treatment.
One of the initial challenges of diagnosis and treatment is to identify and treat the root cause of the problem. If alcohol or substance abuse are in play, the client will require clinical care to discontinue using the substance.
Medications and substances which are seen to induce symptoms
Researchers have found that nearly half of substance-induced episodes of depression, in the general population, are associated with heavy alcohol use. Cannabis, cocaine, stimulants, methamphetamine, and opioids, including opiate prescription medication and heroin also are known triggers of substance induced bipolar symptoms. Some psychedelic drugs, particularly phencyclidine (PCP), are also associated with substance induced bipolar episodes.
Both intoxication and withdrawal from alcohol and substances are additional causes of substance-induced bipolar disorder and may cause symptoms of other mental health conditions, as well. For example, symptoms of anxiety, depression, and irritability occur due to intoxication or withdrawal from alcohol, marijuana, benzodiazepines, cocaine and opiates. It is important to mention that withdrawing from alcohol, benzodiazepines, and opiates should be done with medical consultation or supervision, in order to avoid adverse and, potentially, life threatening complications.
It is also important to note that symptoms of bipolar disorder can be caused by toxins, as well. Exposure to a toxin, such as heavy metals including lead, may lead to symptoms of bipolar depression.
In some cases, mania can be precipitated as an adverse side effect of some prescribed medications, such as corticosteroids. Similarly, if an individual responds to antidepressant medication with mania, that may signal an underlying bipolar condition.
It can be difficult to diagnose a person with substance-induced bipolar disorder because their symptoms of both intoxication and withdrawal may resemble the symptoms of multiple disorders. There may also be an overlap in some symptoms, such as suicidal behaviors. As a result, a diagnosis cannot be fully made until the person has stopped using the substance for at least four weeks at a minimum. Physicians may check the individual’s blood levels for substances to see possible causes and later to verify that the patient has ceased using the problematic substances.
Cases with psychotic symptoms
In the worst case, the person with substance-induced bipolar disorder develops psychotic symptoms, which means that the individual has a break with reality and may experience visual and/or auditory hallucinations, paranoia, hostility, agitation and anxiety, an extreme withdrawal from other people, and severe depression.
Psychosis is a greater risk with higher doses of substances and also with a greater frequency of use. When individuals with substance-induced bipolar disorder, either with or without psychosis, discontinue using the substance, they improve the likelihood of remission.
Some large studies have found that nearly a third of patients with substance-induced psychosis have subsequently met the criteria for either bipolar disorder or schizophrenia.
In addition, some studies of individuals with substance-induced psychosis to amphetamines indicated that about a third later developed either bipolar disorder or schizophrenia. Studies have also found that some individuals with substance-induced psychosis convert to a severe mental illness within two to three years. The risk is particularly great among adolescents and young adults ages 16-25 years old.
Researchers have also found that of individuals with psychotic symptoms that were induced by substances, the highest risk occurred with the use of 2 or more substances (40%). This was followed by the risk for psychosis from the use of cannabis (19%), alcohol (17%), cocaine (15%), and hallucinogenic drugs (4%).
What it looks like
Bipolar disorders include bipolar I, bipolar II, and cyclothymic and related disorders. Bipolar depression refers to a mental health condition that involves mood swings that range from depressed to manic. Symptoms of substance-induced mania can include an irritable, angry, explosive, or an expansive, elevated mood, spending or gambling sprees, pressured or driven speech, goal directed activities, or sexual urgency, and engaging in high risk activities.
Symptoms of substance-induced depression can include a severely depressed mood, a lack of interest in normal activities, social withdrawal, a change in appetite or sleep, low self esteem, low self worth, and hopelessness. Alcohol and substances can decrease inhibitions and impair judgment leading to impulsive decisions and dangerous acts. For example, alcohol, a known central nervous system depressant, can inflame the mood of an already depressed person and ignite a potentially lethal outcome, such as suicide.
Bipolar disorder is considered a lifelong condition for which long term mental health care and management is recommended. However, when the condition is determined to be substance/medication-induced bipolar disorder, the symptoms typically resolve when the substance/medication is discontinued.
In considering the particular substances associated with substance-induced bipolar disorder, experts report that symptoms may occur both with intoxication and with withdrawal from such substances as alcohol, sedatives, and stimulants. In contrast, symptoms began only with intoxication in the case of the use of hallucinogenic drugs. Some substances have triggered mania in some patients, such as methylphenidate, alprazolam, and high doses of caffeine (840 mg).
The major components of substance-induced bipolar
The person must have ingested a substance that is known to trigger this disorder. As mentioned, daily use of marijuana can induce bipolar-like symptoms. A higher level of tetrahydrocannabinol (THC) also may increase the risk. For example, the average marijuana cigarette has about a 10-15% concentration of THC but some forms of cannabis (another name for marijuana), such as the highly concentrated “dab,” contains about 80% THC. However, chronic use of smaller concentrations of THC may also stimulate symptoms of bipolar disorder.
An estimated 1% of the population has symptoms of substance-induced bipolar disorder. The risk for substance-induced disorder may be particularly high in individuals who are genetically prone to severe mental illness, such as individuals with parents or siblings who have a mental health diagnosis.
Having substance-induced bipolar is nobody's fault
Many people with substance-induced bipolar disorder have blamed themselves for their illness; however, the first time these symptoms occurred, they could not have known that the substance would trigger an episode. But, once a person does know that a substance has induced severe psychiatric problems, it is extremely important for the individual to avoid that substance so that these symptoms do not recur or worsen. For example, methamphetamine is one of the substances known to cause substance-induced bipolar disorder. Unfortunately, methamphetamine is highly addictive and consequently, individuals with this disorder urgently need treatment.
The ongoing management of substance-induced bipolar
When a person with a substance-induced bipolar disorder feels better as a result of prescribed psychiatric medication, such as antipsychotic medication, they might assume they are cured, and consequently stop taking the medication. The illusion of being “cured” is enticing. But ongoing treatment may be necessary, even when the illness is managed. Some people may experience a complete recovery from substance-induced bipolar disorder once the substance is no longer present in their bodies, while others experience continuing symptoms. If a doctor has ordered medications, it is extremely important to continue taking these medications unless and until the doctor advises that they can be tapered off.
The process of determining whether it is time to stop medication should be made in partnership with the prescribing physician in order to avoid stopping too abruptly or too soon.
Outlook
Living with substance-induced bipolar disorder can present unique obstacles, and finding the best treatment (therapy and/or medications) can take persistence, time, and effort. Making a connection with the right treatment and treatment providers can dramatically improve one’s quality of life. The majority of people who are properly diagnosed and treated for substance-induced bipolar disorder may gain impressive results. In fact, people who have received medical treatment for their illness often say that starting their medication was one of their most important decisions.
With treatment, people with substance-induced bipolar disorder can reclaim their lives. It is also important to note that treatment is particularly important for people with any form of bipolar disorder, because of the risk of severe complications, including suicide, if the condition is left untreated.
Conditions which often coexist with substance/medication-induced bipolar
Many people with substance-induced bipolar disorder also have other diagnoses, especially anxiety disorders, depression, ADHD, and insomnia, among others. If such disorders are present, they can be addressed during treatment, as well.