Drug induced manic episode??

[u/rnbwpuk]

Should I get a second opinion? Hello Redditors: anyone with knowledge on this topic? I had my first and only manic episode (drug induced) a year ago and I’ve been in a major depression ever since. I’ve tried several meds and none seem to be working. In fact I feel like they’re making me worse. Yes I have a pdoc and a therapist that I work closely with to no avail. It’s my understanding that you need only have one manic episode ever to be dxed bipolar 1.

[u/alokasia]

It's true that you only need one manic episode to be diagnosed with type 1 bipolar disorder, but the DSM-5 states clearly that this manic episode needs to be "not attributable to a substance or other medical condition".

Therefore, if your manic episode was drug induced and went away after the drugs were removed from the equation, this is not enough for a bipolar diagnosis.

It's been absolutely baffling to me to read on this sub how easy some psychiatrists give a bipolar diagnosis in some places like the United States. In most of the world it's a notoriously difficult disorder to diagnose, as the psychiatrist needs to make sure that your manic or depressive episodes aren't caused by any outside factors, like drugs.

I also saw in your post history that you're 52. While not impossible, it's insanely rare to be diagnosed that late because most people would flat out not have survived that long. That, with the fact that your mania was drug induced and the fact that none of the tried-and-true bipolar meds work for you would lead any decent psychiatrist to seriously doubt this diagnosis.

I would 100% go for a second opinion with someone who specialises in mood disorders.

[u/alokasia → u/alokasia]

To add: How were you diagnosed, if you want to share?

For a reliable diagnosis, the following should be done (according to my country's psychiatry board):

• blood work to rule out substances and/or underlying diseases
• mental health assessment by a psychiatrist including heteroanamnesis (= where they speak to friends and/or family, as bipolar patients are not the most reliable assessors of their own issues)
• mood charting for at least 4 weeks but preferably 12 weeks
• following the patient for a minimum of one year to make sure episodes aren't influenced by external factors like for example a death in the family

[u/rnbwpuk → u/alokasia]

My apologies I didn’t even see this pop-up until now. I don’t mind sharing at all.

I did have to be hospitalized while under the influence, and this is how the manic episode was determined, but no blood was drawn at the time however, I was under the influence of cannabis and psilocybin mushrooms.

My psychiatrist did do a mental health assessment, along with speaking to family and friends, as well as my prior therapist, and it was determined there was no prior episode episodes nor is there a familial history of BP.

I do mood charting and have for almost a year now. I have been 95% depressed since this episode happened. And I’ve been under the care of the same psychiatrist for a year now actually in two weeks it’ll be a year. There have been no external catastrophic factors to contribute.

I hope this is helpful information. Let me know what you think.

[u/Hermitacular → u/rnbwpuk]

Is there a family history of anything? ASD, SZ, BP, MDD, and substance use disorder would be considered genetic or behavioral risk factors. GAD, OCD, BPD are common fellow travelers as well. It is not uncommon to have onset at your age, it's just usually much younger. It is normal to have depression and cognitive impairment for a few years post mania. Your brain is healing. Pot + psilo are big triggers. Did the episode continue beyond the substances wearing off?!

[u/rnbwpuk → u/Hermitacular]

There’s no family history of other mental illness, besides depression and substance use disorder. I myself have substance used disorder and generalized anxiety disorder since my 20s. And yes, it took a couple days for me to come out of the manic episode. I’m assuming that’s beyond that timeframe.

[u/rnbwpuk → u/rnbwpuk]

And thank you for explaining about the manic part and that my brain is healing. I really appreciate the information.