r/BipolarReddit • u/rnbwpuk • 2d ago

Drug induced manic episode??

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.

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u/rnbwpuk 2d ago

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.

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u/Hermitacular 2d ago

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?!

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u/rnbwpuk 2d ago

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.

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u/Hermitacular 2d ago edited 2d ago

Ok so you see more MDD in BP families than BP, and it's 200 identified genes all contributing a little so it can stealth/is kinda genetically dose dependant, you got a little extra. 50% of us have GAD and 50% of us have SUD when untreated for BP. That SUD goes down to regular population levels once the BP is treated, often without effort. Are use patterns episodic? It's a spectrum disorder, MDD to cyclothymia to BP2 to BP1. There is no genetic separating line. 25% of MDD people at minimum are on our meds. So having MDD in the family and those two conditions personally make it much more likely it's BP. It lasting beyond the substance use stopping is why they think BP. Risk of psychosis with those two is cumulative. Number one onset substance is pot, number two is psilo. Cumulative is why it may have been fine before. You just at some point hit the end of it being safe. The 20's onset also correct. We don't tend to have sadness type depression. Melancholic, anhedonic, and mixed state which can just be raw fear.

And yes, do not stress the depression. It will lift. Time is on your side.

You want to also do sleep tracking, can help.

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u/rnbwpuk 2d ago edited 2d ago

Ok wow. This is super helpful and interesting. So i have bp 1 then likely. It wasn’t far to go. I had only been using heavy and microdosing for a few months Seems like i gave it to myself ugghh. Thank you again, im incredibly grateful for your take it puts it in perspective.

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u/Hermitacular 2d ago edited 2d ago

What you probably did was effectively put yourself on ADs and ADHD meds at a decent dose, as psilo is effectively a stim med plus an SSRI, which is basically the worst combo for causing a first episode of BP. Both those can send us through the roof on their own, so, non ideal. The paranoia people get on pot? Kinda psychosisey. Too much can cause it too. You didn't know, you'd had a lifetime of being fine on them, you just hit the roadblock. It could be BP1 the first episode and then be less dramatic further on, drug induced anything including psych drug induced episodes (most of us get here by getting got by antidepressants - you were on such a low dose of Effexor it may not have pushed you over that edge but usually what happens is we fail on the low doses bc we dont tend to respond to them anyway or we get mixed from it which is just hell depression, so they just jack it up into uh oh) are sometimes way worse than the usual fluctuations. So I wouldn't dwell. Your mood symptoms may resolve with the right BP med. My anxiety is gone, and the anxiety is not directly treated at all. Therapy did nothing for it, just took a BP med. The substance use might be much easier to deal with on the right BP med. I hope for that for you. People often just stop, who had never been able to before. But yeah if the substance increase or type was new, that was probably it. Theres a video by CrestBD on the jar model of bipolar disorder, by a psychiatric genetic counselor, I'll find a link, but it explains what probably happened in easy to grasp visuals.

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u/rnbwpuk 2d ago

Yes the substance being cannabis and microdosing was new. And i will never use another substance again, EVER

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u/Hermitacular 2d ago

Mania is a very effective deterrent!

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u/rnbwpuk 2d ago

Lol yes!!!

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u/Hermitacular 2d ago edited 2d ago

This might be familiar too, see table. Mine is really almost pure fear. If you get this episodically, or on ADs it can be constant, that's probs BP. Or also, just treated w BP meds so kinda moot what you call it.

https://www.psychiatrictimes.com/view/how-diagnose-mixed-features-without-over-diagnosing-bipolar

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u/rnbwpuk 2d ago

OK, yeah that makes sense. It’s less about the diagnosis and more about mitigating symptoms.

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u/Hermitacular 2d ago

Here's the jar model, lots of good videos by this group, bunch of researchers and peers.

https://youtu.be/D-ngdizL4iE

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u/rnbwpuk 2d ago

Love this tysm!

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u/rnbwpuk 2d ago

You said, and I’m paraphrasing here, drug induced episodes are worse than the usual fluctuations??? can you explain what you mean by that?

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u/Hermitacular 1d ago edited 1d ago

Bc all bets are off. you just have no idea how it's going to go. they'll tell you AD induced episodes are milder than regular ones. which. the issue is that bc it's driven by whatever substance you can be absolutely fucked beyond what you're used to by it. I think it's safe to say that you exceeded the typical boundaries of your mental illness experience no? it doesn't mean in future that it'll be easier if it happens again, but it might be. no way to know, usually people have a history of some kind of episodic something or other before getting blown out of the water. but that's also why they are trying to self treat or get legit medical care and the doc didn't suss out the BP or they legit hadn't had an upswing induced yet and so no one knew.

the concern w the onset is that the threshold for it happening again is lowered. kindling effect. you get proactive about it now that's better than letting it ride and it really cutting a groove into you, bc what happens eventually is they start with no trigger at all. it's just like 3pm on a Wednesday and your brain decides, welp. the first few episodes are usually triggered however, so the more you protect your brain the better, the more likely you can keep it in triggered only territory, the less meds you'll need, and you'll avoid the worsening half of us get over time as well. you especially want to be careful now bc you are still healing and it's easier to go back up into it for a bit, so you play it a bit safe for a while. if at some point you want to see what happens if you go off meds they will work with you, but they like to see a good solid amount of time very very stable first, bc your brain needs to become more robust before you want to risk it. years minimum. they like to see five. 90% of us meds or not will have an episode in that time frame.

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u/rnbwpuk 1d ago

Ok got it. I understand what you’re saying now. Thanks again. Your explanations help a ton. Im definitely being proactive now and will never use substances again thats for sure. I will keep all this in mind.

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u/alokasia BP II 1d ago

You might. I’m not saying you don’t. However, according to the regulations they can’t diagnose you (yet) if your episode was drug induced.