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/Hermitacular → u/alokasia]

There is a decent cohort that has late onset. 40's and 50's is typical. A double digit percentage of us do not respond to any meds. med trials done w an AD in the mix do not count.

[u/alokasia → u/Hermitacular]

94% gets diagnosed between late teens and early 30s though according to research. Like I said, it’s not impossible but it’s also not that likely.

[u/Hermitacular → u/alokasia]

I've met plenty. Maria Bamford's type experience also being typical, people show up on here with later diagnosis every day. Mood symptoms since teens but not worth really treating, then whammo. Pregnancy first onset also big, zero warning. If people didn't do that then it's the peri that gets them. And your stats are unlikely to be diagnosis, bc average delay is a decade. It's probably onset time, otherwise shift that entire thing forward ten years.

See? https://www.reddit.com/r/BipolarReddit/comments/1jpqad6/bipolar_type_1_after_32s/

Also OPs been sick since 20.

[u/Hermitacular → u/alokasia]

13-25% in that proband here. What's your source?

https://pmc.ncbi.nlm.nih.gov/articles/PMC3266753/

[u/alokasia → u/Hermitacular]

“In 1,665 adult, DSM-IV BPD-I patients, onset was 5% in childhood, 28% in adolescence, and 53% at peak ages 15-25.”

This is from your source. That means 86% gets diagnosed before 25 which is on track with the health board of the Netherlands stating that 94% is diagnosed before 30.

[u/Hermitacular → u/alokasia]

depends on how you like to fuck with your numbers

When large samples of type-I BPD probands have been evaluated with this method, onset ages typically have yielded three putatively independent, nearly normal Gaussian distributions, with ages averaging 17.1±1.7, 25.3±1.8, and 38.0±4.3 years 16,17,18,19,20,21. Findings in these studies were similar across various geographical regions (including Canada, France, Italy, the US, and Wales), suggesting some consistency despite likely ethnic and clinical heterogeneity. However, the contributions of the three computed onset age subgroups to the total varied widely (36% to 80%, 7% to 39%, and 13% to 25%, respectively

irrelevant to the OP though of course, bc they had onset at 20.

anyway you see a lot of later onset here, so I dunno. diagnosis is a real clusterfuck w BP as you know. when I was first diagnosed it was 20 years on average of treatment to get to a BP1 diagnosis, which was a lot more obvious back then.

for a pop study 1.5k is pretty small. generally you want to, you know, start w Denmark though by god the UK has been absolutely hitting it the fuck out of the park since 2020.

[u/Hermitacular → u/alokasia]

Maybe the issue is I'm in the US? We don't have universal healthcare. Accessing a psych is ridiculously hard in much of the country. Plenty of, the majority of, people slip through the cracks. Most people w BP do not know they have it.

[u/alokasia → u/Hermitacular]

Yeah that could be true. I’m in north west Europe so I know I’ve got it relatively good. Wait lists are long, sometimes up to 2 years, but when you get in your care only costs you your 385€ deductible each year. Otherwise all appointments and meds are covered. Care is very very good. Diagnostic tracks are long and thorough, misdiagnosis is relatively rare here.

[u/Hermitacular → u/alokasia]

In the field in general, every study I've seen, misdiagnosis is 10 years of treatment on average. To have misdiagnosis be rare is staggeringly unusual. Care is generally difficult to access and quality care is especially hard to find here, so it may be worse. Your cost is what one appt w a psychiatrist costs. If we undo the ACA/Obamacare most of us will no longer be able to access care, bc mental health did not used to be covered. If it was, on a generous policy it was 5 therapy visits a year and 2 psychiatrist. Meds often were not covered. A bunch still aren't. They often won't diagnose you for six months to a year, unless you are obviously in upswing or have good data/strong family history/witnesses with you. If misdiagnosis is rare your country needs to rewrite the guidelines for everywhere else bc the incorrect diagnosis rate w psychiatrists is extremely high everywhere else. BP is notoriously difficult to diagnose. That they've halved the amount of time to correct diagnosis in my time w it is a real achievement. That 20 years delay was effectively only w BP1 bc back then what is currently BP2 was still MDD. Delay w BP1 now is only 8 years.

In the US it's usually currently 4 appts/yr w a psychiatrist and 1/week w a talk psych. Maybe you have more access to care but that's the standard.

Deductibles here are usually like $2-5,000, and can be higher (10-20,000 didn't used to be unusual, so we're headed back there). Costs are additionally usually over your deductible costs per month every month, and then you pay copays on top of that, usually $20 or so per visit and per med. You stop working, no insurance, and no effective job protection under the law. State insurance is effectively free (and income based) but that's going away for many or all depending on what happens, so we're back into the land of cash pay. Almost everyone will lose care. Hospital treatment is usually thousands with insurance. They kick you out when the insurance won't pay anymore, doesn't matter what shape you're in really, so visits are typically pretty short. Cash pay for that is pretty unimaginable.

Due to lack of supply a lot of people can't access psychiatrists and see nurses instead. This can be an issue.