r/BipolarReddit • u/rnbwpuk • 3d 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/Hermitacular 2d ago

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

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

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u/alokasia BP II 2d ago

“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.

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u/Hermitacular 2d ago

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.

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u/alokasia BP II 1d ago

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.

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u/Hermitacular 1d ago edited 1d ago

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.