What it is
Some substances and medicines can directly produce manic or depressive mood states. Substance/medication-induced bipolar and related disorder is diagnosed when a significant mood disturbance with manic or depressive features arises during or soon after using a substance, withdrawing from one, or starting a medication capable of causing it.
Stimulants (including khat and amphetamine-type substances) can produce elevated, agitated, manic-like states; alcohol and its withdrawal can drive marked mood swings; and certain prescribed drugs, notably corticosteroids, can trigger manic or depressive episodes in some people. Recognising the cause is essential, because the treatment is different from primary bipolar disorder.
Why the distinction matters
If a substance or medicine is driving the mood change, the central step is removing or adjusting it, under medical guidance where a prescription is involved, never by stopping a prescribed medicine abruptly on one's own. Mood often stabilises once the trigger is gone.
This is also why honest disclosure of substance use and a full medication review are so important during assessment of any apparent manic or depressive episode. The right history prevents both missed substance causes and the mislabelling of a substance effect as lifelong bipolar disorder. If mood symptoms persist well after the substance clears, clinicians reassess for a primary mood disorder.
Substance-induced bipolar in the African context
In our region the usual triggers are stimulants, including khat and amphetamine-type substances, which can produce elevated, agitated, manic-like states, and alcohol and its withdrawal, which can drive marked mood swings. Steroids and some other prescribed medicines can do the same in vulnerable people. A manic-like state is often understood first as bewitchment or possession, which can delay assessment. The most useful step is an honest account of substances and a full medication review, which prevents a substance effect being mislabelled as lifelong bipolar disorder. See also our bipolar guide.
What helps
The central step is removing or adjusting the cause.
- If a substance is driving the mood change, stopping it, with support, often settles the mood.
- If a prescribed medicine is responsible, raise it with the prescriber, and never stop a prescribed medicine abruptly on your own.
- Where withdrawal is involved, seek medical guidance, since some withdrawals are dangerous.
- If mood symptoms persist well after the substance clears, clinicians reassess for a primary mood disorder and treat accordingly.
- Be candid about substances and medicines, since the right history changes the diagnosis and the treatment.
When to seek help
Seek assessment for any manic or significantly disturbed mood state, and be candid about substances and medicines. If a prescribed drug seems to be the trigger, raise it with the prescriber rather than stopping it yourself. See also our substance use guides.
Sources
- American Psychiatric Association. (2022). DSM-5-TR.
- Brown, E. S. (2009). Effects of glucocorticoids on mood, memory, and the hippocampus. Annals of the New York Academy of Sciences, 1179, 41-55.
- Pacchiarotti, I., et al. (2013). The International Society for Bipolar Disorders task force report on antidepressant use in bipolar disorders. American Journal of Psychiatry, 170(11), 1249-1262.