Did you know that you can experience
a one-off manic episode that's not due to bipolar disorder?
There are things that can trigger it
that you should know about.
I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Mania is an excited or hyperarousal state
that causes over-the-top elevated mood,
irritability, increased energy, decreased need for sleep,
impulsivity with poor judgment, speedy thoughts,
and sometimes even psychotic symptoms
like delusional thinking.
Normally, mania is a part of a psychiatric condition
of bipolar disorder.
With bipolar disorder,
you have episodes of mania and episodes of depression.
Mania inside of bipolar disorder is primary mania,
but mania is a state that can be triggered
by other non-psychiatric conditions.
And when this happens, it's called secondary mania.
The mania occurs secondary to another condition.
So let's look at some of the triggers.
They can be grouped into drugs or medications
and then medical conditions.
First, medications.
Probably the most common culprit is steroids
and this is usually from high-dose steroids
greater than 40 milligrams of prednisone.
Prednisone is an oral form of steroids
that you may be prescribed for an inflammatory condition
like cellulitis from an insect bite, tendonitis,
or even asthma.
But in most of these cases,
you get a prednisone taper that isn't over 40 milligrams,
so there's a low likelihood of you erupting into mania
from this kind of treatment.
But some people can get higher doses or get it intravenously
and these higher doses and IV doses increase the risk.
Two other medications associated with triggering mania
are methotrexate and baclofen.
Methotrexate is an immune system suppressant
that is used to treat certain cancers,
but it's also used to treat inflammatory conditions
like rheumatoid arthritis and psoriasis.
Baclofen is a muscle relaxer
that you can be prescribed to treat pain from muscle spasms.
Stimulant drugs can also do it.
Illicit stimulants like cocaine and methamphetamine
are more likely than prescription stimulants
like Adderall and Ritalin,
but if you take your prescription stimulant
at higher doses than the maximum recommended,
which would be higher than 60 milligrams
for Adderall and Ritalin,
you could experience manic symptoms.
Now, this video is about people
who don't already have bipolar disorder experiencing mania.
But if you do have bipolar disorder,
you have to be careful with stimulants
as they can aggravate your disorder
by either making you manic or triggering rapid cycling
which is having more frequent episodes.
Those are the medications commonly associated
with triggering manic episodes.
Some medical conditions
are things like Hashimoto's thyroiditis,
which is a condition where you get excess amounts
of thyroid hormone produced.
Then there's lupus cerebritis.
Lupus is a condition where your body forms antibodies
against your own tissue.
It doesn't always affect your brain.
But if it does, it's called lupus cerebritis.
There's frontotemporal dementia.
You may have heard this term because it was the dementia
that the actor Bruce Willis was recently diagnosed with.
There's stroke, encephalitis,
which is inflammation of the brain.
Some infections cause brain inflammation
as well as autoimmune conditions.
There's brain tumors like lymphoma
and traumatic brain injury and stroke.
Secondary mania is usually temporary
for as long as the primary condition lasts.
So if it's triggered by a medication,
once the effects of the medication wears off
or once the medication is discontinued,
the mania resolves and you shouldn't have any more episodes.
For someone who has to continue
with the mania-inducing medication
like taking methotrexate as part of a cancer treatment,
the doctor may need to add a mood stabilizer for you
like lithium or valproic acid to control the mania.
Since a stroke or traumatic brain injury
can cause permanent brain changes,
the mania may come and go similar to bipolar disorder.
In this case, your diagnosis would not be bipolar disorder.
It would be mood disorder due to the medical condition.
But this is just a technicality to designate
that the mood disorder is stemming from a medical condition
and not as a psychiatric condition.
The treatment would be essentially the same.
You would be prescribed mood stabilizers.
One thing that could be different
from the treatment of primary mania
is if you have an autoimmune condition
or some other medical condition that is chronic,
you may need more than one medication
to manage your psychiatric symptoms.
Many people with bipolar disorder
require more than one medication, but not all.
There are plenty of people
who get by with just one medication
when they're in the maintenance phase in between episodes,
but having an aggravating medical condition
may make your symptoms less responsive to one agent,
and so you may require combination treatment
like an anticonvulsant and an antipsychotic medication.
Common combinations are lamotrigine and quetiapine
or lithium and lamotrigine.
One more thing about steroid-induced mania.
The mania doesn't always come on after the first dose.
Sometimes there can be a cumulative effect
after taking a moderate dose for several days in a row.
So you want to watch out for signs of mania
within the first three to six weeks
of being on continuous steroid treatment.
Not so much for the 10-day taper.
For more on bipolar disorder,
take a look at my bipolar playlist.
Also, are you looking for more education
and support in your mental health journey?
Check out my Mental Wellness Community.
We just had a workshop on bipolar disorder
and it's called the "Mental Wellness Space."
But for now, thanks for watching. See you next time.