Can substance use hide bipolar disorder for years?

Question

Hello doctor,

My cousin is now 28, but he has been heavily using alcohol and recreational drugs since he was around 20. Recently, after getting sober for eight months, he was finally diagnosed with bipolar depression. The whole family is in shock, and we genuinely want to understand whether substance use at 20 could have masked an undiagnosed bipolar disorder for years without anyone realizing what was actually going on underneath.

How common is it for substances to hide or mimic bipolar symptoms for such a long duration?
Would his condition have been much milder today if it had been caught back then?
Is his brain permanently affected now?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

The age of onset of bipolar disorder is usually in the early 20s. The use of psychoactive substances (these are the substances that affect the brain) does not usually mask an underlying psychiatric disorder, but the symptoms can become mixed and may be mistaken for substance-related effects.

In bipolar disorder (a mental health condition characterized by mood swings from one extreme to another), the first episode is generally depressive, and therefore, it is very common to miss the first episode. Excessive use of psychoactive substances can also be a feature of a manic episode and may help in identifying bipolar disorder.

Therefore, substance use does not mask bipolar disorder, but it can worsen the symptoms and the overall course of the condition.

Brain injury is not a major area of concern in bipolar disorder. By taking regular medications, avoiding substance use, and following IPSRT (interpersonal and social rhythm therapy), symptoms can be stabilized, the course of the illness can be managed better, and relapse can be prevented in bipolar disorder.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.