Talk to your psychiatrist (I'm assuming you have one). However, I would exercise great caution and recognize that just in your posts here, you 1) have a history of a drug-induced mood disorder (I suppose this could be due to medications, but reading between the lines I'm guessing illicit drug use) and 2) you are using a medication which has absolutely nothing to do with controlling mood to "feel better." If you have an anxiety disorder, then get in some therapy and start controlling your symptoms that way. Absent that, I would look at your situation objectively, think about what you're actually getting out of the benzos, and react accordingly.
There's nothing wrong with taking benzos if you have crippling anxiety that has otherwise been resistant to treatment and they allow you to function. You seem to recognize there are long-term risks involved with that treatment. But your story gives me the flavor of "current/future substance abuse," and as a future physician that is unlikely to end well.
To be fair, PLENTY of BPAD sufferers have their first manic episode induced by prescribed SSRIs or steroids. Hypomania by its definition can easily go under the radar, and most BPAD 2 sufferers spend their time depressed, and meet their final diagnosis after seeking help and having a bad experience with a prescribed SSRI. Of course illegal substances can as well, but in my experience physicians forget to screen for patients at high risk of manic switching (family history of BPAD, history of hypomanic symptoms) often. I'll go out on a limb and say I've seen way more manic episodes precipitated by a patient seeking care than illicit drug use but we need a citation here instead.
I have another name for it. Drug abuse.
Red flags go off everywhere when I see somebody defending use of a substance that makes them high.
oxycodone for unbearable back pain
xanax for anxiety
adderall for ADHD
marijuana for literally just about anything
If you could take away the euphoric feeling from use of these drugs but somehow retain their ability to treat the conditions they are used for, their use would drop precipitously.
It's about getting high for the vast vast majority of people.
OP, my note to you is at the end of this
Med students/physicians, a few notes
I have seen these drugs used appropriately and inappropriately. I'm not seeing an issue with using xanax for anxiety or adderall for ADHD.
Lithium is still considered "first line" as it is most *effective* however depending on the full psychiatric picture many psychiatrists do not use it first if they can find success with say, an atypical to "calm" a manic episode and then maintenance on lamotrigine or depakote. Most of the anticonvulsants have less downsides with side effects or levels monitoring/toxicity than lithium. Clinical severity will play a role too. Effectiveness of a medication is not the only consideration so it is not always lithium that is started.
The way OP phrased needing benzos for depression and to go out with friends raised my eyebrow TBH.
However, I will say that anxiety is frequently comorbid with bipolar disorder. Sometimes the two can be treated as though they are seperate disorders, meaning you could treat the anxiety like you would in someone without bipolar and have total success.
Last research I saw on pharmacological therapy for GAD supported benzos as more effective and still first line over SSRIs that are also effective. Not really what any doctor wants to hear. However, last research I saw still supported psychotherapy as more effective long term over benzos for GAD. So the truth is that the use of benzos in psychiatry is more complicated than "these drugs have abuse potential therefore they are bad and shouldn't be used." Studies still support they have medical application.
Let's remember that *agitation* is a standard symptom for mania/hypomania/mixed episode. What makes agitation so different than anxiety? Easy to mix them up. They don't feel very different from what I can tell. And it's very naive to think BPAD + Li or any other mood stabilizer = resolution of all symptoms. While I wouldn't expect benzos to act as a mood stabilizer for a mood episode in BPAD, I wouldn't be surprised if benzos had some effectiveness for some symptoms of anxiety/agitation. If fact, I know they do.
Li can cause tremor and I've heard of some people having anxiety on it! I've seen more than one patient *stuck* on seroquel/other atypical as a mood stabilizer, which then gives them akathisia for which I see neurologists and psychiatrists prescribe - you guessed it - a benzo. I know one patient taking Seroquel for BPAD nightly, taking clonazepam for the akathisia that kicks in acutely when the Seroquel hits them. They started to develop daytime anxiety, their psychiatrist said this was likely rebound anxiety for which he prescribed - you guessed it - daytime benzo.
Prescribing one medication to deal with the side effects of a first one is *never* ideal and to be avoided wherever possible.
The reality is, some people with BPAD effectively "luck out" and can take one medication, however, for most they need to a find a combination of medications for the primary mood disorder and also for not only lingering symptoms but also medication side effects!!
Let's make no mistake, Lithium and atypicals have side effects and suck and there's a reason BPAD sufferers don't want to take them, especially when they start feeling better (although of course to prevent harm they almost always need to continue them).
OP
All of this is to say, OP, I am not going to call you a drug abuser or make judgements for what you and your psychiatrist have worked out with your meds. You and he/she probably know this is not ideal and that if there's a way to manage your BPAD/anxiety without benzos that would be preferable. Talk with your psychiatrist about your concerns about benzos and your career plans.
I can't say there is any psych drug I have heard of a medical student/physician taking and NOT being able to be a medical student or physician just on that basis, but valid concerns were raised in this thread re: medication side effects and long term. Many people develop a tolerance to benzos where they lose effectiveness, often this ends with the dosage being increased, where there is diminishing benefit in the fact of increasing side effects, and as I mentioned potentially rebound anxiety, the very thing you wish to avoid now occurring between doses of the medication, just because the level is getting low in your blood! Medicine is a demanding career for the most healthy. Those with mental illness, particularly bipolar disorder, face special challenges. Being a medical student and a physician can be very anxiety-provoking, and dealing with people successfully a constant.
Check out
psycheducation.org and share the site and any info you think is interesting with your psychiatrist (Dr. Michael Phelps is a psychiatrist and expert in BPAD)
focus on self-care
feel free to PM me
I have an extensive post history on topics of mental health, disability, and medical administration. Feel free to search it as I am too tired to pick the links out for you at the moment. SDN has a search feature to search through a specific poster's history.
