Neuropsychiatric symptoms that may mimic bipolar disorder, such as abrupt mood swings or psychosis, can be brought on by lupus.

Bipolar disorder can occasionally be mistaken for lupus, particularly when neuropsychiatric symptoms like mood swings, mania, or psychosis are present.

These symptoms could be caused by neuropsychiatric lupus (NPSLE) or be adverse reactions to some lupus drugs.

Another layer of difficulty is that many bipolar drugs may cause symptoms similar to lupus.

Symptoms of lupus vs bipolar disorder

It’s important to think about the symptoms of both bipolar illness and lupus and where they might overlap before delving more into the connections between the two conditions.

Lupus symptoms

• joint pain and swelling
• skin rashes (often butterfly-shaped on the face)
• fatigue
• fever
• hair loss
• photosensitivity (sensitivity to sunlight)
• mouth or nose ulcers
• kidney issues (in more severe cases)
• chest pain (from lung or heart inflammation)
• cognitive issues (such as memory problems or confusion)

Bipolar disorder symptoms

• mood shifts between mania (high energy) and depression
• manic symptoms
• depressive symptoms

Overlapping symptoms

• fatigue (persistent tiredness and lack of energy)
• cognitive issues (memory problems, confusion, difficulty concentrating)
• mood changes (irritability, feelings of sadness or depression)
• sleep disturbances (insomnia or irregular sleep patterns)

Can lupus cause bipolar disorder?

Bipolar disorder (BD) is not thought to be directly caused by systemic lupus erythematosus (SLE). There might be a connection between the two disorders, though.

0.62% of SLE patients and 0.26% of controls had bipolar illness, which is a statistically significant difference, according to a major 2017 study that compared 5,018 people with SLE to 25,090 adults without SLE (controls).

The study also found that smoking was associated with a higher risk of bipolar disorder and that smoking was more prevalent among those with bipolar illness. This implies that symptoms resembling those of bipolar disorder may be exacerbated by the autoimmune processes in SLE, which can impact the central nervous system.

Can lupus mimic bipolar disorder?

Neuropsychiatric lupus (NPSLE) is a condition in which SLE manifests as neuropsychiatric symptoms. Bipolar disorder may be mistakenly diagnosed as a result of this.

According to estimates, neuropsychiatric symptoms like mania and psychosis affect two-thirds of people with SLE.

Indeed, research indicates that up to 80% of individuals with SLE experience cognitive impairment, and up to 39% experience despair. About 24% of people experience anxiety as a result of their emotional reaction to their condition. Inflammation and other brain disorders are associated with the biomarkers now used to evaluate neuropsychiatric difficulties in SLE.

This problem is highlighted in a case study: After four years of experiencing severe behavioral changes, such as mood swings and impatience, a 26-year-old lady was first diagnosed with bipolar illness. But after she passed out, it was discovered that she had SLE and limbic encephalitis, which affects the emotional regions of the brain.

Ongoing brain involvement was indicated by an MRI that showed shrinkage in the temporal lobe and claustrum and injury in the pons. Significant neurological issues, such as disorientation and strange movements, were displayed by the woman.

A 15-year-old girl with a family history of schizophrenia and bipolar disorder who displayed signs of an affective condition is the subject of an older 2009 study. She needed numerous hospital stays for mood disorders after being initially diagnosed with bipolar illness with catatonic symptoms.

She experienced a malar rash two years later, which prompted a rheumatologic evaluation that revealed cerebral vasculitis. After receiving a diagnosis of NPSLE, she was able to stop using psychiatric drugs since she responded effectively to steroid treatment.

Can bipolar disorder medications cause lupus?

An estimated 15,000 to 30,000 Americans are afflicted with drug-induced lupus (DIL) annually. This transient illness is brought on by specific drugs and manifests as symptoms similar to lupus.

More than 90 medications have been connected to DIL since 1945. Bipolar disorder is treated with a few of these:

• Valproate: This mood stabilizer is frequently used to treat manic episodes.
• Carbamazepine: As a mood stabilizer, this is commonly administered, particularly in cases when lithium is ineffective or has negative side effects.
• Phenytoin: Although it is sometimes prescribed off-label for mood problems, this is mainly used for seizures.
• Lamotrigine: Though it has a DIL risk, it is well-known for treating bipolar depression.

Although there may be less chance of DIL being induced by other mood stabilizers and anticonvulsants, it is nevertheless advisable for sensitive people to keep an eye out for symptoms.

Can lupus medications cause bipolar symptoms?

Although lupus drugs do not directly cause bipolar illness, some of them may have psychological side effects or mood swings that mimic bipolar disorder symptoms. These could consist of drugs like:

• Chloroquine: It is used to treat lupus and malaria, but it can also cause mood swings and other mental health issues.
• Hydroxychloroquine: This is a chloroquine derivative that is used to treat lupus. Psychiatric problems and mood disorders could result from it.
• Prednisone: This corticosteroid is frequently used to treat lupus. It can cause anxiety, mood swings, and indications of psychosis.
• Mycophenolate mofetil: This immunosuppressant, which is used to treat lupus, can cause anxiety, depression, and mood swings.

According to a case study, a male SLE patient’s bipolar symptoms worsened after taking chloroquine. While taking the medication, he did not exhibit any psychiatric symptoms at first, but later use brought on severe depression episodes and psychotic symptoms.

Treating bipolar and lupus together

Healthcare providers must treat bipolar disorder and lupus together with caution and cooperation since some medications used to treat one illness may have an effect on the other.

Usually, they are handled in tandem as follows:

Medications

Antipsychotics (such as lithium or quetiapine) and mood stabilizers are frequently used to treat bipolar symptoms. However, some bipolar drugs, such lamotrigine, are taken with caution since they have been associated with rare incidences of drug-induced lupus.

In order to lessen inflammation, lupus patients frequently use immunosuppressants like mycophenolate mofetil and steroids like prednisone. Steroids, however, can have an impact on mood and may cause bipolar individuals to experience mania or despair.

If mood instability is a problem, doctors may choose the lowest effective dose or take into account alternatives that don’t involve steroids.

Therapy and counseling

For people with chronic conditions like lupus or bipolar disease, psychotherapy, including cognitive behavioral therapy (CBT), can be helpful in controlling mood swings, lowering stress, and developing coping mechanisms.

The bottom line

When you have lupus, neuropsychiatric symptoms including mood swings, mania, and psychosis might be caused by the disease itself (NPSLE) or by adverse drug reactions.

In turn, some people may get lupus-like symptoms when using specific bipolar drugs. Understanding these links contributes to a precise diagnosis and successful symptom management.