After a Psychotic Break, Finding Clarity in a Bipolar I Diagnosis

Eli Olmstead had spent years being treated for attention-deficit/hyperactivity disorder (ADHD) and anxiety by the time he experienced his first manic episode at age 24. What followed was a two-week episode marked by decreased sleep, racing thoughts and increasing talkativeness, escalating partway through into acute psychosis severe enough to involve police, fire and ambulance response. That crisis led to hospitalization and, finally, a diagnosis of bipolar I disorder.

In this interview, Olmstead talks about the symptoms he and his doctors had long attributed to ADHD, what it was like to reframe years of his life around a new diagnosis, and why he stayed engaged with treatment rather than pulling away after such a frightening experience. He also discusses finding an effective medication in Lybalvi (olanzapine and samidorphan) after his first treatment attempt did not work, and what his life looks like now, several years removed from that hospitalization.

You were already being treated for ADHD and anxiety when you experienced your first manic episode at 24. Looking back, were there signs of bipolar I disorder that you or your doctors missed along the way?

Eli Olmstead: Looking back, some of the signs of bipolar I disorder may have been there, but my doctors and I viewed them as part of my ADHD. I had always had mental health symptoms and was being treated, but it wasn’t until I had a manic episode with psychosis and was hospitalized that I was diagnosed with bipolar I.

Leading up to that point, I was extra productive, super aware of my surroundings, and focused on trying to solve problems and connect dots. I was also way more talkative than usual, which previously my family would push off as part of my ADHD.

In my family, we’ve since said that some of the experiences we thought were ADHD could have been symptoms of manic episodes. It’s weird to think back and wonder whether bipolar I was affecting me earlier in my life.

Going from an ADHD and anxiety diagnosis to a bipolar I diagnosis after a psychotic break is a significant shift. What was it like to finally have the right diagnosis, and how did it change the way you understood your own experience?

EO: It took me a long time to realize how much my life was going to change and how many symptoms I now had to be aware of and look out for. I’m still learning!

Living with bipolar I disorder means I can’t keep pushing things off as stress. I have to tackle what is going on and work through it before it leads to another manic episode. I have become much more aware of the symptoms that were happening before my diagnosis and try to identify what needs to be done going forward.

It has also made me look back at parts of my life differently. Aside from conflating symptoms of ADHD with signs of mania, I have also thought a lot about the confidence I used to feel. Some of what I thought at the time was confidence may have been connected to mania. Now, I am aware of feeling more even in my moods.

A lot of people in your situation might have pulled back from the health care system after something as frightening as a psychotic break and hospitalization. What kept you engaged in treatment and willing to keep seeking help?

EO: I have always been willing to accept help, and I know the health care system is trying to help me. About a year before my hospitalization for the manic episode, I was trying to be more open about my depressed feelings. My parents said, “We would like you to go to the hospital, based on what you’re saying,” and that time I self-admitted.

After my psychotic break, and once I had received a complete diagnosis, everybody in my life was super supportive. My family and friends were relieved that I was finally getting the help I needed. I am also fortunate that I have not had a difficult time finding a treatment approach that works for me. The initial medication I was put on was not a match, and after a month I was switched to my current medication, Lybalvi. Lybalvi has been effective at managing my bipolar I symptoms, and I have not had another hospitalization since starting it.

You got your bipolar I diagnosis faster than many people do. What do you think made the difference, and what would you say to someone who has been struggling for years without getting clear answers about what is going on?

EO: The manic episode that ultimately led to my diagnosis was very serious. It lasted about two weeks, and halfway through I experienced acute psychosis. By that point, I was screaming, bawling and freaking out, and the police, fire department and an ambulance became involved. Afterward, my parents and I were able to look back at the decreased sleep, racing thoughts, increased productivity and how much more talkative I had become and recognize these signs as characteristic of severe mania and the onset of psychosis associated with bipolar I disorder.

For anyone who has been struggling without clear answers, the biggest thing I would say is: Don’t be embarrassed. I offer that recommendation to myself as much as anyone, because I am still embarrassed about some of the ways I acted during mania and psychosis. When you are in a bipolar crisis, you may have very little control over what you are doing. My family had to tell me, “You had no control over it, Eli. You shouldn’t be embarrassed. I get why you would be, but it’s not your fault.” You do not have to have everything figured out right away.

What does your life look like now compared with before your diagnosis, and what has made the biggest difference in getting to where you are today?

EO: Before my diagnosis, there were parts of mania that felt kind of amazing at first. I could be ultraproductive, hyperaware of everything around me and a lot more adventurous. I would rather take the stability any day.

My life now is pretty normal. I work for an aerospace company and live on my own but am never too far from home. If I feel myself having symptoms and want to go home, I still have that opportunity. I can see my parents, my sister and my cousins, get refueled and calm back down to a place where I feel good. I also play a lot of video games, listen to music and see my family when I can.

The biggest difference has been getting the help I needed. Having friends and family who have been super supportive, along with finding Lybalvi, which has been effective and tolerable for me, has gotten me to where I am today.