yond the physiological effects of the medication. This condition is considered an indicator of
true bipolar disorder, not substance/medication -induced bipolar and re lated disorder. Simi-
larly, individuals with apparent electroconvulsive therapy–induced manic or hypomanic ep-
isodes that persist beyond th e physiological effects of the treatment are diagnosed with
bipolar disorder, not substance/medication -induced bipolar and related disorder. 
Side effects of some antidepressants and ot her psychotropic drugs (e.g., edginess, ag-
itation) may resemble the primary symptoms  of a manic syndrome, but they are funda-
mentally distinct from bipolar symptoms and are insufficient for the diagnosis. That is, the
criterion symptoms of mania/hypomania have specificity (simple agitation is not the same
as excess involvement in purposeful activiti es), and a sufficient number of symptoms
must be present (not just one or two symptoms ) to make these diagnoses. In particular, the
appearance of one or two nons pecific symptoms—irri tability, edginess, or agitation during
antidepressant treatment—in the absence of  a full manic or hypomanic syndrome should
not be taken to support a diagnosis of a bipolar disorder.
Associated Features Supporting Diagnosis
Etiology (causally related to the use of psychotropic medications or substances of abuse
based on best clinical evidence) is the key variab le in this etiologically specified form of bi-
polar disorder. Substances/medications that are typically considered to be associated
with substance/medication-induced bipolar and related diso rder include the stimulant
class of drugs, as well as phencyclidine and steroids; however, a numb er of potential sub-
stances continue to emerge as new compounds are synthesized (e.g., so-calle d bath salts).