which came first

Hi community, I'm hoping for some perspective while I confront the desire to free myself (again) from the side effects of my medication therapy...mostly demotivation, constant anhedonia and decreased sex drive.

I've tried extensively to debunk my own diagnosis of BP1 over the last ?? years. It get's complicated by co-morbid ADHD and GAD. What I know for sure is I had suicidal depression for prolonged periods from age 13/14...before mania reared it's head there came substance abuse, and my self-understanding is that all of my manic episodes, which include psychotic symptoms (hence bipolar 1), have been related to alcohol and illicit substance abuse. Does that count as bipolar then?

Perhaps depression/anxiety triggered by undiagnosed and poorly managed ADHD while young leading to substance abuse disorder...as opposed to bipolar. I have discussed this with my psyche but he only sees risk of suicide if I move away from medication therapy.

Any insight would be appreciated.

I have no answers, but I just wanted to let you know I'm in a very similar position. I've come to realize most all of my manic episodes were triggered by antidepressants or rec. drugs. I still have a schizoaffective/bipolar diagnosis though. I am being tested for ADHD soon as well. I'm working on getting/staying sober and after a period of being clean I will bring this up and maybe ask for a re-evaluation since it's kinda pointless right now. The important thing is to be honest with pdoc about what you used and when and let him, the expert, lead the way.