Although he doesn’t recommend it for others, Philip over at Furious Seasons describes what kind of year it’s been since he’s been off of his medications for bipolar disorder:
I’m comfortable saying that if I were going to crash and burn and wind up back at square one, it likely would’ve happened by now. Things haven’t been perfect–there was a bout of depression/seasonal affective disorder a few months back, and my metabolism went haywire after I got off Lamictal and I put on 20 pounds–but I did come through an extremely cold, gray winter (one of the worst ever in Seattle), have been under loads of professional and life stresses and so on. And, yet, things are pretty good.
This isn’t supposed to be happening, not by the standards of medicine and psychiatry. Bipolar disorder is a lifetime diagnosis and you take medications pretty much forever. If you don’t follow through, you are dangerous, a person best kept at arm’s length by one and all.
I know I am lucky, but luck only accounts for so much. The rest is all questions: Did I ever have bipolar disorder? Was my initial diagnosis wrong? Am I a false positive? Did I cure myself? Am I simply a bipolar who does well without meds? Am I in a lengthy remission that will crumple on me someday? Is the diagnosis of bipolar disorder bullshit to begin with? Does the disorder ebb with time? Or am I just a medical freak show, the lone exception that proves the rule?
In his followup post, he describes what led to his decision to try his psychiatrist’s advice to get off of medications altogether, after trying a number of combinations of medications that didn’t seem to be helping him all that much.
I don’t think bipolar disorder has to be a “lifetime diagnosis” — people can and do get better with it over time. And while I don’t think going off of meds for bipolar is for anyone to try on their own (Philip did it with his psychiatrist’s help), it may be something to discuss with your doctor if you feel like you’ve hit a treatment wall. The problem with medication compliance in bipolar disorder is primarily when a person is in a manic phase and feels like they no longer need the medication, and discontinue it on their own, without consulting their psychiatrist or doctor.
The conventional wisdom is that for someone to be successfully treated with bipolar disorder, they must be on medication for a very long time. Sometimes the conventional wisdom is wrong.
Congratulations, Philip! We hope you have many more fruitful years to come.
Read the first post: Losing my religion
Read the followup post: How I got off meds
(5 votes, average: 4.6 out of 5)
Loading ...This entry was posted on Wednesday, July 23rd, 2008 at 4:27 pm and is filed under General, Medications, Disorders, Bipolar, Treatment. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
13 Responses to “One Year Medication-Free with Bipolar Disorder” (Pingbacks/trackbacks not shown below)
Tyler at 6:56 pm on
July 23rd, 2008
Just my own two cents. Was undiagnosed for 4 years, then medicated & under psychiatric care (in Canada) for 5yrs with zero success. Tried a LOT of meds… Was then clued in by my boss to a researcher in Calgary looking at vitamin therapy, and gave it a go (what did I have to lose?)
6yrs later, I have not been on any meds for my bipolar since and haven’t had an episode, just life’s usual emotional ups and downs. Very happy with that! The vitamins work very well for a large number of folks, and it does have some research behind it. For anyone who’s interested, the vitamins are called EMPower Plus, from Truehope.
David Moyer at 9:41 pm on
July 23rd, 2008
It is difficult to comment without knowing the details. I see bipolar as two, bipolar heavy and bipolar light. If he has the bipolar (heavy) with a history of psychosis his strategy may be more risky than if he has the light version. If there is a history of psychosis, the natural history is for remissions of from one to two years after a first episode with shorter remission periods after that. If that were the case a year and a half of remission would not be enough to say he is OK. Regardless, I would recommend nutritional support in the form of E.M. Power just to be on the safe side.
I have serious doubt this indivual is bipolar as the meds were not working. Bipolar is quite easy to misdiagnose; particularly bipolar II, or “soft” bipolar. I’m not sure “congratulations” are appropriate or warranted. This article feels a bit irresponsible to me.
g w fourmyle at 2:31 am on
July 24th, 2008
well, welcome to earth—these ’snake-oil’ pill-pushers still abound—they kill ya, make a buck—that’s their motive and alleged profession—’Do No Harm’? yeah right. an old USF lit prof spoke true–”If you wish to cut people, yet be honest, ethical, you become a surgeon.” well, if you’re nutz, and wish to make others so? that’s your typical shrink—’run a mile’.
Joe Kraynak at 5:34 am on
July 24th, 2008
Not sure I agree with the following entirely: “The problem with medication compliance in bipolar disorder is primarily when a person is in a manic phase and feels like they no longer need the medication, and discontinue it on their own, without consulting their psychiatrist or doctor.”
Many people with bipolar stop taking their meds when they start feeling better because of the meds. People tend to do the same thing with antibiotics. That’s why doctors and pharmacists have to keep reminding them to finish the prescription even after they start feeling better.
James at 8:11 am on
July 24th, 2008
The “soft” form of bipolar disorder is called Cyclothymic disorder. Bipolar one is characterized by more manic phases and bipolar two is characterized by more depressive phases. The difference between the two is a matter of which side if the mood continuum is more prevalent.
It is very common for people suffering from this disorder to discontinue meds. It doesn’t mean they don’t need them. They just don’t realize they need them.
dubya at 10:48 am on
July 24th, 2008
After one year he states, “I’m comfortable saying that if I were going to crash and burn and wind up back at square one, it likely would’ve happened by now.”
Perhaps he’s comfortable, but any knowledgeable person about bipolar,patient or physician, certainly wouldn’t be. After one year he considers cured. Maybe come back in ten and we’ll see.
I do hope in ten he’ll be able to say the same things, though.
Kent at 7:56 pm on
July 24th, 2008
Psychiatric drugs did not evolve along with humanity, like wheat. Throughout most of human history people with conditions that would nowadays be diagnosed as bipolar disorder must’ve survived without medications. They must’ve lived at least long enough to have children (presuming that the condition is inherited). Only in the last half-century or so have there been these drugs that are now said to be indispensible to almost anyone with bipolar disorder.
So I wonder how could the people with this condition, or with any of the other conditions that would now lead to a major psychiatric diagnoses, possibly have made it through life without these drugs if they are now essential. Is life so much harder nowadays, or were they just lucky enough to survive in spite of themselves in previous eras, or is there some other completely different explanation? I think anyone who is convinced of the absolute necessity of modern psychiatric medications should at least consider this question.
Joe Kraynak at 7:58 am on
July 25th, 2008
Long ago, they locked people away in asylums or gave them lobotomies or extreme electroshock therapy. My wife just spent 10 days in a mental healthcare facility. I believe her stay was significantly shortened primarily due to lithium she was given. She had a speedier, less traumatic recovery than she would have had without the lithium.
When she mentioned that 10 days was a long time, one of the staff said that the standard stay not so long ago had been 30 days.
Maybe the meds are not an “absolute necessity,” but they sure help a lot of people. I know I would much rather spend 10 days in one of those facilities than 30… or several months.
I do believe that mental illnesses are becoming more prevalent now than in the past due to environmental and social stressors. Perhaps this is why these medications are more of a necessity now.
As a psychiatrist who has treated many hundreds of patients with bipolar disorder, I would counsel extreme caution with regard to discontinuing medication. While I certainly hope that Philip continues to do well, the overwhelming majority of those correctly diagnosed with bipolar disorder do require mood-stabilizing medication indefinitely.
Sadly, the natural history of bipolar disorder is that, over time, as many as 15% of patients will commit suicide. The time a sufferer spends depressed is usually much more than he or she spends in a manic phase (when suicide risk is less). Unfortunately, it is the depressed phase (as well as “mixed” episodes) that greatly elevates the risk of suicide. Furthermore, there is at least modest evidence that the more manic and depressive episodes a person has, the more “entrained” this cycling pattern becomes–a phenomenon sometimes termed “kindling”. So there is good reason to take a preventive approach to this disorder.
I realize that writing this may be a kind of “downer” for those, with bipolar disorder, who want to be free of medication and its potential side effects. Who wouldn’t want to be “off meds”, all other things being equal? But I believe it would be irresponsible not to point out the risks of stopping medication. There is reasonably good evidence from a number of studies (though not all) that lithium–and possibly other mood-stabilizers–substantially reduces the risk of suicide in bipolar disorder. By the way, lithium is not a “drug” in the conventional sense; it is a naturally occurring element found in some mineral springs. Popular lore has it that the ancient Romans used to drink from such springs, to deal with their “mood swings”! Folklore, perhaps, but this is an under-utilized medication, in my professional opinion–and definitely not one that makes the drug companies a lot of money. (A month’s supply of lithium costs only a fraction of what many less useful medications cost). Lithium does have a number of significant side effects, but when it works, it works very well. Readers who want to learn more about lithium might want to see my editorial on this, in the Journal of Clinical Psychopharmacology (October,2002).
All this is not to say that life-time medication is essential for every single person with bipolar disorder. There may be as many forms of bipolar disorder as there are bipolar patients, and there are always exceptions to the rule. There are a few instances in which a trial off medication may be justified, especially if the diagnosis itself is in doubt, and if the patient can be very closely monitored. It is also important to provide psychological and social support to those with bipolar disorder–medication is only a part of the approach.
Finally, readers of the comments above should cast a cold eye on claims about “nutritional” supplements as substitutes for established treatments for Bipolar Disorder. Much more evidence is needed to validate a purely nutritional approach. There may indeed be a role for certain nutritional supplements, such as omega-3-fatty acids (it’s hard to argue with eating more salmon and herring!)in stabilizing bipolar disorder. But for patients with the more severe forms of bipolar disorder–particularly those who have had psychotic symptoms, multiple hospitalizations, or a history of suicidal behavior–I believe that the best approach remains traditional mood-stabilizing medication and psychosocial support. –Ronald Pies, MD
terri at 6:47 pm on
August 12th, 2008
I totally agree with Dr, Pies. I was diagnosed with bipolar 22 years ago. During that time I have been on Lithium, Zeprexa, Navane, Depokote, Lamictal, Geodon, Seroquel, Ativan and Klonopin and I have to say I’ve hated every minute of it, but without them I swing manic and ultimately end up with some form of psychosis. I have tried several times to get off meds and each time it’s been unsuccessful. Medicine adjusments and changes have been going on for years. All I can say is take each day at a time and as the years pass you get to understand your illness better. I’m currently on Lamictal, Seroquel and Klonopin…I have never felt more balanced. I hold my breath hoping that this combination will continue to work and my weight gain won’t come back. My pdoc switched me from Lithium to Lamictal and I dropped 50lbs. Then because I was having trouble with my heart I had to give up my Geodon and start on Seroquel. My eating is under control and I hope weight gain won’t be much of an issue. Geodon is weight neutral Seroquel is not. Medication weight gain is a huge problem. Another problem that is frustrating is that doseages need to be increased because of building up tolerances.
All and all I have to say medication has given me a more balanced life and even with the side effects it improves my quality of life.
Neumann at 10:51 pm on
August 12th, 2008
I think this whole problem could be avoided if diagnosis were more reliable. I’ve taken every medication, and had multiple diagnoses. I understand that the bipolar “spectrum’ exists to help capture those conditions that are like bipolar disorder, but enough is enough. I quit meds because I couldn’t seem to get an accurate diagnosis, and because of intolerable side effects. I was diagnosed with Adult ADHD by one guy, Bipolar II by another, agitated anxiety by another. So I decided not to take anti-epileptic meds or lithium, because I couldn’t get an accurate diagnosis. So I did this”: I consulted an academic psychiatrist who did a conplete psychiatric evaluation, and then I underwent psychological testing with an academic clinical psychologist, and i asked that they speak. The psychiatrist was from the Mayo Clinic, where I guess psychiatrists and psychologists traditionally work together. It was during the feedback appointment that I got the most benefit and was able to arrive at the medication + cognitive therapy combo that has really helped.
I would ask that professionals worry about accurate diagnosis before deciding what medications one should take. Those professionals I saw were quite confident in their diagnoses, but often wrong. I appeal to the mental health community to return to the spirit that created DSM-III et al…accurate and reliable diagnosis.
Your Friend at 10:35 am on
August 18th, 2008
Hats off to the psychiatrist that suggested that this guy get off his meds. That psych is one in a million!
Be a Part of the Conversation! Comment on this Entry Now:
Just my own two cents. Was undiagnosed for 4 years, then medicated & under psychiatric care (in Canada) for 5yrs with zero success. Tried a LOT of meds… Was then clued in by my boss to a researcher in Calgary looking at vitamin therapy, and gave it a go (what did I have to lose?)
6yrs later, I have not been on any meds for my bipolar since and haven’t had an episode, just life’s usual emotional ups and downs. Very happy with that! The vitamins work very well for a large number of folks, and it does have some research behind it. For anyone who’s interested, the vitamins are called EMPower Plus, from Truehope.
It is difficult to comment without knowing the details. I see bipolar as two, bipolar heavy and bipolar light. If he has the bipolar (heavy) with a history of psychosis his strategy may be more risky than if he has the light version. If there is a history of psychosis, the natural history is for remissions of from one to two years after a first episode with shorter remission periods after that. If that were the case a year and a half of remission would not be enough to say he is OK. Regardless, I would recommend nutritional support in the form of E.M. Power just to be on the safe side.
I have serious doubt this indivual is bipolar as the meds were not working. Bipolar is quite easy to misdiagnose; particularly bipolar II, or “soft” bipolar. I’m not sure “congratulations” are appropriate or warranted. This article feels a bit irresponsible to me.
well, welcome to earth—these ’snake-oil’ pill-pushers still abound—they kill ya, make a buck—that’s their motive and alleged profession—’Do No Harm’? yeah right. an old USF lit prof spoke true–”If you wish to cut people, yet be honest, ethical, you become a surgeon.” well, if you’re nutz, and wish to make others so? that’s your typical shrink—’run a mile’.
Not sure I agree with the following entirely: “The problem with medication compliance in bipolar disorder is primarily when a person is in a manic phase and feels like they no longer need the medication, and discontinue it on their own, without consulting their psychiatrist or doctor.”
Many people with bipolar stop taking their meds when they start feeling better because of the meds. People tend to do the same thing with antibiotics. That’s why doctors and pharmacists have to keep reminding them to finish the prescription even after they start feeling better.
The “soft” form of bipolar disorder is called Cyclothymic disorder. Bipolar one is characterized by more manic phases and bipolar two is characterized by more depressive phases. The difference between the two is a matter of which side if the mood continuum is more prevalent.
It is very common for people suffering from this disorder to discontinue meds. It doesn’t mean they don’t need them. They just don’t realize they need them.
After one year he states, “I’m comfortable saying that if I were going to crash and burn and wind up back at square one, it likely would’ve happened by now.”
Perhaps he’s comfortable, but any knowledgeable person about bipolar,patient or physician, certainly wouldn’t be. After one year he considers cured. Maybe come back in ten and we’ll see.
I do hope in ten he’ll be able to say the same things, though.
Psychiatric drugs did not evolve along with humanity, like wheat. Throughout most of human history people with conditions that would nowadays be diagnosed as bipolar disorder must’ve survived without medications. They must’ve lived at least long enough to have children (presuming that the condition is inherited). Only in the last half-century or so have there been these drugs that are now said to be indispensible to almost anyone with bipolar disorder.
So I wonder how could the people with this condition, or with any of the other conditions that would now lead to a major psychiatric diagnoses, possibly have made it through life without these drugs if they are now essential. Is life so much harder nowadays, or were they just lucky enough to survive in spite of themselves in previous eras, or is there some other completely different explanation? I think anyone who is convinced of the absolute necessity of modern psychiatric medications should at least consider this question.
Long ago, they locked people away in asylums or gave them lobotomies or extreme electroshock therapy. My wife just spent 10 days in a mental healthcare facility. I believe her stay was significantly shortened primarily due to lithium she was given. She had a speedier, less traumatic recovery than she would have had without the lithium.
When she mentioned that 10 days was a long time, one of the staff said that the standard stay not so long ago had been 30 days.
Maybe the meds are not an “absolute necessity,” but they sure help a lot of people. I know I would much rather spend 10 days in one of those facilities than 30… or several months.
I do believe that mental illnesses are becoming more prevalent now than in the past due to environmental and social stressors. Perhaps this is why these medications are more of a necessity now.
As a psychiatrist who has treated many hundreds of patients with bipolar disorder, I would counsel extreme caution with regard to discontinuing medication. While I certainly hope that Philip continues to do well, the overwhelming majority of those correctly diagnosed with bipolar disorder do require mood-stabilizing medication indefinitely.
Sadly, the natural history of bipolar disorder is that, over time, as many as 15% of patients will commit suicide. The time a sufferer spends depressed is usually much more than he or she spends in a manic phase (when suicide risk is less). Unfortunately, it is the depressed phase (as well as “mixed” episodes) that greatly elevates the risk of suicide. Furthermore, there is at least modest evidence that the more manic and depressive episodes a person has, the more “entrained” this cycling pattern becomes–a phenomenon sometimes termed “kindling”. So there is good reason to take a preventive approach to this disorder.
I realize that writing this may be a kind of “downer” for those, with bipolar disorder, who want to be free of medication and its potential side effects. Who wouldn’t want to be “off meds”, all other things being equal? But I believe it would be irresponsible not to point out the risks of stopping medication. There is reasonably good evidence from a number of studies (though not all) that lithium–and possibly other mood-stabilizers–substantially reduces the risk of suicide in bipolar disorder. By the way, lithium is not a “drug” in the conventional sense; it is a naturally occurring element found in some mineral springs. Popular lore has it that the ancient Romans used to drink from such springs, to deal with their “mood swings”! Folklore, perhaps, but this is an under-utilized medication, in my professional opinion–and definitely not one that makes the drug companies a lot of money. (A month’s supply of lithium costs only a fraction of what many less useful medications cost). Lithium does have a number of significant side effects, but when it works, it works very well. Readers who want to learn more about lithium might want to see my editorial on this, in the Journal of Clinical Psychopharmacology (October,2002).
All this is not to say that life-time medication is essential for every single person with bipolar disorder. There may be as many forms of bipolar disorder as there are bipolar patients, and there are always exceptions to the rule. There are a few instances in which a trial off medication may be justified, especially if the diagnosis itself is in doubt, and if the patient can be very closely monitored. It is also important to provide psychological and social support to those with bipolar disorder–medication is only a part of the approach.
Finally, readers of the comments above should cast a cold eye on claims about “nutritional” supplements as substitutes for established treatments for Bipolar Disorder. Much more evidence is needed to validate a purely nutritional approach. There may indeed be a role for certain nutritional supplements, such as omega-3-fatty acids (it’s hard to argue with eating more salmon and herring!)in stabilizing bipolar disorder. But for patients with the more severe forms of bipolar disorder–particularly those who have had psychotic symptoms, multiple hospitalizations, or a history of suicidal behavior–I believe that the best approach remains traditional mood-stabilizing medication and psychosocial support. –Ronald Pies, MD
I totally agree with Dr, Pies. I was diagnosed with bipolar 22 years ago. During that time I have been on Lithium, Zeprexa, Navane, Depokote, Lamictal, Geodon, Seroquel, Ativan and Klonopin and I have to say I’ve hated every minute of it, but without them I swing manic and ultimately end up with some form of psychosis. I have tried several times to get off meds and each time it’s been unsuccessful. Medicine adjusments and changes have been going on for years. All I can say is take each day at a time and as the years pass you get to understand your illness better. I’m currently on Lamictal, Seroquel and Klonopin…I have never felt more balanced. I hold my breath hoping that this combination will continue to work and my weight gain won’t come back. My pdoc switched me from Lithium to Lamictal and I dropped 50lbs. Then because I was having trouble with my heart I had to give up my Geodon and start on Seroquel. My eating is under control and I hope weight gain won’t be much of an issue. Geodon is weight neutral Seroquel is not. Medication weight gain is a huge problem. Another problem that is frustrating is that doseages need to be increased because of building up tolerances.
All and all I have to say medication has given me a more balanced life and even with the side effects it improves my quality of life.
I think this whole problem could be avoided if diagnosis were more reliable. I’ve taken every medication, and had multiple diagnoses. I understand that the bipolar “spectrum’ exists to help capture those conditions that are like bipolar disorder, but enough is enough. I quit meds because I couldn’t seem to get an accurate diagnosis, and because of intolerable side effects. I was diagnosed with Adult ADHD by one guy, Bipolar II by another, agitated anxiety by another. So I decided not to take anti-epileptic meds or lithium, because I couldn’t get an accurate diagnosis. So I did this”: I consulted an academic psychiatrist who did a conplete psychiatric evaluation, and then I underwent psychological testing with an academic clinical psychologist, and i asked that they speak. The psychiatrist was from the Mayo Clinic, where I guess psychiatrists and psychologists traditionally work together. It was during the feedback appointment that I got the most benefit and was able to arrive at the medication + cognitive therapy combo that has really helped.
I would ask that professionals worry about accurate diagnosis before deciding what medications one should take. Those professionals I saw were quite confident in their diagnoses, but often wrong. I appeal to the mental health community to return to the spirit that created DSM-III et al…accurate and reliable diagnosis.
Hats off to the psychiatrist that suggested that this guy get off his meds. That psych is one in a million!
