Bipolar disorder medication can have side effects, but there are risks involved in not taking it, too. We look at the pros and cons.
If the idea of taking medication doesn’t appeal to you, you’re not alone.
Maybe you prefer not to take any pills if it can be avoided. Or it may be that you feel like your bipolar disorder medication isn’t helping or you’re worried about the side effects.
While those are valid concerns that you can discuss with a doctor, keep in mind that medications can also help ease bipolar disorder symptoms or the number of episodes you experience.
If you’ve been diagnosed with bipolar disorder, know that treatment plans vary. You can with a doctor about potential side effects, and any symptoms you’re already experiencing, to find a maintenance plan that’s right for you.
There are different types of bipolar disorder and the symptoms can range in severity. Depending on the type, people may experience these distinct states:
- mania or hypomania: periods of high energy and elevated moods, when you feel elated, energized, or irritable
- depression: periods of low energy and mood levels, when you feel sad, indifferent, depressed, or hopeless
Some people go years between manic and depressed episodes, while others experience them in quick succession.
Bipolar disorder is a lifelong, progressive mental health condition, which means that it requires long-term treatment. The symptoms won’t go away on their own — and these symptoms can negatively impact the person’s health, safety, and quality of life.
That’s why some combination of medication, psychotherapy, and lifestyle modification is often part of treatment — though your bipolar disorder treatment plan is specific to what kind of bipolar disorder you have and your symptoms.
Medication can help stabilize your moods so you don’t experience as many manic or depressive episodes. This stability also makes therapy and personal routines possible and more effective.
“Manic or depressive symptoms may occur much more frequently in individuals who are untreated with this condition,” explains Joseph Swider, MD, a psychiatrist at Heading Health.
“Medication is the cornerstone of treatment because, in addition to treating a current episode, medication can prevent the next episode from occurring.”
Plus, Swider says, other treatment methods, such as therapy, are “almost impossible” when someone is currently experiencing a manic episode.
That’s why “bipolar disorder is not something to treat with psychotherapy alone,” explains Caitlin Billings, LCSW. “Most people who choose to not take medication battle for balance and struggle with major role obligations, such as parenting, employment, managing finances, and maintaining stable long-term relationships.”
“The sooner a person explores medication and finds a suitable prescription for bipolar, the better the prognosis,” Billings shares. Medication and the stability it can bring can improve your daily quality of life.
However, some people experience medication side effects that they can’t tolerate. These side effects are the main reason people with bipolar disorder stop taking their medication.
There are risks to living with untreated bipolar disorder, though some people do. They often chose to manage their bipolar disorder symptoms with other treatment methods, to mixed success.
Untreated bipolar disorder can lead to serious and dangerous symptoms, including:
Impulsive actions or psychosis
When someone is currently experiencing a manic episode, they are more at risk of engaging in harmful behavior, including:
- excessive drinking
- dangerous driving
- impulsive spending
- harmful sexual activity
These behaviors can put you at risk of:
- loss of work
- substance use disorder
- strained or unhealthy personal relationships
- financial or legal issues
- sexually transmitted infections (STIs)
- issues with law enforcement
- accidental death
“When in a manic episode, an individual may lose the ability to reason abstractly or concretely and may become much more impulsive or even psychotic,” explains Swider. “It’s these psychotic symptoms or impulsive acts which may occur when an individual is manic that could result in emotional, occupational, or financial harm.”
While psychosiscan occur during both manic and depressive states, it is most common during manic episodes. Symptoms include:
- incoherent or irrational thoughts
- jumbled speech
- lack of awareness
Suicidal thoughts and attempts
Untreated bipolar disorder can also lead to increased suicidal thoughts — especially during a depressive phase.
If you or someone you know is considering suicide, you’re not alone. Help is available right now:
- Call the National Suicide Prevention Lifeline 24 hours a day at 800-273-8255.
- Text “HOME” to the Crisis Text Line at 741741.
Not in the United States? Find a helpline in your country with Befrienders Worldwide.
Progressive brain damage
Research suggests that untreated bipolar disorder can lead to a series of structural changes in the brain that cause long-term damage. This is because, explains Billings, “the disorder results from unstable brain chemistry, which over time and with each episode, can degrade brain matter and lead to more and more uncontrolled episodes.”
An older 2003 study found that bipolar disorder could possibly cause loss of an important amino acid (NAA) in the brain, which is important in regulating emotion and memory; other research has found that it can cause progressive gray matter loss.
A 2015 long-running study found that manic episodes led to decreased volume in certain parts of the brain, pointing to the progressive effects of bipolar disorder.
There are several different kinds of medication used to treat bipolar disorder, including:
- mood stabilizers or anticonvulsants, such as lithium (Eskalith), divalproex (Depakote), or lamotrigine (Lamictal)
- atypical antipsychotics, such as olanzapine (Zyprexa) or lurasidone (Latuda)
- anti-anxiety medications, such as benzodiazepines like clonazepam (Klonopin)
It isn’t uncommon for people diagnosed with bipolar disorder to try multiple medications until they find a fit or for their psychiatrist to change their medications over time.
About 40%–50% of people who take lithium respond to it.
Many folks with bipolar are wary of treatment with medications.
According to research on people living without taking their medication for bipolar disorder, side effects were their primary reason for not taking medication. The most distressing side effects included weight gain, tremors, decreased sex drive, and lithium toxicity.
Other people worry that bipolar disorder medication dulls their creativity, makes them feel like a zombie, or takes away their personality.
While medication is considered the most effective way of managing bipolar depression, treatment for bipolar disorder often involves a combination of medication and other treatments.
“Therapy can be helpful to the individual in order to help them understand their mental illness, process ways it’s impacted them, and learn techniques to minimize bipolar disorder’s effect on their lives,” explains Swider.
Cognitive behavioral therapy (CBT), can help you identify and cope with unwanted thoughts or behavior.
Interpersonal and social rhythm therapy (IPSRT) can help you to regulate your eating, sleeping, and exercise habits to balance your symptoms.
Building a routine
Building — and sticking with — a routine can be incredibly beneficial to someone with bipolar disorder. This means going to bed at the same time every night, eating meals at regular times throughout the day, and engaging in stress-reducing activities.
Many people also find it helpful to chart or journal their moods daily so they can better learn their triggers and watch for patterns.
Food alone can’t treat bipolar disorder, but making sure to eat nutritious foods regularly can benefit your overall health and how you feel. Prioritize consuming:
- whole grains
- herbal tea
- foods rich in omega-3 fatty acids, such as salmon, eggs, and flaxseeds
- selenium-rich foods, such as brazil nuts or shrimp
“Bipolar doesn’t have to prevent anyone from living up to their full potential, and it’s not hard to treat,” says Swider. “But it does have to be treated for best results.”
Medications can help protect you against some of the more serious symptoms, including rapid cycling between manic and depressive episodes, progressive brain damage, dangerous behavior, suicidal thoughts, and psychosis.
Therapy and lifestyle changes can also help you take charge of your health.
If you’d like to get help but are unsure where to start, the
Looking for a therapist, but not sure where to start? Psych Central’s How to Find Mental Health Support resource can help.