When we talk about the negative side of taking medication for bipolar disorder, its usually about the side effects. Weight gain, sexual dysfunction, memory problems, etc. Then our doctors will titrate our medications, starting with small doses and increasing them until we reach the desired outcome: low to no symptoms with the least amount of medication. In the same manner, when youre taken off of a medication, it has to be done slowly. This is because stopping a drug is as much of a risk as starting one in the first place. Withdrawal from psychiatric medications is not just unpleasant, it can be life-threatening.

Compare it to drug addiction. Psychiatric medications change brain chemistry, and the brain gets used to those changes and relies on them to function properly. When you stop taking bipolar disorder medications, the brain no longer has that crutch.

Imagine a staircase. Its been built so that the stairs are the perfect height and depth for you. Take away some of those steps, shorten some and make some taller. Now run down it and try not to fall. Unlikely. Thats going cold turkey. When you taper down use, the redesign goes slowly, so you can still use the staircase and make it safely to the bottom.

Different drugs produce different withdrawal effects. You may experience physical symptoms, psychiatric symptoms or both. Withdrawal effects can show up after only a couple of hours of missing a dose.

How a person reacts to stopping a medication will depend on the drug, the dosage and the amount of time taken to reduce the dosage. It will also vary person to person.

These are the main withdrawal effects for the drug classes used to treat bipolar disorder:

Lithium

  • Nausea/vomiting
  • Headaches/body aches
  • Chest tightness
  • Sweating
  • Anxiety
  • Irritability
  • Relapse into hypomania, mania or depression
  • Suicidal ideations

Mood stabilizersThese include drugs like lamotrigine, valproic acid, carbamazepine and divalproex sodium.

  • Nausea/vomiting
  • Headaches
  • Fatigue
  • Dizziness
  • Balance problems
  • Muscle weakness
  • Seizures
  • Insomnia
  • Irritability
  • Anxiety
  • Difficulty concentrating
  • Mood swings
  • Suicidal ideation
  • Relapse

Atypical AntipsychoticsThese include drugs like aripiprazole, clozapine, ziprasidone, lurasidone, risperidone, asenapine, quetiapine and olanzapine.

  • Dyskinesia
  • Headaches
  • Joint pain
  • Diarrhea
  • Nausea/vomiting
  • Sweating
  • Dizziness/light-headedness
  • Crying
  • Insomnia
  • Irritability
  • Mood swings
  • Panic attacks
  • Hallucinations
  • Psychosis
  • Suicidal ideation
  • Relapse

Withdrawal symptoms can happen even when time and care are taken to taper slowly. So, it is especially dangerous to abruptly stop using them. If you are experiencing side effects of a medication or feel that it is not right for you, talk to your doctor. They can take you through the process as safely as possible.

Do not discontinue your medication without talking to your doctor. If it is an emergency, such as an allergic reaction, go to your closest emergency department.

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Image credit: Erin Vermeer