People who take medications to treat most serious medical conditions, including diabetes, high blood pressure, and thyroid disorders usually never question the need to be on long-term medication. Many people with bipolar disorder, however, constantly wonder whether they really need to continue taking medication to keep symptoms in check.

For a large majority of people with bipolar disorder, remaining on a preventive dosage of a mood stabilizer indefinitely is strongly recommended for the following reasons:

• A mood stabilizer can prevent future manic episodes.
• By preventing serious episodes, the mood stabilizer reduces the kindling effect – the tendency for mood episodes to become more serious and more frequent with each episode.
• A mood stabilizer may provide some protection against the possibility of anti-depressant-induced mania.
• Lithium and perhaps other mood stabilizers may help reduce the risk of suicide. (Lithium is the only mood stabilizer clinically proven to reduce the risk of suicide.)

Does this mean that everyone who’s been diagnosed bipolar has to remain on a mood stabilizer and perhaps other medications for their entire lives? Not necessarily:

• People can be misdiagnosed. How often this occurs, nobody really knows.
• Brains change. Over time, a brain may “grow out of bipolar” or at least become less vulnerable to severe mood swings. In addition, a person’s life may become less stressful over time – perhaps requiring less medicinal protection.
• People who have “lighter” forms of bipolar disorder may find that they’re able to manage their symptoms without medications – for example, with psychotherapy, family therapy, lifestyle changes, nutrition, and/or other forms of therapy.

So, to answer the question posed in the title of this article, “Go Off Your Bipolar Medications?” I recommend the following:

• If you have a severe form of bipolar, often accompanied with psychotic symptoms that have resulted in multiple hospitalizations and have a history of suicidal thoughts and behaviors, a combination of medication and psychotherapy is essential.
• If you and your doctor question a previous diagnosis, a trial off medication may be useful, as long as your doctor carefully monitors the situation. (You may go off your meds and “feel great” when experiencing mania, so you need to keep in touch with your doctor to obtain an objective evaluation of how you’re really doing.)
• If no medication or combination of medications seems to be helping, then trying different treatments and therapies may be the only solution.

As much as I would like to tell you that simply changing your diet will cure you – perhaps eating more fish high in Omega 3 or taking nutritional supplements – most people, especially those who have the most severe forms of bipolar disorder, respond best to the traditional treatments – a combination of medicine and therapy. (For more about alternative treatments for bipolar, check out “Alternative and Complementary Treatments for Bipolar Disorder.”)

Caution: Never stop taking your medications or adjusting the dosage without consulting your doctor first. Stopping some medications too quickly can cause serious problems. For example, stopping an anti-seizure medication cold turkey can actually cause seizures. Always consult the person who’s managing your meds before making any changes.

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    Last reviewed: 31 Oct 2008