Why Bipolar Medication is Not Optional

Top reasons you should keep taking your prescribed medications

Bipolar disorder is a major mental illness. The bottom line is that if you have a mental illness, you have to take responsibility for your treatment -- and in most cases, that means seeking professional help, accepting that you need medications, working with your mental health provider to find the right combination of medications (often changing them as time passes), and taking the medications that are prescribed for you.

It also means discussing side effects with your provider and, as long as they are not dangerous or debilitating, working to find ways to deal with them.

So why do people resist or not take medications? Everyone has their reasons, but none of those reasons are good ones.

1. Medications Are For Life

"I don't want to take medications for the rest of my life," says Linda. "There's got to be another way!" The truth is, even if you find an effective alternative treatment for your bipolar disorder, it's still for life. And so far, there are no proven alternative treatments for BP.

If you have a chronic mental illness, it's caused by an imbalance in your brain's chemical and electrical systems, and it's not going to go away on its own. The classic comparison is to diabetes. That doesn't go away. It can be controlled by diet, exercise, and medication, but failure to be responsible means you risk gangrene and the loss of eyesight, kidney function, and life.

Failure to be responsible for your mental health treatment risks such things as your family, your job, your home and, again, your life.

2. I Don't Want to Be Dependent on Medication: I Should Be Able to Tough it Out

Robert thinks he should be able to pull out of his depression by himself. "I feel like something is very wrong with me to be so miserable when I am in a job I know many people would love to have.

I know my family has a history of bipolar, but I really don't want to go on meds."

Even though Robert is aware of bipolar disorder in his family, he doesn't even ask for a diagnosis because he doesn't want to take medication.

Whether or not to start taking medications is each individual's choice, but by choosing not to do so, Robert is choosing to continue to be miserable. He may also be putting himself and others in danger.

3. I Miss My Mania

Greg feels bereft now that he is no longer manic. He longs to go back to that wonderful state of mind. He's tempted to go off medication so he can be that high-flying person again.

Sure, mania can be fun (if psychotic symptoms don't make it terrifying). You know you can do anything. There's nothing frightening in the whole world. You can outsmart anyone. You have a limitless supply of money. Your creativity soars past the sky to the sunbursts of newly-forming stars.

As Andy Behrman wrote in Living Mania-Free, "There's a tremendous amount of loss associated with 'saying goodbye' to mania, as it was my friend for so many years." Unlike Andy, your mania probably didn't land you in prison, and if you're lucky, you didn't ruin yourself financially. But you can't stand the loss of creativity or the feeling that you always knew what to do in every situation.

You were manic for so long that the "new you" who isn't manic is a stranger. Redefining yourself as someone who is not manic isn't a one-step process. Andy sought ways to "fill the gap" left by his departed mania, and it took quite a while. Life can still be rewarding, but you have to give it time.

After you've listed all the things that were bad about being manic-depressive, you'll have a basis for getting to know the stranger you've become. Then when you hunger for the highs, review the list. Is it really worth going off your medications to bankrupt yourself, to tell your boss (in fast-talking, exquisite detail) why you are right and she is wrong to the point that you lose your job for insubordination, to write a book (in a week) that seems to be perfection but that no one else can understand?

And is it worth crashing into the torments of depression?

4. I'm Better Now, I Don't Need Medication Anymore

Rhonda has had a great response to medication after being diagnosed with clinical depression. She can't remember ever feeling as good as she does now. She has energy. She can make decisions easily that last year was tormenting. Instead of sitting in a chair staring mindlessly at the television for hours, paralyzed over what she should be doing, she is getting things done effortlessly. She's cured! So why should she continue to take medication?

Because she's not cured. Stop the medication, and the depression will probably return.

In Rhonda's case, the antidepressant she is taking may be triggering hypomania as well. Rhonda's doctor should be monitoring her behavior and mood state closely. Hidden bipolar disorder may have been uncovered.

Sometimes depression that's related to a traumatic event like the death of a family member may respond to the temporary use of an antidepressant. When enough time has passed for the person to have adjusted to what happened, the antidepressant may not be necessary anymore. That call can only be made by the patient and prescribing doctor together. They may find that when the antidepressant is discontinued, depression does return, at which point grief counseling, therapy and/or restarting medication treatment are all options.

But long-term clinical depression doesn't go away forever on its own. Rhonda could be headed for a serious mood crisis if she stops taking her medication. Her doctor should evaluate whether to try prescribing a mood stabilizer along with the antidepressant.

5. Side Effects Are Making Me Miserable

There are plenty of side effects that mean you need to stop taking a particular medication: signs of tardive dyskinesia, a serious movement disorder; blurred vision that doesn't go away; fainting; muscle weakness or pain, and many others. Still, unless a side effect is immediately life-threatening (in which case you need to get to the nearest emergency room), you should not stop taking it abruptly -- that can often cause more complications. Know the serious side effects of your medications and call the prescribing doctor immediately if you experience them.

But there are other side effects experienced by many people that are very troublesome but not dangerous. Karen, Ralph, and Susan don't have dangerous side effects, but they are common and problematic. Karen has gained 50 pounds from her medications and is so depressed and angry about her weight that she wants to stop medication altogether. Ralph has lost his sex drive and has the same reaction. Susan feels groggy and listless all the time.

All three of these people need to talk this over with their doctors. Susan almost certainly needs a medication change. But what about Ralph and Karen?

The first question they each need to answer is: How well do the medications work for me?

Ralph attempted suicide twice before starting on medications and hasn't felt suicidal at all since then. His depressive episodes are rare and not severe. Karen lost three straight good jobs due to out-of-control manic behavior including hallucinations and now has held the same job for four years with one promotion with no more psychotic symptoms. She is sometimes mildly hypomanic but never manic. Their medications are doing a great job.

Ralph's psychiatrist may be able to make some changes or additions to his medications that will improve his sexual desire and performance. Perhaps they will decide to try substituting one new med for another to see if the new combination is as effective as the old but doesn't have the sexual side effect. The one thing that would be completely irresponsible would be to simply stop taking his prescribed medications for this reason. But if the new medications don't work as well, Ralph may just have to choose between suicidal depression and a diminished sex drive.

Weight gain from psych medications is a huge problem. Those of us who started out slim and are now just plain fat know how depressing that is. Again and again, we hear, "I've tried everything to lose weight, and nothing works." And it's true that although being seriously overweight isn't immediately life-threatening, it can have dangerous health effects in the longer term.

Karen needs to know that it is not impossible to lose weight while taking psych meds. Just being aware of this may help her. Research has proved that people can lose weight even when taking such pound-packing medications as Seroquel (quetiapine) and Zyprexa (olanzapine).

In Karen's case, too, consultation with her prescribing doctor is essential, but in the end, she will have to decide whether she'd rather go back to the uncontrolled mania that causes serious problems or continues battling with excess weight.

So there you have it -- five bad reasons for not taking or discontinuing medications. In every case, the reality is that medications are a far better option that going without -- and that problems related to medications can and should be reviewed with your physician.