can you stop your bipolar medication
that's what I'm gonna talk about today
I'm dr. Tracy Marx a psychiatrist and I
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today's topic is based on a viewer
question from the bee man and he asks
dr. Tracy can you please do a video on
stopping bipolar medication or can it
even be possible to stop taking your
bipolar medication
thanks thanks bee man and there were
also two more requests for the same
topic as well bipolar disorder is a
serious mental illness that involves
recurring episodes of depression and
either hypomania or mania it normally
requires medication to treat the acute
episodes as well as keep them from
coming back once they resolve but there
are people who go periods of time
without medication so let's break that
down in a classical picture of bipolar
disorder the episodes alternate you have
an episode of depression that comes and
then it goes and how long the episode
last depends on the individual the
average amount of time is six to nine
months then this is followed by what we
call the intereseted this can last weeks
for someone who's rapid cycling or
months or even years before you have
another episode in this period you're
usually back to your regular functioning
the next episode would be mania or
hypomania the mania tends to last for
weeks it's hard to sustain mania from
for very long but you can have a buildup
of increasing energy and goal-directed
activity that lasts for weeks before you
actually go into hyperdrive now this is
the classic picture not everyone is
classic in 2007 the National Institute
of Mental Health published a study
called the step BD study where they
followed people with bipolar disorder in
an outpatient setting to see what
treatments seemed to work best and it's
a great reference study I'll have it in
the description for you
that studies showed that only 58% of
people with bipolar disorder types 1 and
2 fully recovered that is the majority
but that's not everyone it also showed
that 49% of those people had another
episode within two years and twice of
twice as many of those episodes were
depression in a previous video that I'll
reference on the corner and in the
description I talked about the
differences between bipolar 1 & 2 plus
bipolar two disorder we've seen that
over time people tend to have more and
longer depressive episodes than they do
the hypomania so how can we use this
information to answer the question about
getting off medication well if you're
someone who fully recovers in between
episodes and your episodes are separated
by years then you may be able to manage
without medication until the next
episode comes the key here is
recognizing when the next episode is
coming with mania it can just slip up on
you quickly often people don't seek help
during the mania especially hypomania
because it can feel good or you could
have the irritable form of hypomania
where you just figure you're going
through a bad patch right now and it'll
pass the danger of watching and waiting
is once you've sunk into a depression or
escalated into mania it's harder to get
things under control
we can do it with medication but it's
much easier to tweak what you're already
on if you have a relapse on medication
but if you're off meds the process of
onboarding with a new medication regimen
takes more time and if your doctor tries
to do a fast taper upward we call that a
titration where you increase the dose
stepwise to get to a therapeutic dose
you can get more side effects like
sedation or feeling like a zombie also
if you go too long without meds while
you're having an episode the period of
time you spend in those episodes without
treatment makes future episodes harder
to treat it's called the kindling effect
let me say that again going long
stretches of time in an episode without
treatment has the cumulative effect of
making your future episodes less
responsive to the medications this may
play into the concept of treatment
resistant depression also you really
want to see a video I did on how
untreated depression shrinks your brain
cells I know that sounds dramatic but
unfortunately it's true
so am I saying that you can't treat
bipolar disorder with therapy and no
medication yes actually I am saying that
there's been bunches of studies on this
and I I have references in the
description psychotherapy can be a good
addition to treatment but it's it's not
been shown to be effective as an only
treatment and in the studies they'll use
the term mono therapy to mean only
treatment one thing therapy can be
helpful for is in delaying the onset of
future episodes so this can be useful if
you're trying to stay off medication in
your inter FSO period a therapy
developed for bipolar disorder is called
interpersonal and social rhythm therapy
this therapy focuses on the problems in
your relationships and helps you
establish regular daily routines mania
tends to be more destructive
interpersonally in the manic state the
person can do all kinds of things that
hurt them or others like having affairs
run up credit cards ruin business deals
embarrass themselves at work or school
because they're acting bizarrely
and scaring people in contrast
depression tends to be more of a silent
personal pain that others don't
necessarily see the person who live with
you may see how dysfunctional you are
but they still may not appreciate the
depth of despair and darkness that you
feel so interpersonal therapy focuses on
the problematic areas in your life that
involve how you relate to other people
in your environment in the therapy the
therapist would help you identify some
of these problems and help you
troubleshoot solutions as for the social
rhythm part of the therapy mood
disorders especially bipolar disorder
are very sensitive to changes in your
body clock and overall body homeostasis
which you can think of as your body's
overall rhythm early signs of a manic
episode approaching is the decreased
need for sleep with social rhythm
therapy you keep close track of certain
daily routines like when you wake up and
when you go to bed and when you eat your
meals and it's been shown that people
who keep a schedule with these things
and they don't vary it very much they
recover faster during an episode and
lengthen the time in between episodes
that's kind of a big deal let me say it
again following a daily routine helps
you recover faster and lengthens the
time in between episodes now I realize
your schedule may not always be entirely
under your control but if you can adjust
your life so that you can keep a regular
sleeping and eating hours you can do
better overall with your bipolar
disorder this doesn't mean you have to
eat three meals a day however many meals
you eat in a day they just need to be
regular people using this therapy will
sometimes use the social rhythm metric
to track your activities there's a
longer version of it which is 17 items
and then there's a shorter one that's
five items for the SRM five the items
that are tracked are the times that you
get out of bed have your first contact
with another person start work housework
or volunteer activities have dinner and
go to bed if you use that metric you
would track the times for these
activities over two weeks the goal is to
keep them as constant as you can last
thing just to be complete I mentioned
earlier that in the step BD study they
showed that only 58% of people have a
full recover recovery in between
episodes so what about that other 46%
those are people who get better from
their episodes but they still have some
lingering symptoms so they're better but
they're not quite right so if that's you
it's not a good idea to stop your
medication if you're not at a hundred
percent so getting back to the original
question can people with bipolar
disorder stop taking
vacation my answer is some people can
for a while but for the best treatment
and best chance that your condition
won't get worse over time
you probably shouldn't stop your
medication please share this video with
others and let me know what you think in
the comments I'll see you next time
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