Does Bipolar Disorder Require Lifelong Treatment With Medications, Even When You Feel Better?

Bipolar disorder is a complex and lifelong illness. It comes in different types, depending on the duration and severity of its main episodes — hypomania, mania, and depression. Some people manage their condition well even without medications, but others find it hard to cope with the bipolar disorder even alongside drugs and psychotherapy. Every patient is different.

Prescription drugs can keep mania and depression under control and prevent relapses once your emotions have stabilized. The majority of bipolar patients are not fond of the idea of taking medication for the rest of their lives, but just like someone with Type 1 diabetes needs their insulin for life, medicating for bipolar disorder will keep your condition stable.

Doctors recommend taking your medication even when you feel good and think you could do well without it. Many people who were diagnosed with bipolar disorder decide that they can live without medication, but quitting usually means that they’ll have a relapse sooner. Mood-stabilizing medications are recommended even when you feel better, because they help you to avoid relapses.

Common medications prescribed for bipolar disorder

Mood stabilizers

Lithium is probably the most widely known and used mood stabilizer. It takes between one to two weeks of regular use to reach its full potential. It’s a staple mood stabilizer for both mania and depression, but it doesn’t do a good job at managing rapid cycling or mixed states. Experts recommend monitoring its concentrations in the blood every three months within the first year for newly diagnosed patients, and every six months after the first year.

Anticonvulsants

If lithium is ineffective or poorly tolerated, an anticonvulsant called valproic acid is usually recommended instead. Even though it was originally developed to treat epilepsy, valproate is considered a “mood stabilizer equivalent”. Unlike lithium, it's mostly prescribed for mixed episodes, rapid cycling, or in cases of hallucinations.

Antipsychotics

People with bipolar disorder who experience psychosis, hallucinations, or are in other ways out of touch with reality during manic or depressive episodes, will be prescribed an antipsychotic medication. Antipsychotics are usually prescribed in combination with a mood stabilizer if mood stabilizers alone fail to help.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are among the most commonly prescribed antidepressants. In people with bipolar disorder, SSRIs are used to treat depressive episodes, in combination with a mood stabilizing drug for the treatment of mania. According to research, SSRIs can worsen symptoms of bipolar disorder if taken without a mood stabilizer.

What everyone should know about bipolar disorder drugs

Antidepressants are not that good

Many recent studies on the effectiveness and consequences of using antidepressant pills in the treatment of bipolar disorder suggest that antidepressants simply don't work that well for bipolar disorder. While antidepressants can help people with bipolar overcome depressive phases sooner than some other medications, it’s now known that they can trigger manic behavior and cause faster switching between episodes, a form of bipolar disorder known as rapid cycling.

Visit your doctor often

Regular checkups, blood tests, and therapy sessions are good tools to track your moods and keep your bipolar disorder under control. Blood tests help doctors regulate the dosage of your medication. It can be hard to find the right dose because every patient has their own individual needs. Regular checkups can keep you safe and free from symptoms.

Don’t expect miracles

Habits people with bipolar disorder should consider alongside taking medication

Psychotherapy

A lot of research has been conducted on the benefits of talk therapy for bipolar disorder. Studies indicate that interpersonal and social rhythm therapy is a great way to keep your condition under control. It’s recommended alongside medication. Cognitive behavioral therapy and family-focused therapy have also shown effective.

Love and support

Surrounding yourself with friends and family who understand bipolar disorder and support you unconditionally is a therapy on its own. Knowing that you can turn to someone for a hug or a piece of advice when you’re not feeling well is priceless.

Rest

Science has found that good night sleep is among the most important factors of a good mental health. When the brain is relaxed, your pituitary gland releases growth hormone that helps to repair the body. First few hours of sleep decrease the levels of cortisol, or the stress hormone, and it’s a known fact that stress is one of the major tigers for symptoms of bipolar disorder.

Who should avoid taking medication for bipolar disorder?

The only scenarios in which bipolar patients should refrain from taking medication, according to the British Association for Psychopharmacology (BAP), are:

• When the adverse effects include criminality, risks of harming self or others, and risk of suicide.
• Women themselves should decide about medicating in pregnancy or while breastfeeding, keeping in mind that hormones can increase the symptoms of bipolar disorder at this time. Pregnant women who decide to take medication should be familiarized with all the risks and possible side effects for the fetus, and a breastfed child should be monitored for possible reactions if the mother chooses to take drugs and breastfeed (which is not recommended).

The bottom line

There is no single best treatment for a serious mental condition like bipolar disorder. The use of drugs should be integrated within a systematic approach that involves psychoeducation, as well as certain lifestyle changes.