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Medications: To have or not, that is the question!

This is the million dollar question.  If you're newly diagnosed, the idea of being on medication for the rest of your life can be terrifying.  If you've been on medications for years and now they have stopped working, the possibility of no medications can also be terrifying.  So what do you do?  

I've grappled with this debate for over a decade.  I was finally properly diagnosed with Bipolar Disorder and Anxiety Disorder over 10 years ago.  My family wasn't very understanding of what I was going through.  So, they immediately said, “Oh, you don't want to take medications.  You don't want people to know you...have...a...metal illness.”  Even after my parents and husband went through the educational course offered by a national non-profit, my parents still thought I didn't need medication.  I ended up deciding to take the medication cocktail...because only one medication just wouldn't do.  These worked for a while.  I stabled out, but I lost so much of who I was that I wasn't entirely certain that the medications were worth it.  I had lost all desire to do any of the things that I used to do.  I had checked out of being a wife, mother, and educator.  I had given up.  My children were young then. 

For the sake of my family, I kept trying new medication combinations.  I even remember waiting for the first day the new medications would become available so I could try them, in vain.  This went on for years.  The constant rapid mixed cycling took its toll.   I did have several attempts and hospitalizations.  I finally decided to try ECT.  I did not come to this decision lightly, but the first time I did it...It worked!  I felt like my old self again.  This lasted for about a year, maybe two.  So, the medication roller coaster began again.  After a few more years of this, I tried ECT again.  It did not work so well this time for me.  In fact, it made things worse.  I'm not knocking ECT.  It can be a very effective form of treatment.  These were just my experiences with it. 

So that brings us current.  I am now medication less.  There are no more medications that I can take.  I used to think this is what I wanted.  I never wanted to take medications for my entire life, not to mention all the weight I gained as a result.  Now that I'm on the “other side”, the grass is not so green.  In fact, it's brown and brittle.  I cycle between mania and depression so fast and often that I cannot keep up.  It is really wearing me down.  I never thought I'd long for the day that I'd find a medication that would take all this away, but here I am.  I've done the medication roller coaster and I've done the no medication thing.  I'm not entirely sure which is better.  I guess it depends on the person.  I have increased my exercise.  I've improved my diet.  I've increased my creative outlets.  I'm doing what I'm “supposed” to do.  Yet, I still cycle daily.  

I think if anyone is considering whether or not to take medications, you must first do your research, talk to your doctors (they need to know your intentions), make sure you have really tried EVERYTHING.  I feel that I have done everything, but I'm now hopeful that something will come along to help.  I'm hopeful that something will make life a little more bearable.  I just have to be patient and do all I can in the meantime to keep myself healthy.  My advice to anyone with the medication question:  Do your research.  Really think it through.


HI Susan! thanks so much for writing about this topic!

I know you wrote that you've tried pretty much everything...I'm so sorry ---but I wonder if you've tried an MAOI (monoamine oxidase inhibitor) with lithium? I'm medication-resistant & I have bipolar one disorder. Over the past decade I tried 25+ other meds and I opted for unilateral and bilateral ECT (which worked for my acute bipolar depression with suicidal ideation). I have seen at least 20 psychiatrists and not ONE ever suggested to me to try the following medication that I describe below...

My latest psychiatrist (and the best one I've seen) suggested that I try the "old-school" medication of a MAOI (monoamine oxidase inhibitor) Parnate for my bipolar one, in combination with lithium. I did some research and found that MAOI's are suggested to those with medication-resistant bipolar disorder. They have food and dietary restrictions that are more than worth the sacrifice to me, i.e. no alcohol and no foods containing high amounts of the amino acid tyramine. MAOI's can work even more effectively in combination with lithium. (Two small studies done back in the 1970's proved that hypothesis and I was impressed with the study results.)

The MAOI and lithium combo. finally worked to alleviate my longtime bipolar depression. I'm so thankful to these medications for helping me get my quality of life back. If even one person is helped by this comment, I'll be thrilled.

have you tried the maoi patch? It gets around the dietary restrictions.

DBT can be brilliant for Bipolar Disorder. It teaches you to regulate your emotions. Cope with distress. The mindfulness part is life changing although this needs to be invested in a big way. It is hard work with constant attention to your emotions. If your moods are up and down daily then the meds probably have little effect unless it's a mixed effective episode. To do it successfully you have to stick to a very strick routein.

I appreciate your comment. People who do take medications also use DBT. Medications don't cure you. They give you a baseline if you are seriously ill. The rest is hard work!

I was diagnosed with Bipolar I in 1989, when I was 19 years old. Now I'm 44. I've taken anywhere from no medication, to very complicated cocktails and have also tried ECT. I did not have a good experience with ECT and would not like to try it again. Now I take Lamictal and Trileptal and focus on overall health. I eat healthy food, exercise, and do meditation to keep my stress under control. Pyschotherapy has helped me a great deal. I also attend a support group. This is working the best of anything I've tried.

i was told by a supposed top notch shrink that taking Mao inhibitors for bipolar depression gives you a fifty percent chance of triggering a manic episode, I said no way and then he said ECT is the gold standard. Bullshit! I had 17 treatments and all it did was knock out large chunks of my memory. I exercise but I have to fight my way through it every day. Bottom line: there is no risk free effective treatment for bipolar 1 depression.

Thank you for stepping forward and broaching what can be a difficult and confusing topic. I have struggled with the idea of taking my medication since I was 16. Although I started with a diagnosis of Major Depressive Disorder, with other complicating diagnoses, it has gradually evolved into a diagnosis of Bipolar II. Throughout my years of treatment, I would eventually go off my medication when "I felt better". I suppose most are familiar with that feeling- not that you're necessarily cured, but that meds just aren't necessary anymore because you've "evened out", or are "doing well". I never committed to therapy, but instead went to my medication management appointments with my psychiatrist. Eventually, I would crash again, and needed to go back on medication. The ground eventually gave out under me- with the combined weight of chronic physical health problems, rising alcohol addiction that was no longer "functional", and the evolution of my psychiatric condition, my psychiatrist referred me to a DBT therapist. She worked with me to build the bare basic skills to have a life worth living at that point in my life, until I was no longer safe. She then put her foot down with me and my family, and refused to treat me any longer until I was hospitalized. She sent me to a wonderful dual diagnosis program that had a DBT program so that I could continue my skill set practice, and where I could get my medication cocktail stabilized. I finally became my own best support- I WANTED to get better. I was finally committed to taking my medication. For a few years, I had a wonderful life(comparably). I was making friends again, I was sober, I was taking knitting classes, etc. I had found joy in my life again. I adopted a wonderful pit bull, Argos, who really helps my PTSD; I feel safe around him, even though he's the biggest lap dog in the world. And he's now safe with me, since he was an abused rescue. Then my medication cocktail stopped working. Gradually, kinks started showing up, and we had to make adjustments. Then the side effects began. I can no longer take an entire class of medication due to the risk of a severe side effect. Lithium and such don't work for me at all. And now we've discovered that the antidepressants that I've always needed are causing me to cycle into mania, yet we've found no mood stabilizer that I can safely take that works well. So I find myself perfectly willing to fully commit to a medication regimen for the rest of my life, and unable to find one I'm able to take. Right now I'm in the process of mourning that loss with my therapist, because it truly is a loss- a loss of something that I relied on, something that gave me hope for today, for the future. I've started seeing a new psychiatrist after taking a genetic test from Genomind- it was very revealing about the way my brain works, and why I can't take certain medications, and what I might be able to try next. It also gives suggestions about supplements I can take to support my mental functions, as prescribed by my psychiatrist. She is well versed in the genetic testing and the new research in this area and supplements such as 5HTP and SamE. I try to have an open mind, and do my own research, as always. Read all of the available information about your prescriptions, not just the short version, and always ask questions. Your doctor only knows as much about how you are responding to your medication as you tell them. I recommend keeping a medication journal. Your dosages, side effects, moods, etc. this gives you the opportunity to give full, accurate feedback to your doctor. However, medication is, after all, just one of the tools in the toolbox of good mental health and healing. For me, DBT therapy was like being given the guidebook to life, but behavioral therapy isn't for everyone. There are different types of therapy out there, though! Just like we might try different cocktails of medications, we can try different types of therapy. I consider therapy part of the trinity of good mental health: psychiatric support(medication, ECT, or not), therapeutic support, and social support(friends, family, work, social interaction, pets, hobbies).
Right now, I'm just trying my best to stay positive within the parameters I have available. Some days it feels like very little, but on other days I feel lucky to have any options. Today I walked out of my doctors office feeling like we were just starting the fight, instead of at the end of a losing battle. It was a good day.

Hi Heather,

Did the 5-htp work for you? I know it's the precursor to serotonin and I seem to see it cropping up more and more

I wrote a blog on this topic. Over the 25 years I've had bipolar, I've had my antidepressants stop working 8 times and had to go back to square one. My bipolar 2 progressed to bipolar 1, and after a decade of being a successful disc jockey and medical transcriptionist, I had to apply for disability in 2006. To my surprise, they backdated the time of my disability to 2003 after looking at my work dysfunctional history and medical records. The last two meds I tried, first Pristiq and then three years later Viibryd, worked within a week. I'm hopeful that medications will continue to get better, and I read the comment about MAOI's. If the med I'm on now, Brintellix, gets burned out, I'll either try Femitiza or MAOI's. Seems like there are a lot more choices. I'm allergic to Lithium so I use Tegretol and Lamictal for mood stabilization and Clozaril for mood stability and Tardive Dyskinesia.

I have schizoaffective and am now starting Clozaril. So far it has been a blessing. I have tried Zyprexa, seroquil, lithium, saphras, Risperdal and none of them has been quite as effective as clozaril. Besides the weekly blood tests this medication is more effective for me. It's not the magic bullet but my symptoms are much more manageable.

I was off medications for a decade. If you are severely ill-you will need them. When you are too ill to function-then you realistically need medication. Lighter cases would probably respond to light or no medication. I've been on both sides. My perspective.

To meds or not to meds
About 3 years into taking depakote and an SSRi a boss asked " have you done this work before?"
My memory, ability to recognize objects on a page and my analytical ability had dropped so severely that where previously I was a high performing expert user of this computer program, I was now incompetent. I'm afraid to take IQ test for fear of getting a low score, previously I was top 1% intelligence.

In "the good old days" poor performers could get by.
Now forget it, especially now that I'm in my 50s. My last boss suggested retirement and living frugally. Being Disabled by meds is unacceptable to me. I don't want to be old, and poor, someone who doesnt contribute, and lastly being an unemployed MALE kills my self esteem adding to depression.

The doctors answer = prescribe MORE anti depressants which forces me to take MORE LITHIUM to prevent mania = more side effects and lower IQ.

I can't afford deep depressions or mania because I'm also an addict. To relapse is to die.

I wake up after 4 hours of sleep and can't get back to sleep for 2 hours. This makes it even harder to hold job. If I increase or eliminate my SSRI dose, I can get back to sleep.
I take ultra low doses of SSRIs since they are powerfully effective for me. (1/2 minimum pill every other day).

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