Going Off Bipolar Medication -- Almost Always a Bad Idea

Going off bipolar medication is a bad idea -- well, it's almost always a bad idea. I know why people want to do it. I would suggest that pretty much everyone on bipolar disorder medication has wanted to go off of it multiple times during treatment. This is completely normal and almost unavoidable. In spite of this strong desire, though, going off bipolar medication is almost always a bad idea.

Why Do People Want to Get Off Bipolar Medication?

People want to get off bipolar medication for several reasons, but three big ones are stigma, side effects, believing they don't need it.

1. Stigma -- The stigma around psychiatric medication can be extremely strong for some people. For example, like me, many people are taught from the time they are children that psychiatric medications don't work or are just a crutch that only weak people need. Other people may not have been raised this way but feel the pull of medication stigma elsewhere. Either way, bipolar medication can be seen as undesirable, by a long shot.
2. Side effects -- The side effects of psychiatric medications could fill books. They can be horrible and life-altering. It's not surprising that people would want to escape them. No one wants to be on a medication that causes suffering. This doesn't mean that they're not worth it, this doesn't mean that side effects can't be handled, but it does mean that wanting to go off bipolar medication to rid oneself of them is normal.
3. Belief in lack of need -- When medications work, people feel better; they feel like themselves. This is great. But the problem is when you feel well, you think that, like other well people, you don't need medication. And as everyone would like to avoid side effects and not be subject to stigma, the person on medication convinces himself that he's no longer sick and no longer needs medication. (This is not the same as anosognosia, by the way, which is a clinical inability to recognize one's illness.)

Getting Off Bipolar Medication Is a Bad Idea

But the fact of the matter is, you need bipolar medication to be well. This is true for 99.9 percent of people with bipolar disorder I or bipolar disorder II. I can't say it's true of every person on the planet, of course, but I can say that you, and I, probably fall into that 99.9 percent.

I've seen it happen over and over again. A person falls victim to one of the above three trains of thought and convinces themselves they would be better off without medication. Initially, they are okay. Initially, they do well. They don't know why they were on medication for so long. But then, little by little, they fall, and inevitably, they end up in the hospital either because of a suicide attempt or psychosis. And as anyone who has been there can tell you, it's a very, very long and painful climb out of that hole. When I tell people not to go off bipolar medication, it's because I don't want people to have to experience that.

When Is Going Off Bipolar Medication Not a Bad Idea?

I can think of two times that gett off bipolar medication isn't a bad idea:

1. If you plan on becoming pregnant (or are pregnant), there are certain medications that are contraindicated.
2. If you are only getting side effects from the drugs and no relief.

In both cases, any attempt to get off bipolar medication must be done with strict medical supervision. A doctor will be able to advise you on how to get off medication safely and be there in case something bad happens. Even with help and in those cases, though, it doesn't mean that getting off of bipolar medication will be successful. Unfortunately, failure in this regard is always an option. 

Going Off Bipolar Medication -- The Short Story

In short, don't even think about trying to get off bipolar medication by simply throwing your medications out the window. I understand that impulse -- I've had it myself -- but it won't serve you. The best thing you can do (assuming you're not in one of the above two very specialized groups) is to be honest and open with your doctor and explain why you are in such distress over your medication. Be clear that you cannot withstand its lack of effectiveness if that's the issue or its side effects if that's what you're concerned about. Be clear that you need a change to happen. Don't let a doctor sweep your concerns aside. Your concerns matter, and if handled correctly, they can improve your treatment outlook. The answer isn't no medication; the answer is better medication management.