The Great Medication Dilemma

A common issue for bipolar individuals is medication -- to take or not to take? Lithium, anti-convulsants such as Depakote, and atypical anti-psychotics like Abilify can each prove very effective in preventing and managing the cycles of mania and depression. Most of us don't miss the depressed times, but let's be honest, those "up" moods can be really fun and productive! Plus, research suggests a relationship between creative genius and the shifting moods and insights experienced during bipolar episodes. Given these facts, plus the side effects medications can have, it's not surprising that many of us stop taking our meds periodically.

I can say from personal experience that, although understandable, the decision to stop taking prescribed meds is a very bad idea -- it is a decision I always regret. There are two main reasons: one, stopping the meds usually precipitates an episode, and two, stopping cold turkey results in withdrawal symptoms, sometimes severe.

Four years ago I came to the (misguided) conclusion that, while I clearly had recurrent bouts of depression, I was not actually bipolar. So without talking to my doctor, I discontinued my anti-convulsant and anti-psychotic. I still took the anti-depressant, though, which made the situation even worse since anti-depressants can trigger mania.

For a long time -- more than six months -- I thought I was okay and that I truly was not bipolar. My behavior gradually became more erratic, however, and over time it was evident, to those around me at least, that I was escalating through hypomania into mania. I had the classic symptoms of expansive and grandiose mood (plus a LOT of irritability), excessive involvement in pleasurable activities, risk-taking, lack of sleep, and so forth. When I took off one day to cross five states for a romantic tryst, my mother did venture to ask, "Are you manic?"

My response was "Well, if I were, I probably wouldn't realize it anyway!" But shortly thereafter I did realize something was terribly wrong, because I moved into a mixed state of mania and depression combined. Along with the above symptoms I had intense jealousy and fear, bouts of crying, feelings of hopelessness and self-loathing, and other signs of depression. I was very frightened, so I finally asked my pdoc (psychiatrist) for a mood stabilizer. He put me on Topamax -- I had been taking Depakote before then -- and unfortunately I had significant side effects including neuralgia and hyperasthesia (even the slightest touch or other stimulus to my skin and mucous membranes was extremely painful).

Finally I was on Depakote again, but by then I was well into the depressed phase. Because I was unmedicated in the earlier part of the episode, the depression was long and severe. I self-injured and thought frequently of suicide. I went so far as to make a plan, and was saved from carrying it out just in the nick of time.

I have to admit that there have been occasions since then when I missed up to several days of a medication, especially if I ran out because I forgot to refill it. However, as much as I hate taking the drugs, I know that I don't want the experience I had before. I might not survive it the next time. And I'm not quite done with this Earth yet!