While there are all kinds of good reasons for wanting to stop taking a particular bipolar disorder medication, doctors agree it’s almost never a good idea to do so suddenly and on your own. Bipolar Disorder: The Rebound Effect of Halting Drugs “Sudden major changes in a treatment plan can cause all kinds of changes in the patient’s biochemistry," says Melvin G. McInnis, MD, director of psychiatry programs at the University of Michigan Depression Center in Ann Arbor. “It’s much more beneficial for changes to be calculated and gradual, in a situation that’s not acute.” Stopping psychiatric medications suddenly can cause a range of symptoms — from the dizziness and ringing ears associated with abruptly stopping certain antidepressants, to the actual withdrawal that you could experience from going off an anti-anxiety medication. If you suddenly stop taking lithium, one of the drugs most commonly prescribed to stabilize bipolar disorder moods, you can experience “rebound,” a worsening of your bipolar symptoms. “Long-term use [of some drugs such as lithium] causes brain cells to compensate — like water building up behind a dam,” says Gregory Simon, MD, a psychiatrist and researcher at the Group Health Center for Health Studies in Seattle and chair of the scientific advisory board of the Depression and Bipolar Support Alliance in Chicago. “If those drugs are stopped suddenly, symptoms can come back even more severe than they were at the start.” This is not to say that wanting to stop one or more of your bipolar disorder medications is unwarranted. In fact, there are many justifiable reasons to stop a bipolar medication, including dangerous side effects. Sometimes several drugs have to be tried before the right combination of drugs is found. After a period of treatment, the efficacy of a drug sometimes seems to wear off, although researchers aren’t sure whether it’s actually the drug in question or something unrelated that’s going on in the patient’s environment that is bringing an escalation of bipolar symptoms. It’s also the plain and simple fact, Dr. Simon says, that drugs for bipolar treatment are not always that effective to begin with. “Although the drugs make them better, people may still experience some degree of depression and some periods of feeling speeded-up or racy. It’s understandable that a patient would want to quit, more so than would the patient who is taking blood pressure medication or medicine for high cholesterol,” Simon says. Bipolar Disorder: Going for Gradual, Monitored Change If you feel as if your medications aren’t working, your doctor will most likely prefer that you work with him on a series of steps that may include:
Keeping a diary of symptoms, if possible, for a week or two.Being honest with your doctor about those symptoms and your frustrations and concerns.Working with your doctor on options, including increasing your dosage, decreasing your dosage, and changing medications.Making a gradual, monitored change from one drug to another.Bringing your family and loved ones into the conversation.
Family members can be particularly valuable at this time, providing your doctor with additional insights about your response to particular medications. “The management of bipolar disorder is a collaboration between the treatment provider, the patient, and the family,” says Dr. McInnis. “The individual bears the burden of the illness. His responsibility is to adhere to the treatment regimen and report back to the doctor with a degree of fidelity on the symptoms and the severity of life stressors. The family is the sounding board for observations and perspective. With that trio in place, one can really effectively manage the treatment through all kinds of storms.”
