Medications: for the rest of your life?

Q: when having bipolar do you have to take meds for the rest of your life? [now there's a succinct question writer...]

Dear Ms. C' --
Here's how I answer that for my patients.  First, why don't we find something that works really well.  Then, when you ask that question, you'll know just what you're looking at doing "for the rest of your life". 

Then, we look at how severe your symptoms are.  If they've never been really terrible, and you could risk a recurrence without risking your job, your marriage, your kids, or your life (as might be the case with bipolar I, for example), then the risk of trying a taper off of the medications is relatively low; you might choose to do that at some point.  If you wanted to do that to avoid some side effect, I'd try to eliminate the side effect first. 

For people with such relatively low-severity symptoms who might choose to risk a relapse (we're talking Bipolar II here, primarily), there is still the risk that the medications that might be working well now would not necessarily work again if tapered off then restarted later.  That's the risk that really worries me as a prescribing doctor: we've got it controlled now; that might not be so achievable later, yipe.  Unfortunately, we cannot really say who risks this and who would be able to restart no problem, so it's an unknown theoretical risk. 

Finally, you almost certainly won't be on those medications the rest of your life, because as time goes on we're going to have better and better treatments (at the rate things are improving now, which looks to get even better as more is understood about the fundamental problem(s) that causes these symptoms in the first place.  Eventually it is conceivable that we'll have a medicine you take once and never again, because it fixes that fundamental problem (no kidding; our hospital has been approached by a research group that wants to inject human DNA to actually solve a problem that a person would have to take medicine continually for -- it's already being tested for some medical problems!). 

Dr. Phelps

Published January, 2001