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When Bipolar Mania Gets Out of Control

For many with bipolar disorder, mania feels dangerously good.

Bipolar Disorder Medications: Why Quit?

In recent years, the medication menu for treating bipolar disorder has become quite complex. Most people with bipolar I start with lithium. Drugs used to treat other illnesses have also been pulled into treatment: antiseizure medications, antipsychotics, calcium channel blockers, and benzodiazepines.

The medications can work very effectively in smoothing the highs and lows, helping people feel "normal," says Edith Harvey, MD, staff psychiatrist with the Hope Program at the Menninger Clinic in Houston.

"There are a lot of people out there who are extremely functional despite their bipolar disorder -- doctors, lawyers, judges, movie stars," Harvey tells WebMD. "It's a very treatable disorder. I would have to say the majority of people who get into treatment stick with it. It's a smaller percentage that repeatedly get sick."

What makes people quit taking medication? Very often, it's denial that the problem is a real illness. Another issue is intolerable side effects, especially lethargy and weight gain. Or the medication may not be working very well, says Harvey.

Many people quit because they don't like their doctor, Bearden says. "Usually, the doctor saw them for five minutes, gave them a drug, and they didn't like the drug. Not feeling listened to is a huge factor."

"People may be aware of the risks of not taking anything, but it's a free country," Harvey says. "A lot of times, people have to go off their medications and get sick again before they are more accepting of treatment."

Fine-Tuning Treatment for Bipolar Disorder

It's critical that patients get intensive, ongoing psychotherapy plus medication -- but very often that doesn't happen, Jamison tells WebMD. "There is a lot of evidence that the combined use of medications and psychotherapy makes treatment successful. That should be the standard of care, but it is not."

Indeed, the psychiatrist is the anchor in the treatment program, Bearden says. "Psychiatrists are becoming a lot more tuned in to patients. We're getting a lot better at listening. We're really trying to understand what's going on from the patient's perspective."

A large study called STEP-BD looked at the effectiveness of treatments for bipolar disorder. The study showed that people with bipolar disorder receiving intensive psychotherapy in addition to medication recover faster from depression than those receiving medication alone. These results support the concept of combining medications and psychotherapy in the treatment of bipolar disorder.

"The big focus is on developing a more individualized approach -- not just prescribing a medication, but listening to the patient's feedback on various medications," she tells WebMD. "It's more of a team effort. It's such an art, not just finding the right medication, but finding the right dosage for that person, even using combinations of medications."

Harvey agrees: "Lithium is a wonderful medication, but some doctors don't fine-tune lithium as well as they should. If people take high doses of lithium, it may slow them down, and they don't want to continue with it. Having people on the least amount possible helps them still be productive, still feel that creativity. We can keep them from becoming manic without having the severe side effects -- weight gain, water retention, and fine tremor."

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