Living Well With Bipolar: What "Successful" Patients Do - A Quick Follow-Up

John McManamy Health Guide
  • Yesterday, I posted about two studies that documented what “successful patients” did to stay well. This included a high awareness of what was going on inside their brains and around them and adjusting accordingly, plus paying attention to sleep and taking strategic rests, not to mention building connections.


    As for meds, I wrote: 


    Most intriguing, there was little emphasis on meds, and one can see the logic in this: As we move along in our recovery, the emphasis is on what we can do to help ourselves, not on passively waiting for treatments to kick in. 


    This drew a comment from Lisa:

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    Is a patient with bipolar only "successful" if they are medication-free?


    Many thanks for asking this Lisa. Let me set this in context. Much of the conversation on meds is dictated by the extremes. There is a rigid psychiatric view that posits that we need to be on meds the rest of our lives, this despite a total lack of credible long-term study evidence.


    Then there are elements in the recovery movement who mistakenly believe that being off meds is a sign of successful outcome, despite how well or not well the individual is actually doing. 


    In a follow-up comment, Lisa essentially answered her own question:


    I regularly work 6 days a week, am a single mom and am in grad school and would be afraid to go meds-free.


    In response, Willa wrote:


    You work six days, are in grad school, and a single mom?  Why on earth would you want to mess with ANY regime that made all THAT possible!  You go, girl! - That's my take on it.


    That’s my take on it, too, but we would be leaving a totally wrong impression if I did not add this pertinent observation from Tabby:


    Once on the glacial amount of meds, your ability to remain "high functional" or to become such deteriorates exponentially.


    Tabby validates the experiences of many, who have only gotten worse - not better - on meds. Typically, symptoms may improve but functionality goes south. Too often, our doctors feel that this is a fair trade-off. Then there is the concern - most forcefully advanced in Robert Whittaker’s "Anatomy of an Epidemic" - over the damage of staying on meds long-term. (Whittaker though left out the neuro-protective benefits of lithium.)


    I certainly endorse where Tabby is coming from. This is why I have always supported the notion of the “expert patient.” A good many of us may need to be on meds long term, but we need to be questioning our doctors every step of the way. 


    So, back to square one. Most of the patients in the first study (by Sarah Russell) were on meds, but they made it clear that they had other priorities in managing their recovery, such as being microscopically attuned to their moods and energy levels and acting fast (typically by taking breaks). 


    Maybe you can see how this reconciles with meds. If we can spot an episode or a stressor coming before it happens we may not have to be on high meds doses. We can stay functional, and bump up the dose when necessary. But this is a very sophisticated strategy. We don’t learn our recovery skills overnight, so no-meds/no-recovery skills is a recipe for disaster.


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    One final point concerned a comment from Crystal, who expressed skepticism to the studies, but what I picked up showed a concern we all share, namely: Only two studies? That’s it? Crystal wanted to know more about how these patients managed their meds. In my view, we would need at least ten studies for just this alone. 


    She also wondered whether these so-called successful high-functioning patients merely had a “milder” form of the illness. Good question. Maybe to that we can add whether we can separate out “good prognosis” patients from “bad prognosis” patients. Again, we need more studies, lots of them.


    So much we don’t know. But at least we’re starting to ask the questions.

Published On: October 21, 2013