I have accepted the fact that I will need to be medicated for bipolar the rest of my life. I know there are some readers and visitors who want to avoid meds for many different reasons, but I know that I am not stable enough to go without prescriptions. I was losing stability years ago, and honestly I am scared for what might happen if I were to quit the pills. I like being stable, even at the expense of the occasional hypomanic spells. The potential consequences of being unmedicated are too much for me to take the risk of quitting, even to have some of that manic fire back again.
I also believe that finding the correct medication is a combination of luck, skill, and uncertainty, and that you are always aiming for a moving target. The bipolar changes and becomes more or less stable whenever the hell it feels like, and the correct medication regime must therefore change in response.
This is a short history of the medications I have taken over the past 10 years, initially for depression and then for bipolar after getting the correct diagnosis.
2004 into mid-2005: Tried Zoloft, then Celexa?, then Effexor. No relief from mood swings, no noticeable help from any of these drugs.
2005 to mid-2006: discontinue Effexor, start with Wellbutrin and add Zoloft. I believe this pushed me into a worse bipolar state, and shit fell apart pretty quickly.
August 2006 into 2009: Went into the hospital in August, came out with prescriptions for Lithium, Lamictal, Wellbutrin, Risperdal (and later its more expensive cousin Invega), Ativan for anxiety, and later Effexor again. Provigil or Ritalin to stay awake. I felt like an unstable zombie; sometimes it worked, sometimes it didn’t, and I was still oscillating pretty hard at times. I quit this doctor in spring 2009.
Spring 2009: Lamictal, Ativan; quit everything else quickly; titrate slowly off of Effexor (which is a real bitch to get clean from). New doctor, more minimal approach.
July 2009 through 2010: Lamictal 200 mg/day. No real side effects at all. This worked at first, but I started losing stability about halfway through 2010.
2011: Lamictal 300 mg/day, Abilify 10 mg/day. Still no side effects I can find. Started losing stability around October 2012, became more urgent as of January 2013.
January 2013: Lamictal 400 mg/day, Abilify 15 mg/day. Seems to be working well as of February 2013. The extra Abilify might be making me sleepy in the mornings, but most days it is not a problem when I drink enough coffee.
January 2014: after taking the same dosage for a year with pretty good results, I decide to try halving the Abilify to 7.5 mg/day (I didn’t tell the p-doc about this). Within a month I enter a dysphoric manic state with high anxiety. The doctor said let’s bump the dosage to 30 mg/day, so I went back up to 15.
March 2014: Lamictal 400mg/day, Abilify 15 mg/day. Once again, things seem to be working normally. If it works, don’t fuck with it.
July to November 2014: The drop in Abilify isn’t working. In response to a couple more nasty dysphoric episodes, I voluntarily increase up to 30 mg/day. The doctor prescribes 45 mg/day, not realizing I haven’t told him the whole story. I plan on staying at 30 mg/day unless I have another crash.
December 2014 to December 2016: Lamictal 400 mg/day, Abilify 30 mg/day. The dosage seems to be working, and I feel better than I have in a few months.
November 2017: I decided to reduce my Lamictal intake to 300 mg/day. I was a little hypo at first, but after a couple weeks I felt fine at the reduced dosage.