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Okay...slightly long story...I was diagnosed with Bipolar II about six years ago after living for five years with very bad mental health--mostly depressive episodes, with occasional hypomanic episodes. I started Lamictal around that time (400mg). Four years ago, I added Abilify (20mg), and it was like a magic pill: my mood episodes went away almost completely and I have experienced very few Bipolar symptoms since. The mood swings that I do experience are mild and manageable.

Here's the problem: as the years have passed and I've stabilized, I've become more forgetful about my meds, and over the past seven months I've gotten kind of experimental without realizing it until recently. I take my meds rarely, maybe twice a week tops--a combination of forgetfulness and curiosity--and I think it's been at least two weeks now since I've taken them at all. And despite the fact that I have a huge amount of stress in my life right now, I feel very stable! I've had little upturns and downturns in my mood in response to outside circumstances, but it's nothing I can't work through with patience other forms of self-care. 

I know that what I've done is really irresponsible, but I just don't want to be reliant on medication and I guess I've been seduced by the possibility that I might have somehow recovered? From a chronic mental health condition? It makes no sense to me. But I finally confided in my parents and best friend that I've been doing this, and all of them said they've noticed no changes in me. During this seven month time span, my psychiatrist (who didn't know I wasn't taking my meds) suggested lowering my dosage because of my lack of mood symptoms. Still, my mom is really worried that I stopped taking them without consulting a doctor, and the reality of my choice is hitting me, and I'm starting to feel scared. Is it just a matter of time before I start having serious mood symptoms again? Is it possible for Bipolar Disorder to become less severe with age? Could I even have been misdiagnosed? I was fifteen when I started having depressive episodes, almost twenty-two when I went on Abilify, and now I'm twenty-six. 

I don't have a psychiatrist right now because I just had to change health care plans. I know I should get in to see one as soon as possible, but I don't know how long that will take. What should I do in the meantime? I still have meds. Start taking them again? I really don't want to because I want so badly to be right about not needing them anymore. And could it be bad to go back to that dose if I've been off it for a while?

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Playing around with meds is definitely risky. Who knows how long it could take to spiral out of control again - weeks, months? Years? But unfortunately there is no cure. Remission is what we get, and it sounds like right now you are stable which is good. I am happy for you! But just be careful. If I were you I would find a pdoc and when you have your appt, tell him/her about your meds situation and see what they think. 

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With the Lamictal, you have to titrate up slowly again, you can't just go back to the dose you were on previously. Thats really not something you should do on your own without guidance from a doctor.

I'm not bipolar, but I had my first major depressive episode when I was 15. After some years on meds, I did have a period of relative stability in my twenties where I was able to function without them. So yeah, that can happen. It doesn't mean it won't come back. In my case it came back with the additional fun of psychosis.

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I have never spoken with anyone who actually liked taken psych meds.  We take them because they are better than the alternative.  Also, it is common for most of us to, at least once, go non-complaint.  It seems okay at first, but usually ends poorly.  Just try and remember what your life was like before the meds, how much the meds helped and if you really want to risk going without them and landing back where you were.  Take care of yourself.  Good luck.

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Some of your story sounds like mine.  I was 15 when I had my first depressive episode.  I have heard that the earlier in life you have a mood disturbance the greater chance that it will eventually bipolar.  I don't remember the age in which it doesn't matter, maybe 18 or 20, but I do remember 15 being in the range for higher risk.  Not hard science, but consistent anecdotal evidence.

For the next 8 years or so I had depressive episodes on and off.  My wife (who knew me then) thinks looking back I may have had hypomanic episodes as well.  If I did I didn't know it at the time.  College can be a crazy time anyway.  After college, I didn't have any depression or hypomania (that I knew of) for 12 years.  Also note that I had not gotten any treatment, ever.  After 12 years, depression came back full force and over the course of 8 weeks I became dangerously suicidal.  I then started treatment.  That was two years ago.  Now I'm doing really well with therapy and meds.

I've had periods of denial.  I do doubt my BP2 dx.  I've only (knowingly) had two hypomanic episodes.  I'm 99% sure they were.  But my lows and highs don't last very long.  Sometimes I think that since the highs didn't last over a week then maybe I was just in a good mood.  I can't deny the depression.  Hell, I had planned my suicide and was abusing narcotics just to make it through the day.

I'll likely be on meds forever.  I went 12 years without symptoms.  What if I'm fine for another 12?  Would I unnecessarily be taking meds the whole time?  But the way I look at it is that if I don't stay on meds, I'll get blindsided when it hits again (and it probably will), and given my history of dangerous suicidal ideation, I can't take that risk.

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Just saw my new psychiatrist and she is questioning the bipolar diagnosis since the worst of my hypomanic symptoms came when I was on high doses of Concerta and Ritalin (was misdiagnosed with ADHD as a child and on the meds for eleven years!)...she gave me the green light to wait another month before deciding whether to restart medication. I'm so confused! I don't want to be on meds if I don't need them, so how do I know if I need them? I'm an artist, and I do have periods of intense productivity and excitement about my work, but does that need to be pathologized? What differentiates hypomania from normal spurts of creativity? Some of your stories have really scared me...I don't know what to do. 

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The thing about Abilify is it has a long half-life so you theoretically can go without taking it for a few days and not feel a resurgence in symptoms. It's one of the reasons that pdocs like longer half-life meds. It helps with compliance.....or rather it is a bandaid fix for those with compliance issues.

The truth is that bipolar disorder is progressive and the longer it goes without being treated the harder it becomes to treat. That is a statistical fact. Those who are diagnosed later or who have their diagnosis corrected later in life have a poorer prognosis.

So the truth is you COULD go off your meds with your pdoc's supervision but statistically you are looking at this coming back to haunt you at some point in the future, and most likely sooner than you'd think or hope. It happens that way with me an antidepressants. I tell myself that I should try to go without them because I don't like that they restrict my emotional range and that I can't feel sad about anything anymore. I stop taking them and I feel "better".....for a few months. But inevitably I have to start them again.

Interesting also that you point out that you were diagnosed with depressive episodes young and it turned into bipolar 2 in your 20s. That's exactly how it happened to me. I was a very bright, fluttery kid, but I was also VERY sensitive and could become easily depressed. I started taking antidepressants around when I hit puberty and I've needed meds pretty consistently ever since then except for a break that I took through high school. But by the time I got to college it all came spilling out again and I just couldn't do it anymore.

Bipolar disorder is a cycle. So yeah you can go without your meds, but do you really want to live in fear of a mood episode? That's a precarious life. And sure maybe you were misdiagnosed, but is there any other diagnosis that fits more than bipolar disorder? It sounds though like you have had hypomanic episodes and they can be distinct.

Truth is that Lamictal is one of the mildest options you could possibly take for bipolar disorder and there are much more difficult medications. However, your psychiatrist may be onto something with the dosages. Now that you've been out of mood episodes for a while, maybe you can decrease doses. Lamictal generally goes to 200mg for bipolar disorder. Some people need more but for the majority of people, studies showed that doses above 200mg didn't confer any added benefit in bipolar disorder. So maybe decreasing the Lamictal and you could always drop the Abilify down to 10mg as that is still a safe dose for bipolar maintenance especially if you're also taking Lamictal.

Of course, I will always recommend making changes with your pdocs supervision. If it's a while until my next appointment and I feel like I want to make a change and there's justification for it, I call my pdoc's office and just ask to speak with him when he has time. In an urgent case, a pdoc should be willing to discuss with you.

When is your next appt?

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