Recovery from bipolar disorder
 
The conventional psychiatric drug approach

The most common treatment for bipolar is a combination of psychiatric drugs (called polypharmacy) that may include antipsychotics, lithium, anticonvulsants, antidepressants, and benzodiazepines. 

One study found that 72% of bipolar patients were taking 2 or more drugs, 55% were on 3 or more, and 36% were on 4 or more. [1]  It isn't unusual for people with bipolar to take as many as 6 different drugs.

Bipolar drugs have been well-studied in hundreds of gold standard trials. They have been shown to reduce bipolar symptoms and lessen suicide rates, and may be a vital option for those in severe psychiatric crisis. However, many studies demonstrate they have a variety of limitations:

Although individual drugs are routinely tested and FDA approved, combinations of drugs are not. This leads to a difficult reality:

Bipolar drugs are not sufficiently tested together, so their use in combination is often unsupported with strong evidence. [2]

Failure to consider the overall impact of drugs in combination can lead to a troubling prescribing cascade where new drugs are increasingly added to address side effects created by previous ones. This can create a growing burden of medication-induced toxicity in the body and a situation where the impact of every individual drug becomes unclear. In fact, polypharmacy is associated with worsening outcomes. [3]

With the lack of sufficient gold-standard evidence to support bipolar polypharmacy, practitioners use clinical experience and prescribing guidelines to optimize patient care. But even with these tools, the evidence against multi-drug prescribing is plentiful. For instance, two of the most widely used bipolar drugs—lithium and valproate—when used in combination, are able to stabilize only 24% of the patients with rapid cycling. [4]

Your health, your choice
Although the majority of doctors believe there is a place for
polypharmacy in treating bipolar, a growing number see the practice as flawed, especially for the developing brain and personhood of a child. 

Doctors note the poor outcomes of polypharmacy, the difficulty in predicting the interactions of multiple drugs, the long-term safety concerns, and the reality that our mind, body and emotions require a much more holistic and integrated approach than a pill can provide. 

Understanding these realities, many people are reevaluating the risk/reward profile of bipolar drugs and working to take a more holistic evidence-based approach to their recovery.

Your practitioners are your trusted guides. Consider reviewing the above information on bipoalr polypharmacy with them. You may want to discuss the specific studies referenced below. This is important since people with bipolar are often dissatisfied with the information they received from their doctors about psychiatric drugs - especially related to side effects. [5]

The good news is that there are a number of non-drug approaches that have been shown to significantly reduce bipolar symptoms without the many side effects and withdrawal difficulties of psychiatric drugs. These non-drug approaches can often help you create sustainable mental wellness and achieve a reduction in psychiatric drug dosages.

Always work with trusted and licensed practitioners.  Any changes in psychiatric drug use should always be done under practitioner care. Please see disclaimer.


An integrated wellness approach

There are thousands of peer-reviewed gold-standard medical studies that support the use of non-drug approaches for mental health recovery. In fact, there are 27 broad non-drug approaches that have proven effective. Many are useful for bipolar (download free monograph).

It is often best to consider bipolar from a holistic perspective that includes many therapeutic options separated into four categories of care.

The "higher" in this diagram we operate (toward Preventive), the better, since these are the approaches that help us sustain mental wellness. However, once we develop symptoms, it may be helpful to use techniques in multiple categories simultaneously to maximize recovery. 

Preventive care
Preventive approaches include a number of common sense practices we can adopt that often have a significant impact on mental health. Often called wellness basics, many of these approaches have been proven very helpful for bipolar including a safe home, proper diet, mindfulness, regulating our "body clock" (with light and darkness), restful sleep, ensuring gut-health, mind-body disciplines (like yoga) and more.

Restorative care
Restorative approaches address root-causes and direct influencers of mental health symptoms. They come in two varieties: biomedical and psychosocial. Since our body and mind interact so deeply, it is often helpful to address both simultaneously.

Biomedical practitioners can help identify an individual’s unique bio-individuality through blood/urine and other testing, using detailed biomedical test panels. This is important since over 25% of the time, mental health symptoms are caused by or significantly influenced by physical issues. [6] These tests can uncover nutrient imbalances, hormonal issues, amino acid irregularities, food allergies, pathogens, inflammation, toxicities, or other root-cause physical conditions. Walsh-protocol nutrient therapy has been found to be particularly effective: 75% of people with bipolar who undergo 6 months of nutrient therapy report significant symptom improvement and the ability to reduce medication, while about 5% can eliminate medication altogether. To help you locate practitioners, review our Integrative biomedical mental health practitioner finder

Psychosocial practitioners can help identify and address an individual's past trauma, stress, social challenges, emotional difficulties and unhelpful thinking patterns that can cause or influence bipolar symptoms. This is important since assistance is often helpful to work through issues that may be difficult to overcome alone. Cognitive Behavioral Therapy and Interpersonal & Social Rhythm Therapy have proven to be effective for bipolar symptoms. A variety of trauma-informed therapies are also available, since childhood trauma is much more common in those with bipolar. Directories of therapists, psychologists, peer specialists and other psychosocial practitioners are usually available in your community.

Symptom relief care
Symptom relief approaches seek to address residual symptoms that are not removed by preventive and restorative care. 

Prescription lithium (lithium carbonate) is one of the most common symptom relief therapies for bipolar mania. It can reduce bipolar mania symptoms and the likelihood of suicide. But, it is also intolerable to some people and can cause kidney damage with long-term use.  Non-prescription lithium (lithium orotate), although not well-studied, is showing promise at low dosages and appears to avoid the kidney damage of prescription lithium. 

There are also a variety of herbs, sensory therapies and very low charge electrical stimulation approaches that have also been shown effective for bipolar symptoms.

Over-care avoidance
Over-care avoidance limits the use of psychiatric drugs and other medical interventions to only what is necessary. It is important to avoid excessive medical care since it is not only expensive, but can be harmful. Increasingly, practitioners seek to minimize the use of psychotropic drugs, especially polypharmacy, because of side effects, withdrawal difficulties and their inability to cure.

However, some people find psychiatric drugs helpful. When using drugs, they should be taken in minimum effective dosages - no greater than the amount needed to gain significant symptom relief and for no longer than is required. 

Work with trusted integrative practitioners
Many practitioners are joining the 
paradigm shift to Integrative Mental Health - a discipline that embraces the best of both drug and non-drug treatments.

We are all different and require individualized paths to recovery. Integrative practitioners offer a variety of therapy options, and can advise you on the ones most appropriate for your bio-individuality, personal history, stressors, and preferences. Through experimentation, you can find the ones that work best for you. If your practitioners do not offer non-drug options, it is often best to engage practitioners that do.  

Dr. Kenneth Duckworth, Medical Director of the National Alliance on Mental Illness, is clear: "psychiatric medications... are rarely enough to promote recovery alone [7] ... many (people) report that a combination of treatments is most effective."[8]  In support of this outlook, NAMI advocates select non-drug options that can aid recovery [9while Mental Health America articulates many more. [10]

Although non-drug approaches are not a universal panacea and they take more work than popping a pill, many people have found that diligent use of non-drug options can significantly reduce bipolar symptoms with little or no side effects, helping them realize mental health recovery.  

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