Treatment of bipolar disorder without medication: is it possible?

Medications for bipolar disorder can have side effects, but there are also risks in not taking them. We look at the pros and cons.

If the idea of ​​taking medication doesn’t appeal to you, you’re not alone.

You may prefer not to take pills if it can be avoided. Or you may feel like your bipolar disorder medication isn’t helping you, or you’re worried about side effects.

While these are valid concerns that you can discuss with a doctor, keep in mind that medications can also help relieve the symptoms of bipolar disorder or the number of episodes you are having.

If you have been diagnosed with bipolar disorder, be aware that treatment plans vary. You can talk to a doctor about potential side effects and symptoms you’re already experiencing to find a maintenance plan that’s right for you.

Bipolar disorder is a mental health condition that can cause extreme changes in mood or energy levels. Formerly known as manic depression, it affects approximately 4.4% of people in the United States.

There are different types of bipolar disorder and the symptoms can vary in severity. Depending on the type, people can experience these distinct states:

  • mania or hypomania: periods of high energy and high mood, when you feel elated, full of energy, or irritable
  • depression: periods of low energy and low mood, when you feel sad, listless, depressed or hopeless

Some people go years between manic and depressive episodes, while others experience them in quick succession.

Bipolar disorder is a progressive, lifelong mental illness, which means it requires long-term treatment. Symptoms don’t go away on their own – and these symptoms can have a negative impact on a person’s health, safety and quality of life.

This is why a combination of medication, psychotherapy, and lifestyle modification are often part of treatment, although your bipolar disorder treatment plan will be specific to the type of bipolar disorder you have and your symptoms.

Medication can help stabilize your mood so you don’t have as many manic or depressive episodes. This stability also makes therapy and personal routines possible and more effective.

“Manic or depressive symptoms may occur much more frequently in people who are untreated with this condition,” says Joseph Swider, MD, psychiatrist at Heading Health.

“Medications are the cornerstone of treatment because, in addition to treating an ongoing episode, medications can prevent the next episode from occurring.”

Additionally, says Swider, other methods of treatment, such as therapy, are “almost impossible” when a person is currently having a manic episode.

That’s why “bipolar disorder isn’t something to be treated with psychotherapy alone,” says Caitlin Billings, LCSW. “Most people who choose not to take medication struggle with balance and struggle with major role obligations, such as parenthood, employment, managing finances, and maintaining stable, long-term relationships. term.”

“The sooner a person explores medications and finds an appropriate prescription for bipolar, the better the prognosis,” Billings shares. Medications and the stability they can provide can improve your quality of daily life.

However, some people experience medication side effects that they cannot tolerate. These side effects are the main reason people with bipolar disorder stop taking their medications.

There are risks to living with untreated bipolar disorder, although some people do. They often chose to manage their bipolar disorder symptoms with other treatment methods, with mixed success.

Untreated bipolar disorder can lead to serious and dangerous symptoms, including:

Impulsive actions or psychosis

When a person is currently experiencing a manic episode, they are at higher risk for engaging in harmful behaviors, including:

  • excessive consumption of alcohol
  • dangerous driving
  • impulse spending
  • harmful sexual activity
  • assault

These behaviors can put you at risk of:

  • job loss
  • substance use disorder
  • strained or unhealthy personal relationships
  • financial or legal problems
  • sexually transmitted infections (STIs)
  • problems with law enforcement
  • accidental death

“During a manic episode, an individual may lose the ability to reason abstractly or concretely and may become much more impulsive or even psychotic,” says Swider. “It’s those psychotic symptoms or impulsive acts that can occur when an individual is manic that can lead to emotional, professional, or financial harm.”

While psychosiscan occur during manic and depressive states, it is more common during manic episodes. Symptoms include:

  • hallucinations
  • delusions
  • incoherent or irrational thoughts
  • confused speech
  • unconscious

Suicidal thoughts and attempts

Untreated bipolar disorder can also lead to increased suicidal thoughts, especially during a depressive phase.

A 2015 study estimates that 25-60% of people with bipolar disorder attempt suicide at least once in their lifetime. Between 4% and 19% die by suicide.

Progressive brain damage

Research suggests that untreated bipolar disorder can lead to a series of structural changes in the brain that cause long-term damage. Indeed, explains Billings, “the disorder results from unstable brain chemistry which, over time and with each episode, can degrade brain matter and lead to increasingly uncontrolled episodes.”

An older study from 2003 found that bipolar disorder may possibly lead to the loss of an important amino acid (NAA) in the brain, which is important in regulating emotions and memory; other research has shown that it can cause a gradual loss of gray matter.

A long-running 2015 study found that manic episodes lead to decreased volume in parts of the brain, highlighting the progressive effects of bipolar disorder.

There are several types of medications used to treat bipolar disorder, including:

It’s not uncommon for people diagnosed with bipolar disorder to try multiple medications until they find a fit, or for their psychiatrist to change their medications over time.

About 40-50% of people who take lithium respond to it.

Many people with bipolar are wary of drug treatment.

According to research on people living off medication for bipolar disorder, side effects were their number one reason for not taking medication. The most distressing side effects included weight gain, tremors, decreased libido, and lithium toxicity.

Other people worry that drugs for bipolar disorder will dull their creativity, make them feel like zombies, or take away their personality.

Although medication is considered the most effective way to manage bipolar depression, treatment for bipolar disorder often involves a combination of medication and other treatments.


“Therapy can be helpful for the individual to help them understand their mental illness, deal with the effects it is having on them, and learn techniques to minimize the effect of bipolar disorder on their life,” explains Swider.

Cognitive-behavioral therapy (CBT) can help you identify and deal with unwanted thoughts or behaviors.

Interpersonal and Social Rhythm Therapy (IPSRT) can help you regulate your eating, sleeping, and exercise habits to balance your symptoms.

Build a Routine

Building — and sticking to — a routine can be incredibly beneficial for someone with bipolar disorder. This means going to bed at the same time every night, eating meals at regular times throughout the day, and participating in stress-reducing activities.

Many people also find it helpful to log or log their moods on a daily basis to better understand their triggers and monitor trends.


Some people benefit from taking supplements and vitamins in addition to their medications and a Balanced diet. These may include:

  • fish oil
  • vitamins B9 and B12
  • creatine
  • magnesium
  • vitamin C
  • Vitamin D
  • probiotics


Food alone cannot cure bipolar disorder, but making sure to eat nutritious foods regularly can benefit your overall health and condition. Consume in priority:

  • whole grains
  • Beans
  • turkey
  • nuts
  • herbal tea
  • Saffron
  • foods high in omega-3 fatty acids, such as salmon, eggs, and flax seeds
  • selenium-rich foods, such as Brazil nuts or shrimp

There are also certain substances that you should avoid, such as cannabis. Some studies show that it could make your symptoms worse.

“Bipolar doesn’t have to stop anyone from reaching their full potential, and it’s not hard to treat,” Swider says. “But this Is should be treated for best results.

Medications can help protect you against some of the more serious symptoms, including the rapid cycle between manic and depressive episodes, progressive brain damage, dangerous behaviors, suicidal thoughts, and psychosis.

Therapy and lifestyle changes can also help you take control of your health.

If you want help but don’t know where to start, National Institute of Mental Health (NIMH) provides resources to help you find treatment. The Depression and Bipolar Support Alliance offers free online support groups and other information.

Are you looking for a therapist, but don’t know where to start? Psych Central’s How to Find Mental Health Support resource can help.

About Margie Peters

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