I don't think you can have a solid rule about EVERYONE with bipolar. It is too variable. ADs alone and the first 2 with lithium (SSRIs which are cruel to me) were horrible and I was promised no more ADs by a world famous expert in bipolar who conducted a clinical trial I did. But Lamictal didn't work so well for me and while I was off ADs for years I did eventually go back on them with adequate mood stabilization. And while I think I tried being off them one other time just because we weren't finding one that worked without causing high blood pressure I didn't do well. And when I had to go completely off my AD to go on an MAOI I got a pretty good luck at what it is like for me to not be on an AD and it was not pretty.

My pdoc uses them with caution and we do things like backing off to nearly nothing or in this recent case taking several days completely off the AD when manic because MAOIs are really stimulating. On the other hand the stimulating effect allows me to tolerate enough APs and mood stabilizers to be able to function with the doses I need.

But it really kind of annoys me when any dr. proclaims that "this is the way for everyone with bipolar/PTSD/GAD/OCD/etc" because everyone is different. I did a PTSD treatment once that was very intense. The creators say it is a 12 week once a week treatment. It took me 5 months twice a week because it was so hard that each step took me longer and I had to back off a few times because I was getting too upset. It worked but the "this treats PTSD in 12 weeks" thing was a joke for me. Fortunately my pdoc never really expected 12 sessions would do it and we just kept going until we were done but individual differences matter in all things mental illness I think.