Is keeping sane is the same as keeping sober?

Hi everyone,

I've been thinking about something for a while and would appreciate it a lot if somebody provided a feedback on my musings.

I hope it comes out coherent

I've seen my pdoc last week and he agreed to reduce my lithium to 300 mil from 450. So, I'm pretty much on sub-therapeutic dose now, if all goes well, in a month I'm getting off it completely!

It's been 3 years since my first and only manic episode. I work full time, my family is good again, I have a ton of friends, working on my prof. designation, life is good. And I am so very very scared.

My doc is a wonderful guy, he is the same pdoc who saw me in the hospital when I turned myself in three years ago. He is hopeful that I can make it, but he also told me that one of his patients was symptom free on meds for 20! hears and complete lost it when she was taken off them.

He also asked a question that really bothered me: "If you start to go manic again and it feels really good and exciting and awesome, why would you want it to stop by seeking treatment?"
I wasn't sure what to tell him, to be honest. This made me think very hard about my manic break and how I behaved at that time and why. And I came to this conclusion.

When I got manic my brain craved excitement. On its own it could only produce that much endorphins, it wanted more, but needed outside stimulation to get them flowing. Pretty much the same as an alcoholic's brain work (in layman's terms). I didn't know I was ill at the time, so I obliged. I started drinking, smoking pot and that knocked my systems into overdrive. Everything else that followed was a classic manic nightmare.

Now my question is, if I chose not to indulge my brain and didn't start substance abuse, would I still get that manic? What if on it's own my brain can't really go beyond hypomania? It never did before or after by some reason?
Does that mean I have a fighting chance if I just chose not to go down the rabbit hole the next time? I know there was a moment when I made a conscious decision to let go, because my life wasn't very good at that time, I felt very disappointed and not in control of things. So it felt like a huge burden fell off my chest when I got manic.

Can I just "chose" to stay away from manic episodes by not indulging in them and not fueling the flames? I'm sure hypo will happen from time to time, but for me that's an extremely productive time with no side effects other than mild irritability at the end.

I don't think I am not bipolar, I know I very much am. But I also don't think I am absolutely powerless in how much illness presents itself. I know that up until some moment I do have control and I can take action to prevent the worst from happening.

I think I "know", but I'm very scared that it's just wishful thinking on my part...

Wow, I can really relate to you. I've been med-free most of my life, and I have only needn't classically manic twice, both after I fueled the flames with drug use.
I can mange without meds, but I am tired of it, I just started Lamictal.
I think if your doctor lets you go off, then it's safe. BUT, if your mood or behavior changes noticeably, I would notify your doctor immediately.

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Your question is a very good one and something I have wondered myself. I had a 'breakdown' in 2000 and was hospitalized (I also turned myself in) but took meds for only a short time, mostly because I didn't like the side-effects but also because I knew I had thinking errors that needed major work. I decided to go another route ... I got intensive counseling and joined a 12-step support group (Co-Dependents Anonymous) and continue to go to this day. I have leaned on this group and my sponsor, close friends, exercise, rest, healthy eating, work I enjoy, and better thinking to maintain my mental health and 14 years later I am doing well. I trust my friends and sponsor to help me with thinking errors and fears when I can't seem to get there by myself.

I was not afraid like you describe to not take meds because I never took them for long but I can relate to your fear of "going back there". I'm not so bold to say that I will never be that far in the hole again but 14 years is a pretty good track record.

It sounds like you are in a good place and have some understanding of how you became manic in the first place. That is a good foundation for trying to go med-free. The only suggestion I have is to have a intimate support system in place - a few healthy people you trust and know your history to call when you feel the fears creeping in. I call it "importing a better brain" when mine is feeble. It works for me.

((((Ms.Beeblebrox)))) Best wishes!

That's interesting you talk about needing an extra push from external stimuli to get you all the way up. I've often wondered the same thing about myself.

It's like turning the propeller on an old aircraft before it'll start up and run on it's own. Neat.

Like staying on meds. And not ditching them? Yes, then it is like staying sober.

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I have become Extremely manic without using any substances at all. I've gone 3 months with 2 hours' sleep a night (up all night doing things like dancing, hiking, making collages out of tiny bits of paper & mirrors). So you can, in fact, go manic w/out drugs or alcohol. I am an extreme case--I mostly get manias, not depressions as often. I am medicated & have never gone off my meds. I'm on low dosages of seroquel & depakote. I get seizures, too so the Depakote helps w/that.
It sounds like your condition is not severe & that you have a real good pdoc. I think you can trust yourself & your MD
BTW, I love Beeblebrox!

Thanks everyone who replied!

It's very comforting to know that there are people who understand what I'm talking about and can relate! Helps a lot.

As for my condition being mild, I'm not sure if I agree with that. My pdoc diagnosed me as BP1 because my manic episode was severe, with loss of functioning and caused major disruption to my daily life. I agree with that assessment.

However, I started going off the deep end only after I was put on Cipralex, which is a notorious AP for causing manias in otherwise steady bipolars. And later on, as I already mentioned, I helped the episode develop by abusing substances I never even touched before in my life (a.k.a pot).

I did become depressed on my own twice before. But those depressions were 10 years apart, started during times of extreme stress and were not too deep (no suicidal ideation, major loss of functioning, need for hospitalization, etc).

And what comforts me the most, is the fact that I was never psychotic, even at my worst manic state. I did get overactive imagination and became overly interested in angel lore, but never really thought it real, saw anything weird, or claimed special powers or abilities. But I did get almost every other symptom in the book, including very embarrassing ones that I still have difficult time thinking about.

So, I am very very unsure if I can be classified as a "mild case". What do you think?

P.S. Dix888, thank you, I love him too! The Hitchhikers guide was one of the first books I ever read in English, so it holds a special place in my heart

However, I started going off the deep end only after I was put on Cipralex, which is a notorious AP for causing manias in otherwise steady bipolars. And later on, as I already mentioned, I helped the episode develop by abusing substances I never even touched before in my life (a.k.a pot).

Don't APS have anti-manic properties? This must be the exception. I will need to look into this medication to learn more.

Ah, this makes more sense. It is a SSRI AD, not an AP. Sure, the SSRIs can cause mania. But this AD must be the worst.

Yes, AD is what I meant Thanks for correcting me, makes way more sense now!

I personally can not choose to avoid much when I am manic. I mostly dont even remember what I do. I know I am very impulsive. I dont think just do. Like everything in the world is amazing and what the hell is a consequence? Lol It takes us onto a whole different level of logic. It may just be me but I would say your mind will not remember the consequences at the time of drinking and smoking pot you just jump in.

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Eh, I am more into Tom Woottons approach (learning to expand your comfort zone moodwise). I call it "learn to body surf the emotions". Aka, you don't get out of the sea to spend the time in hotel pool... you learn to ride the waves without getting hurt (too much).

I'm glad you're working this out with your pdoc and not on your own. And I'm glad he's actually willing to do it!

As for "controlling" a manic episode, I suppose it depends on how far it goes. I know for myself that my manias (which are rare for me) cause me to lose all impulse control. So if I am that high I can't control it because I DON'T WANT TO. So therein lies the danger.

However if I am still cognizant I can put things in place to keep me safe, such as use cruise control so I don't speed, eliminate caffeine, tell my husband not to let me drink alcohol, etc. so I think to so this you must be very aware of yourself. But it absolutely can be done, and you'll never know if it works for you if you don't try.

But please don't let yourself feel like a failure if this doesn't work out. There is no shame in needing extra help from meds.

Thanks again! Great insight everyone.

I start thinking that maybe it's just different from person to person? Some peoples' brains probably are very efficient in producing hormones on their own and don't really need outside help? Mine does, I proved it couple times.

I have been very stressed out because of work and I felt pretty much the same as before my first manic episode took off. Very agitated, emotions go into overdrive, hard to calm down, etc (was still on full dose of lithium). And the need to take something to help it along got pretty strong. But I still remembered what would happen if I obliged. I think I have pretty bad PTSD from my mania, so it's not really easy to forget that there are consequences. I just didn't take anything, went to bed early, forced myself to sleep and was fine in the morning. Might not work forever, but I think it's worth a try. Anyone else had this sort of experience?

As for my pdoc being supportive, I'm very happy that he is. He is a very nice person, I feel lucky. But it wasn't his idea. He referred me to a reproductive psychiatrist last year because I wanted to know what to do in case I accidentally get pregnant while on lithium. It was that pdoc who told me that I am most likely not BP1 but BP NOS because of the uncertain role of AD and other substances in development of my mania. And that ONE manic episode does not warrant the life time use of lithium. It was after that visit that my pdoc started to taper me off.

Interesting though, when I was in the hospital for the first time I got put on lithium, lamotrigine and seroquel. Because I really wasn't in a good shape at the moment. But I got severe reaction from the last two and had to be taken off them immediately. My pdoc was very upset, said that I had unusual sensitivity to meds and that it would be very hard to treat me. I wonder what would happen to me if I didn't have that reaction and was still on all three? I guess it would be way harder to get off them now, if ever. What do you think?

wildflowerchild25 thank you! I try to tell myself that all the time. Of course it's great to not have to take meds, but I'd rather eat them by the handful than go raving mad again and destroy everything I worked so hard for!

Anyone who'd wanna be married to Zaphod must be bipolar

I dont really have any constructive advice, I just hope you can successfully work through your issues. I know how hard it is to strike that balance. It took me a trip to rehab to finally accept that I needed help for my mental health issues as much, or more, than I did help to give up drinking. (Soda) cheers to you friend

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I know I loooove the username! I got the reference too lol

Haha. My favorite books of all time. My little part time (as in I do a lot of work when I'm hypo, then it sits there the rest of the time haha) glass jewelry business is called 'Wonko Art Glass' because the I share the same first and last name of Wonko the Sane.

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I think I should include this in the list of my symptoms!

"Wants to be married to Zaphod" lol

This is how I know I belong to this forum

Thank you lil_better and wildflowerchild for your replies.

My hypomanias I have the judgment of a five year old, maybe a three year old. I often "shh... If you don't talk they won't know your drunk" teen but hypomanic instead of drunk when I first start. I often need very sharp, to the point reminders of what is not appropriate usually every five to ten min if I haven't got detracted by something else. I don't have the ability to really curb myself from doing stuff. However my therapist was able to get something stuck in my head for before things get bad. ( Currently the whole chair desk and tablet are vibrating because of how fast Im shaking my leg in that they won't know stage.)

Hey everyone,

I've decided to post quick update on my situation, in case anyone is interested

It's been over two weeks after my lithium dosage was reduced to 300 mil. It's way below therapeutic level for me now, but I am still taking it to taper off gradually.

I'm very happy to report that I'm doing well! My emotional range recovered to its pre-med levels but I have not experienced any manic/hypomanic/depressive symptoms so far. I do get a bit agitated from time to time, but its more of an anxiety type of agitation that is very normal to me and happened when I was on the full dose of lithium as well. I'm a lot less bloated, which is great!

I've been thinking lately about how my recovery progressed and how I managed to reduce my meds and stay well. I thought of couple of things that I think helped a lot. I won't say that I have only myself to thank for the recovery, I think I just majorly lucked out this time around, but I do believe that those things helped in getting where I am now.

1. I never ditched my meds without consulting with my pdoc. I was very tempted to, after I gained 15lb in the first three months of taking lithium and I was pretty mad at him for not treating it as an emergency, but looking back I think he was right. I did stop putting on weight after I became aware of how much more hungry drugs were making me and started exercising, so he turned out to be right. I still have 7 extra lb on me though, but it doesn't bother me too much anymore.
2. I worship sleep. For the first year or so I would not stay up after 10 pm to save my life. I think that was one of the major factors in my healing process. I still try to go to bed around 10 and 11 on those occasions when I don't, I feel significantly more agitated the next day.
3. I stopped drinking alcohol completely for the first two years after my manic stint. I started drinking socially again this year, but I try to limit it to one beer/wine glass a night and no more than once a week. Did drink a bit more lately with the colleagues, but I am stopping that!

I've been stable for three years so far. Couldn't even imagine that my life will be ever good again after that horrific episode back in 2010. I know the symptoms can return anytime, but I am very hopeful that even if they do I will be prepared and deal better second time around.

Thank you so much for that moremi. I posted a question this morning but didn't get much of a response.
You just answered it. Thanks

I will just tell you what my experience is...I am diagnosed as BP2, but not that long ago, I was drinking heavily and abuse a prescription of Ritalin. That combination, no question drove me into manic state....and repeatedly....every night was mania until I passed out...

After I sobered up, my symptoms mellowed and stabilized except for the rages I would have almost like clockwork, every 3-4 months -- total all out rages...I would do and say things that are not me....are not according to my beliefs. they would last anywhere from a day to 3/4 days, with lulls of a few hours. Drinking made them MUCH MUCH worse, and pot, well that made me paranoid....I could never understand why pot made me SO SO SO paranoid, now I get it...I used to really enjoy pot until I was about 22/23 and then it just completely wacked me everytime.

yeah, drugs and alcohol make symptoms much much worse...but for me, after I sobered up, medication and therapy were/are still very important...

Look at it like a diabetic -- a diabetic wouldn't quit insulin because they are symptom free -- why would you? Do the medications have side effect for you that you don't like? If so, consider a different drug regimen.

But again, that's my two cents.

Because diabetus is a clearly tested condition and it's main compenent is not inappropriate behaviour.

Big part of why BP is a problem is how the symptoms impact your life.


I mean, idf you wanna use medical comparision... how about... do you take anti-biotics for the rest of your life if you have an infection? If you sprain your ankle or break a bone, does it mean painkillers for the rest of life? Does cancer mean life long chemo?

Does a chemically or situationally induced episode mean drugs for life?

To be clear, I think BP can be pernament thing and one has to be careful with themselves. But I don't think we need to be drugged at all times necessarily. That leads in same case just to every increasing coctail of drugs and body being resistant to milder chemical intervetions.

To be clear, I think BP can be pernament thing and one has to be careful with themselves. But I don't think we need to be drugged at all times necessarily.

I agreevwithnthis statement. I also believe that over time periodic drug vacations are in order under a doctors supervision. This can then help you determine what drugs are now necessary.

Good point...