Dear Therapist:

I was diagnosed with bipolar disorder as a teenager and have been on medication since then. While I am doing well and have not had any episodes in a long time I have not been successful in work or in shidduchim. I feel that the medication stifles my personality and makes me less of who I really am. I have discussed this with my psychiatrist, but he just tries to push me off. I think I am ready to move off my medication and move on with being the person I know I can be, but no one really hears what I am saying. Can you please give me your opinion if you think this is the correct approach?

Response:

Since I am not a psychiatrist, I cannot advise you on specifics with regard to medication. I will remark briefly, leaving more in-depth discussions about psychopharmacology to the panel’s psychiatrists.

As I’m sure you know, for many people on psychiatric medication, the sense of wellbeing and an associated desire to discontinue medication is not uncommon.  Recognize that this can in fact be a tribute to the efficacy of the medication regimen. When one is properly treated, this very sense of wellbeing can be a strong reason to remain on medication. Discontinuation of a proper medication regimen can lead to consequences that the medication is helping to prevent.

Of additional concern for those with bipolar disorder is the possibility of an extreme reaction that can go unchecked. Depressive episodes can begin suddenly with little warning. This can make continued treatment more challenging. The onset of a manic episode can be as sudden. In addition, when in the grip of a manic phase, euphoria, high energy and other seemingly “positive” feelings tend to mask associated problems that often lead to highly problematic symptoms and behaviors. This hinders the person’s ability to acknowledge that there is a problem. This often means that treatment is not sought until late in the process—or until the euphoria gives way to depression.

Nevertheless, you certainly have the right to understand—and be involved in—your treatment. If your psychiatrist evades discussion of your treatment, perhaps he doesn’t recognize the seriousness of your concerns. Scheduling an appointment with the express purpose of discussing your concerns can give him the clear sense that this is something that is important to you. The two of you should be able to have a comprehensive conversation about your total treatment.

Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317