Aug. 14, 2024 – After receiving a bipolar depression diagnosis following a suicide attempt in 2014, Tiffany Jean Taylor was prescribed antipsychotics and antidepressants for treatment, and talk therapy was recommended. But when she found herself at the same hospital 4 months later, Taylor had a “full-circle moment” when she realized she wasn’t getting any better. She knew she needed to try something different.
“I went home, and I really started to embark on my holistic mental health journey, said Taylor, 38, who has now been off psychiatric medications for a decade. “At that very moment, I decided to start looking at different theories and different modalities for my healing.”
People with bipolar depression are often treated with antipsychotics for mania and antidepressants for depressive symptoms. But some patients like Taylor seek out alternative ways to treat this condition without the use of prescription drugs, according to Maria Ingalla, a psychiatric nurse practitioner and owner of Paperflower Psychiatry, which has multiple locations in Arizona.
“I've had a lot of patients who are just not interested in medication or have tried medication before and had really intense side effects,” Ingalla said. “The medication is lifelong because it’s a chronic disease.”
While prescription medication is the primary form of treatment for bipolar disorder, “I think it's important to be clear: Medications are not the only treatment for bipolar disorder. There are so many other things that can be done to help modulate the problems that often come with both bipolar disorder, and more specifically, bipolar depression,” said John Leslie Beyer, MD, a psychiatry and behavioral sciences professor at Duke University School of Medicine.
Chemical imbalance in the brain plays a role in bipolar disorder, and prescription medicine can help level out these brain chemicals. But psychiatric drugs do not “add or subtract” chemicals in your brain, said Ingalla. Rather, they may stabilize an overactive chemical that could be triggering certain bipolar symptoms.
Historically, one of the hallmark signs of bipolar disorder has been severe and persistent disease, where a person has an episode of depression or mania that they feel unable to control, said Beyer. It’s also important to note that bipolar disorder is a recurring illness for 90% of patients, meaning they will have another episode at some point of their lives.
But in the last decade or so, the term “bipolar disorder” has been used more fluidly. As the condition is more understood as existing on a range, between normal emotions and impaired emotions, the term is often applied not only to full-syndrome bipolar disorder but also to a milder tendency for moods to become detached from a person's baseline, Beyer said.
For the latter, nondrug treatments could be an option, particularly given certain side effects that come with prescription drugs, he said. Some of the most concerning side effects of psychiatric drugs include complications that can develop within the liver and the kidneys. And some medications could also affect your blood sugars, possibly increasing the risk of diabetes.
“I think it starts by recognizing what the impact of bipolar illness is on that person's life,” said Beyer. “If it is such that it has significantly caused functional problems, problems in relationships, problems in jobs, problems with divorce – which bipolar is known to do – then I would not in any way hesitate to say we need to think about medications.”
So, who might be a good candidate for a more holistic approach? If your mood is stable, but you were diagnosed with bipolar disorder during a traumatic phase of life where you struggled with emotional highs and lows, you could be a contender for exploring treatment options outside of medication. This is especially true if you are stable but were diagnosed between ages 16 and 24, when the brain is still developing.
“It’s possible that as we arrive at the maturation of the person's brain, they've settled down into their lives so much that they may be able to handle some of those challenges that happened earlier in a different way than when they seemed to have had a bipolar episode,” Beyer said.
“For the people that don't have the high-risk bipolar disorder – meaning they are severely and persistently mentally ill – we probably need to have an open mind about something that happened during a person's adolescence.”
But keep in mind: It’s crucial that you speak to your psychiatrist before you stop taking bipolar depression medication, as many drugs require you to taper off slowly, as directed by your doctor. Use even more caution if you are having severe mental health challenges, such as destructive manic episodes, said Ingalla.
“It is possible for a lot of people – but not all people – to find a good space to heal and to maintain good mental health while holding good lifestyle patterns," while trying to give up medication, she said.
After being diagnosed with bipolar disorder six times by six doctors, making multiple hospital visits, and having severe depression, Caitlin Pyle had been prescribed nearly a dozen antipsychotics and antidepressants at various times over several years. Pyle, 37, began to explore potential causes of her mental health struggles – such as mounting stress from a tumultuous divorce. Now, after 4 years of healing from bipolar depression without psychiatric drugs, the Florida-based transformational life coach said self-awareness is a major part of recovery, as well as refusing to accept the common narrative that you can’t heal bipolar disorder without prescription drugs. Taylor, who is now a mental wellness coach and practitioner in Ohio, echoes this sentiment.
“I had to change my identity. I had to change the way that I acted. I had to change the way that I reacted. I had to get in touch with my feelings. I had to connect with myself. I had to be self-aware. I had to be self-responsible. I had to self-actualize,” she said.
Possible Nondrug Treatments
One form of nondrug treatment is social rhythm therapy, which has been shown to be a great alternative for managing unstable bipolar moods, according to Beyer. This type of psychotherapy centers on lifestyle management and following a daily routine that includes things like eating a healthy diet, regular exercise, self-care practices, and keeping a regular sleep-wake cycle.
“It has some really good data about its efficacy both in treating patients with medications and those without medications,” Beyer said. “Those same ideas that support what social rhythm therapy is are also just good ideas about how to help people work to manage their own moods and take care of themselves far as noticing if they're having any mood problems and finding where stress impacts upon mood reactivity.”
Traveling, late nights, and certain stimulants – such as caffeine, alcohol, and drugs – can all trigger unstable moods when you have bipolar disorder, according to Ingalla. Being exposed to bright lights in the morning can help keep your mood regulated. If you are having a manic episode, try dark therapy, suggested Ingalla. Go into a pitch-dark room between 6 p.m. and 8 a.m. and do your best to relax. Getting a pair of blue light glasses could also help when practicing dark therapy.
Don’t Let the Diagnosis Define You
Not being limited by your diagnosis and believing that you can push through seemingly unbearable moments is paramount in recovery, said Taylor. She recalled a time when depression had left her bedridden for several years.
“I had to be honest and say that nobody is going to come get me out of this bed,” she said. “I literally am the only person that can force myself to move my body and socialize and take a shower and eat.”
Taylor also said that when she cut off relationships where she felt disrespected, or where certain boundaries were crossed, she had fewer mania symptoms.
Remember that your doctor is going to play a key role in any plans to adjust, or even wean off of medications completely, Beyer said.
“It’s important to have a working relationship with your doctor to discuss things like: ‘What should I look out for?’ or ‘What are the early signs that I really may have an underlying bipolar disorder?’” he said.
If you and your doctor agree you should stop taking bipolar medication, connecting with a good therapist will be critical for the next part of your healing journey, as they can also help keep you in check and monitor your emotions, Ingalla said. “Medication can do some things, but therapy does everything, in my opinion.”
