Hi Ellie,

Your profile in our community doesn't state your diagnosis or current medications, and I don't know your treatment history; hence I can't accurately answer your question. However I can tell you what advice I would give to the "average" individual with Bipolar I Disorder.

• Stay on a combination of an antipsychotic medication plus a mood stabilizer:
  
  Research has shown that monotherapy (treatment with just one medication) is usually inadequate for the treatment of Bipolar I Disorder.
  
  Aust N Z J Psychiatry.
  2005 Aug;39(8):652-61.
  
  Maintenance therapies in bipolar disorder: focus on randomized controlled trials.Muzina DJ, Calabrese JR.
  
  OBJECTIVE: Lithium remains the cornerstone of maintenance therapy for bipolar disorder despite growing use of other agents, including divalproex, lamotrigine, carbamazepine and the atypical antipsychotics. Lithium has the largest body of data to support its continued use as a prophylactic agent; however, most of this data comes from early studies that did not use contemporary analytic methods. Alternatives to lithium are needed because of the relatively high rate of non-response to lithium monotherapy and the drug's frequent side-effects. This article reviews available data with an emphasis on double-blind, placebo-controlled studies that examine the efficacy of lithium and other putative mood stabilizers: carbamazepine, divalproex, lamotrigine and olanzapine.
  METHOD: The authors reviewed key literature using Medline searches using key words: bipolar disorder, controlled trials, mood stabilizer, lithium, lomotrigine, divalproex, olanzapine, carbamazepine.
  RESULTS: Lithium remains the gold standard for overall preventative efficacy in bipolar disorder, especially to decrease manic or hypomanic relapse. Of the mood stabilizers that have marked prophylactic antimanic properties, lithium appears to possess the greatest antidepressant effect. Divalproex may also prevent recurrent bipolar mood episodes but the relative lack of controlled maintenance studies makes this less certain. There now exists an extensive and well-designed research database supporting the use of lamotrigine in the acute and prophylactic management of bipolar I disorder. Lamotrigine offers a spectrum of clinical effectiveness that complements lithium, in that it appears to stabilize mood 'from below baseline' by preventing episodes of depression and has been shown to be effective in rapid-cycling bipolar II disorder. Carbamazepine may be a useful alternative to lithium, divalproex and lamotrigine, particularly for patients with a history of mood-incongruent delusions and other comorbidities, but controlled data is more equivocal and it may lose some of its prophylactic effect over time. Emerging data continue to support the growing use of atypical antipsychotics, particularly olanzapine.
  CONCLUSIONS: Any monotherapy for use as a maintenance therapy of bipolar disorder appears to be inadequate for long-term use in the management of the majority of patients with bipolar disorder. Combination therapy has become the standard of care in the treatment of bipolar disorder and particularly in patients with treatment-refractory variants such as those with rapid-cycling. The emerging consensus is that patients on monotherapy, if followed for sufficiently long periods, will eventually require concomitant treatment to maintain a full remission. There exists a need for controlled trials that use random assignment to parallel arms including combination therapy followed by data analyses that include both relapse rate and survival techniques.
  
  PMID: 16050919 [PubMed]



• Stay on your combination therapy for your lifetime:
  
  Research has shown that Bipolar I Disorder is an episodic, but lifelong, condition. Thus it requires lifelong therapy.
  
  Eur Arch Psychiatry Clin Neurosci.
  2003 Oct;253(5):236-40.
  
  Recurrence of bipolar disorders and major depression. A life-long perspective.
  Angst J, Gamma A, Sellaro R, Lavori PW, Zhang H.
  
  OBJECTIVE: It is not known whether the risk of recurrence declines with time in bipolar disorders and in major depression. This study describes the life-long recurrence risk of bipolar I, bipolar II and major depressive disorders.
  METHOD: 160 bipolar-I, 60 bipolar-II and 186 depressive patients hospitalised between 1959 and 1963 were followed up every five years from 1965 to 1985. The course prior to the index hospitalisation was assessed in retrospect. The recurrence risk was computed by the multiplicative intensity model (Aalen et al. 1980).
  RESULTS: The cumulative intensity curves for the transition from states of remission to new episodes remained linear over 30 to 40 years after onset, indicating a constant risk of recurrence over the life-span up to the age of 70 or more. The recurrence risk of bipolar disorders (0.40 episodes per year) was about twice that of depression (0.20 episodes per year); BP-II disorders had only a slightly higher recurrence risk than BP-I disorders. There were no significant gender differences in the course of either bipolar or depressive disorders.
  CONCLUSION: If long-term trials confirm its efficacy, these results support lifelong prophylactic treatment of severe types of mood disorders.
  
  PMID: 14504992 [PubMed]

Ellie I hope this information helps you, and that you can discuss this important issue again with your psychiatrist.

Phil Long M.D.
Administrator