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Dr G: long gaps between episodes
monkeybee posted:
Hi Dr G,

Please forgive me if I have asked a similar question before; I just can't decide how I feel. I have been stable for around 4 months. I realize that's not a very long time but it already has me wondering if I even have Bipolar Disorder. I have had an extremely unstable couple of years but I was pregnant and postpartum most of the time so there were problems with hormones.

Before the last two years (other than postpartum depressions), I hadn't had any major episodes in about 10 years. My questions are, do you honestly believe lithium is necessary for someone who has had such infrequent episodes? Could just taking meds as needed work? My doc insists on lithium (she is weaning me off my other meds) for the rest of my life and so does my husband but ultimately it is my decision. I just wonder if every doctor would agree that meds are needed all the time in every situation.

Thank you,
Joseph F Goldberg, MD responded:
Dear Sarah,
I can't speak for what every doctor would agree on, but there is general consensus in practice guidelines and the generally accepted standard of care that if someone has had even one severe and unequivocal manic episode, that warrants lifetime treatment for bipolar disorder, with rare exceptions (e.g., the episode was substance-induced or secondary to a medical problem). It may well be the case that if someone stabilized on lithium and had no subsequent episodes, that's because lithium was working and doing its job. (If your home got robbed in a high crime area and you then installed a security system and you didn't get robbed again in the next 10 years, does that mean you should get rid of the security system?)

Dr. G.
monkeybee replied to Joseph F Goldberg, MD's response:
Thanks for your response Dr G. I really appreciate your analogy.

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