Dear Dr. Phelps,

I'm disturbed about recent developments relative to  what had been described as bipolar disorder, a problem with which I dealt for al,ost 20 years.  I am now 50 years old. There is no question that even a well-educated layman would arrived at the same conclusion to the diagnosis given the facts.

In point of fact I would have to say that my particular case of bipolar disorder would have been described among the more serious. And yet there has been a peculiar change of condition in the last four years.

I'm well aware of fact that bipolars tend to have a poor track record in compliance with medication.  And of course I would have to be listed among them.  I underwent an extensive sessions of therapies, both group and private for a number of years with an organization in my state known as Circles of Care.  It was during these therapy sessions that I began to discover how to change my behavioral patterns.  In short, I have not been on any medication whatsoever for the treatment of the disorder in almost four years.  During this time, I have had no symptoms to suggest either a manic or depressive phase.

I'm confused as to whether I've actually made a sufficient change my behavioral patterns to allow me to live a "normal" life, one that allows me to pursue my professional career as a music director (which I have).  Is it possible for someone to receive therapy to the degree that symptoms could be mediated to such a remarkable degree?

I monitor my condition very carefully.  There have been a number of situations in which have taken Xanax for a very short period of time when stress levels have been exceptionally high.  After several days of this treatment, everything seems to quiet down without further complication.

Of course I would prefer not to take a lot of medications given my current state, which seems remarkably well adjusted.

Any insight you might be able to offer with regard to the situation would be appreciated.
 

Dear Mr. R' -- 
Your experience may be exceptional, but in any case, congratulations.  Sounds like you've had a great outcome.  Often when this kind of thing happens for my patients, we celebrate without knowing precisely what was the basis of the improvement.  In your case, it sounds like you think the Circles of Care therapy played a role.  

As you may have learned, there is no clear evidence that a therapy, including this one, can treat the symptoms of bipolar disorder to the extent that they do not return.  Your story is thus exceptional.  I believe it is possible that a few select people could get this kind of response from a therapy (as opposed to a medication).  There is a story, for example, of a fellow who was able to control his rapid cycling by limiting exposure to bright evening light.  

If those around you are able to confirm that you do indeed seem to have arrived at "mood stability" over time -- since this can be hard to judge on one's own sometimes -- then you may continue to see just this (because 4 years is a long time to go without symptoms).  If your doctor sees the same stability over time -- we are not good judges because we see only a few "snapshots", instead of the whole video -- she/he might be willing to sit back and wait for any further symptoms before turning to a medication approach.  Good luck with that. 

Dr. Phelps