Q:  Is it possible to "grow out of" bipolar disorder? If so, in your opinion, how long will it usually take? Thank you.


Dear Jesse -- 
Good question.   There's no good, simple answer to this one.  There are some people who have a manic episode, clear cut, no question about their diagnosis.  Then they never have another one, nor a severe depression.  So, there are some people who do seem not to have the "chronic", i.e. ongoing version.  On the other hand, after a few mood episodes it seems that it would be very rare for a person to stop having symptoms.  In many people, possible most, it looks like having symptoms for a time creates the likelihood of having more symptoms later; and the more it happens, the more it happens.  That's a pretty common pattern. 

So you can see that this phenomenon makes the question you ask even more complicated.  If you're doing fine, haven't had symptoms for a long time, on medication, can you slowly taper off and be fine?  Well, you see, you might be running a risk of a recurrence that would "advance" you along the curve of this symptoms-beget-symptoms course, and sometimes when this happens people don't respond to the same medication approach they used to respond to (e.g the one they just tapered off).  

So that problem makes your question a very tricky one.  At minimum, one thing is very clear:  if people are going to try a period of time off their mood stabilizer, there are two CRUCIAL steps:  

1. Tell your doctor, tell your doctor, tell your doctor: somebody needs to know what you're up to and help you monitor this, and this she/he is one of those people.  This also gives her the opportunity to help you figure out how much risk you might be taking, to try to answer the question in your particular case. 

2. When your doctor gives you the okay, taper the medication slowly.  I heard one expert talk about taking a year to taper off lithium in someone who was doing well.  Six months is routinely mentioned, and taking more than a month is absolutely crucial as there are good data showing that stopping faster than that is associated with rapid relapse of symptoms.  

There, that was surely more than you were really asking.  The short answer is "yes, it's possible", but probably rare, and finding out if that's you, leads into a much more complicated and very, very important examination of risk, as I've tried to hint at here.  Use caution!

Dr. Phelps