Is it possible to manage symptoms of bipolar disorder without medications–for example, if diet and sleep are in good control?

Bipolar disorder presents many challenges to patient and clinician alike. A good alliance and use of psychotherapy which can help with depression is important, since most people spend the majority of their time in depressive episodes. The good news on self-care strategies is that regular social rhythms (predictable sleep, primarily coupled with good practices like regular exercise, avoiding substances like alcohol, and stress reduction practices) can reduce the occurrence of manic episodes. The converse is also true—poor sleep hygiene (e.g., working night shifts) can increase risk of recurrence.

The importance of learning from past experience cannot be overstated for clinicians, patients and their families. Symptoms of recurrence are often similar in the same person, so monitoring and early detection of a relapse may be possible.

Good self-care and learning from prior episodes are essential tools for improving outcomes in bipolar disorder. It is also essential to recognize that medications reduce risk of recurrence of episodes and help to reduce the intensity of episodes once one has begun. The type and phase of bipolar disorder is essential to inform medication choice, as are outcomes and side effects. The medication strategy is best implemented in the context of a strong alliance with shared decision making involving the patient, family, and healthcare professional.

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