And again being ignorant, but does bipolar actually ever just decrease or go away or whether you learn to live with it without medication and if so is the quality of life worth being able to say you're medication free?
I don't believe bipolar just decreases or goes away in the vast majority of cases (maybe in some).
There is a spectrum of severity.
Some people with type 2 learn to manage with lifestyle alone.
Lifestyle is key to managing all types of bipolar, including severe and those who only achieve control on meds.
In type 1, depending on how bad it is, how bad the manic episode(s),
perhaps,
but if you've had mania vs hypomania, by definition that is more dangerous.
+/- psychosis, which is always possible no matter how many "psychosis-free" manic episodes you've had, is also dangerous.
To be or not to be on meds,
For bipolar, it depends on a few things.
1) How much time do you spend in euthymia?
2) Most spend up to 80% of their adult lives clinically depressed. Impairment in one or more areas of functioning. Of course, there's coping, and differing levels of distress from that. Doesn't necessitate medication just based on that. How "dangerous" is it when they're in a depressed episode? Is it mixed? Impulsive? Suicidal? Attempts?
3) Besides that, you have to look at mania.
For many, when you see the harm that one severe manic episode can wreak, not to mention the evidence regarding how many episodes of depression or mania one could have in a year.....
One manic or depressive episode could be so dangerous that one decides it cannot be "risked" again over a lifetime.
If I had an illness that could not only cause me to lose touch with reality, but not even know that I had, loss of insight... and during that time, I might be violent towards myself or others, not to mention all the other **** I could do (burn my house down with my cats in it, catch HIV, etc)
I don't know that's a degree of loss of control I could ever be OK with.
If I were on medication that I knew I would never become psychotic, but that off of them that were a possibility....
If it were me, I would likely take medication forever or until it caused me such side effects as to wonder "what now?"
I believe up to 1/4 manic depressives complete suicide. This is a lot higher than for unipolar depressives, which suggests there is something more dangerous suicide-wise about bipolar than just the depressive aspect.
Is medication the answer? I don't know. But I don't think anyone feels very comfortable with all of the above. The stakes are even higher than ruined lives, marriages and careers lost. Death. Psychiatric death is just sad, sadder than some other types of death.
I could write more likening bipolar to epilepsy. Most types of epilepsy, you have 2 seizures, you get meds for life. If you achieve a no seizure state for a certain number of years on meds, than it might be OK to try going off meds. If you have another seizure then, the neurologist will beg you to go back on meds and stay on them for life. This is because for the neurologist, they can't tell when the next seizure will not only cause brain damage, make your seizures harder to control, but which one will be status epilepticus, or SUDEP (sudden death in epilepsy).
Most people tolerate anti-sz meds so well it's not worth the risk of a seizure while driving, swimming, home alone, etc etc etc to try to live a med-free life that you put at risk off meds.
You have to decide if the risk of the even low frequency event (seizure or manic episode/mixed episode/suicide) is worth no meds, or if it's better to be exposed to higher frequency side effects from medications.
Or what if what they love to do in life is what is making them sick? I mean physician depression and suicide happens because people are driven to insanity unable to choose life over their love of medicine.
This is why I say typically purusing medicine as a career meets the most basic definition of addiction: continued pursuit in the face of increasing harms.
I can promise you another thing, if you are a bipolar physician and your condition ever gets bad enough to get any glance from the medical board, they can subpoena your med records, your psychiatrist, and even in "friendly" states they can mandate therapy including medications using their own psychiatrist's recommendations over yours, and mandate regular piss tests to see that you are in compliance with the meds they want you to take to have your license, anywhere from 1 year to your whole career.
There's not a lot of scenarios that I can think of that end in "take these psychotropic meds or lose your livelihood," but there you go. Just interesting is all.