The quick answer is that it all depends on who we’re talking about. If it’s someone with bipolar I who historically becomes manic, depressed, or psychotic once medications are stopped, the risk is obvious, She is at high risk for going into a mood episode. In fact, the most common reason a person with bipolar disorder is hospitalized is because she stopped taking her medication and went into a serious mood episode.
Depending on the individual, behavior while manic, psychotic, or in a mixed state can have devastating financial, legal, and social consequences. It can take years to pull out of the debt from maxing out credit cards and draining savings accounts. Diseases contracted while in a hypersexual state may not be responsive to medications (HIV, hepatitis), and/or a spouse or significant other may decide that this is the last straw and important relationships can be broken forever. Impulsive and illegal acts committed while manic and/or psychotic may mean years of legal headaches, and there is an unfortunate and growing trend in this country to incarcerate people with serious mental illnesses. The risk of suicide is also greatly increased when someone is actively depressed or in a mixed state.
On the other hand, if we’re talking about someone with bipolar disorder who has had very few mood episodes, it becomes a different gamble. And for readers looking for ‘yes’ or ‘no’ answers, here’s where we get fuzzy. There are people who go years, and even decades, between episodes. Some of these people will decide the risk of being on medication outweighs the risk of being off of it. If this is something you, or someone you care about, are contemplating, it’s vitally important to have a strong support network and a good handle on the warning signs that a relapse is coming (such as disrupted sleep patterns, increased spending, impulsive behavior, increased alcohol intake, etc.). As with other disorders that go into remission, such as multiple sclerosis and lupus, it’s sometimes easy to think, or to wish, that the illness is gone altogether. Unfortunately it’s not; it’s just sleeping.