Bipolar – Transition from "Maintenance" to PRN

I’ve been on an antipsychotic – Quetiapine – for bipolar type 1, for 20 months and, if I continue taking it as a daily prescribed medication, I will have the complex problem of obesity to contend with by the end of this year. My psychiatrist is in accordance with my recognition that, however useful it has been, it’s not a viable long strategy. Indeed, every plan we’ve tried hasn’t been a long-term solution. I’ve tried Olanzapine, Lithium, Asenapine and Lamotrigine, all with worse side-effects than Quet.

So after 9 months of not seeing him, I saw him yesterday. His new plan is Aripiprazole and, because that’s likely to cause me insomnia, Melatonin to counteract it. Failing which, sodium valproate, but we agreed not to implement that plan until a month after I’ve moved home, which is happening in 6 weeks time.

It didn’t take much research time for me to reject his plan and I have written to him in this respect. I have told him that it’s my intention to reduce my Quet from 200mg to zero in the next five weeks, following which I’ll use it as a PRN medication. I’ve welcomed his response, particularly if he knows a medication that would be better suited for PRN use.

I’m sharing this here because I’d appreciate guidance specifically from people who have tried self-managing – not entirely without medication, which I feel is reckless with a BP1 diagnosis – but only using medication for PRN, with more of an emphasis on healthy ways of coping with mood changes through good lifestyle habits.

I would also appreciate it if those of you with anxiety issues refrain from projecting your anxiety about life beyond sedation onto me. I am interested in hearing from people who have SUCCESSFULLY managed an approach to bipolar that leant more on healthy lifestyle, and less on sedatives as a crutch.


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