Bipolar Treatment and Risk Tolerance

Every medical treatment comes with risk. If you have a headache, you could take ibuprofen or you could have a craniotomy looking for brain cancer. One has considerably more risk than the other. (Of course, if you have brain cancer, then the reward could be quite great.)

This means every time you undertake a bipolar treatment knowingly, or not, you weigh the risks vs. rewards in your head. And one of your doctor’s main jobs is to manage that risk vs. reward scenario. Doctors, for example, almost never prescribe barbiturates anymore due to the fairly large risk of addiction. Instead, they prescribe benzodiazepines (or nonbenzodiazepines; very similar) which do not carry such an increased risk. In both cases, they carry the reward of managing anxiety.

But some people don’t want to take benzodiazepines either, because some people tolerate more risk than others.

Skydiving is Dangerous

In my fairly short skydiving career I did 150 skydives. I obtained various forms of licenses, jumped out of multiple types of aircraft, jumped in formation and jumped from a helicopter. Good times.

But, the thing about skydiving is, when you jump from a plane you will die unless you take evasive action (i.e., deploying your parachute). That comes with a certain inherent risk. (The risk is not nearly as high as most people believe. About one death per 133,928 skydives.)

But I was willing to take that risk because for me, the reward of skydiving outweighed the risk. Some people think skydiving is crazy. They are adverse to that level of risk.

[caption id="attachment_2111" align="aligncenter" width="332" caption="This is in no way me. Photo by by Ori Kuper."][/caption]

Bipolar Treatment and Risk

When one gets medical treatment there is an inherent risk also. And each treatment carries different risks. So, for example, an SSRI that has been prescribed for 30 years might be less risky than an antidepressant that has been available for 1 year as the former’s effects are well-known thanks to the hundreds-of-thousands of people who came before you.

When you start treatment, your risk tolerance (and your doctor’s) is likely very low. You will pick the safest treatment because there is no reason to pick something riskier when you don’t have to.

Risky Bipolar Treatment

But the longer you’re unsuccessfully treated for bipolar disorder the more risk you are likely to accept. That’s because either you’ve tried the lower-risk options and they haven’t worked, or the severity of your illness has reached the point where you need help immediately.

This increase in risk tolerance is pretty typical. There are many things I wouldn’t do when I started treatment that I do all the time now. (Sometimes we learn the things we perceive as risky aren’t as risky as we thought.)

Bipolar Treatment and Risk Tolerance

But, make no mistake; I can jump off this ride any time I like. I can decide a drug has too many side effects and work with my doctor to get off of it. I can decide to work with them to get off my meds altogether perhaps due to new information. Risk tolerance can change, I (and you) can change your treatment strategy any time you like.

Tolerating Risk Tolerance

So clearly some people consider some treatments too risky, and others don’t. Both of these people are “correct” as both are assessing the level of risk for them, personally.

It’s important to remember though, risk tolerance is personal. You cannot look at someone and tell them to tolerate more risk just like you can’t look at someone and tell them to tolerate less. Both sides need to respect the assessment of the other.

I don’t drive people to a drop zone and tell them to jump out of a plane because the risk of death or injury is real, but that doesn’t mean I don’t think jumping is OK for me.

Photo by Ori Kuper care of the USPA National Skydiving Championships for Canopy Piloting.

You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.