Is an antipsychotic always needed??

I have Bipolar 1, I've had psychotic episodes in the past including hallucinations, paranoia, etc. which always landed me in the hospital, but I went 10 years without having any and that whole time I was on the antipsychotic abilify, after 15 years of being on that my dr started trying different meds because I was depressed a lot. Come to find out later the abilify caused my impulsive behavior I had the entire time I was on it. Gambling, spending, binge eating, etc. Look up abilify lawsuits and you'll see what I mean. And since I've been off it all that stopped.
Anyways all the antipsychotics we've tried since then haven't worked. I've only had 2 manic psychotic episodes since then but I attribute that to stupid things I did while transitioning to different meds such as staying up all night and smoking marijuana. Usually I am just depressed and moody lately, irritable, etc. I'm trying wellbutrin in addition to the trileptal and lamictal I've always been on and those have been good for me. I really hate the dude effects of antipsychotics so if I can avoid them that would be great. So my question is, can BP be manage without an antipsychotic? With just mood stabilizers? And then the wellbutrin which I'm taking for the depression and help with ADD. I have some anxiety and irritability lately but I'm hoping that subsides. Sorry if this was all over the place and rushed but my 3 year old has been impatient for my attention the whole time lol

Sorry you've been struggling with meds related issues- I know only too well how frustrating and exhausting it can be. My totally non-professional opinion when it comes to your question is that whether an antipsychotic is permanently needed depends on the individual (I know that probably doesn't help much!)

As for myself, I also have what I presume to be bipolar I- I'm in the U.K. and the diagnosis is simply worded as bipolar affective disorder. However, I've had around four manic or mixed episodes with psychosis, one of which led to my hospitalisation and another which almost did. I've had my bipolar diagnosis for around 16 years (I'm 32 now), and for many years I was stable on just my mood stabiliser, Tegretol- my longest continuous stretch of stability on that regime was about 5 or 6 years. However, at times it's had to be combined with antipsychotics and/or antidepressants, for high and low mood episodes, respectively, usually for a few months to treat individual episodes, rather than years.

For the last 5 and a half years or so, though, I've been on antipsychotics long term (Seroquel and/or Zyprexa), but that's because I'm so prone to mixed episodes, which they are extremely helpful for. I managed to come off my AP safely for 6 months in '14, leaving just my mood stabiliser in place, but had to go back on them after the stress of losing my dad suddenly sent me into a mixed episode.

Sorry this is so long and centred on myself but I hope some of it might help. I'd definitely be asking this question of your pdoc and having a full discussion about what may be the best course of action for your meds going forward. Good luck and let us know how it goes. Hugs, if wanted.

I've heard of people taking just a mood stabilizer if you're being closely managed by your pdoc. I think it is worth it to try. Anti-psychotics have the worst side effects. It probably takes more effort to stay healthy: getting enough sleep, not using drugs, eating healthy and watching caffeine intake, etc.

I know this wasn't your question, but you can also only be on an AP.

My psychiatrist want's me only on Vraylar, which is an AP.

Bottom line: One drug is possible.

I have biopolar type 1 , I only take lithium slow release 1225mg for my biopolar at the moment I'm doing fine , I did get some initial side effects such as a heavy stoned feeling but that's gone now , there are no side effects to speak of now

I've been on just a mood stabiliser after I stopped taking seroquel about 7-8 months ago. I feel generally ok but I really have to monitor my mood and the things that affect it. Like you, I also had worse and more impulsive habits when I took aps. I used to take party drugs and stay out dancing later because I would think of it as a crutch - "I'll just pop a pill and sleep for 12 hours after getting home from the club!" Now that I don't have a magic sleep regulator, I have to be really careful about how much I drink, how late I eat a meal, when I start the long process of getting myself sleepy enough for the long sleep. I used to be a big electronic music party head but now I can't really take stimulants without it ######6 up the next several weeks of sleep. And I definitely can never take MDMA again if I want to stay off seroquel.

So yeah, I think its possible. Anti-psychotics are a lifesaver - they were literally a lifesaver for me during many horrible episodes - but they have ugly side effects, impulsivity aside, and I'd like to live as much of the rest of my life as I can without them. Best of luck to you.