title: Managing bipolar moods without medication: a qualitative investigation.
abstract: OBJECTIVE
  Although many diagnosed with Bipolar Disorder (BD) choose to manage their moods without medication at some point, their experiences of doing so are not well understood. This paper aims to explore the processes by which people manage bipolar moods without medication.
  
  
  METHODS
  Ten people diagnosed with BD who do not use medication were interviewed. Analysing their accounts using grounded theory methods led to developing a model of how they perceive the processes involved in managing moods without medication.
  
  
  RESULTS
  Participants engaged in repeated evaluative processes around their strategies for managing moods. Some participants decided not to influence elevated moods due to their perceived advantages. Participants׳ intentions and actions were influenced by their perceptions of themselves and by the meanings they attached to bipolar moods, which were in turn influenced by feedback from others.
  
  
  CONCLUSIONS
  The complexity of the processes described by participants suggests that traditional models of explaining non-adherence may over-simplify some individuals׳ experiences. Future research could focus on identifying factors predictive of successful attempts to manage moods without medication. Professionals should place more emphasis on non-medication approaches in order to increase engagement with people who do not use medication. This may involve focussing on individual׳s longer-term goals rather than on modifying moods in shorter-term. Conclusions are based on participants who had experienced significant bipolar moods, but who largely seemed satisfied living without medication.
  
  
  CONCLUSIONS
  Future research should ascertain whether such processes apply to a wider group of individuals who do not use medication for bipolar moods.
authors.affiliation: South West Yorkshire Partnership NHS Foundation Trust, United Kingdom. Electronic address: reed.cappleman@swyt.nhs.uk.
authors.forename: Reed
authors.initials: R
authors.lastname: Cappleman
authors.affiliation: Division of Health Research, Lancaster University, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Smith
authors.affiliation: Spectrum Centre for Mental Health Research, Lancaster University, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lobban
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010349:Patient Compliance / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Bipolar disorder; Medication; Nonadherence; Qualitative research; Self-management