As a psychiatrist for the last forty-five years, I've heard this experience you describe with your psychotropic medications over and over and over.

Everyone forgets to take their medications sometimes. It usually begins that way. Then the doubt sets in, "I'm not feeling any different so perhaps I don't need the meds as much as I thought.

Eventually, for some, next comes difficulty with rational thought. You can't don't make decisions in your best interest. "It's hopeless anyway."

One of the biggest issues with mood disorders is a loss of ability to judge your mood relative to baseline. If you're depressed, you feel you should be depressed; it's who you are. If you're on the high side, it's not a symptom, it's normal.

I always tell patients to listen to family members. If they ask, "Are you taking your meds?" they are recognizing changes that you may be incapable of seeing yourself. They are not always right, but they know your baseline better than you do.

The other thing I caution my patients is about lag time. When you start taking your meds, it takes a while before they work. When you stop them, there is always a lag time before the effects of stopping them begin to show up.

Throw in this mix a bit of rebelliousness --"I don't want to have to take meds to be normal"--and it sets the trap for periods of instability.

Final thoughts: 1. Enlist in your recovery a trusted and nonjudgmental family or friend who will give you honest feedback. 2. Remember the lag time. 3. Learn to recognize the earliest signals that you might begin to have a mood change; often it's sleep, too much or feeling you don't need it.