Selecting a bipolar medication often involves trial and error to customize a suitable solution. It’s about tailoring the treatment to individual needs and acknowledging the challenge of attaining an ideal medication plan. When Tricia H. received a diagnosis of...
Selecting a bipolar medication often involves trial and error to customize a suitable solution. It’s about tailoring the treatment to individual needs and acknowledging the challenge of attaining an ideal medication plan.
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When Tricia H. received a diagnosis of bipolar 2 disorder in 2019, she took it as good news, because it opened new treatment avenues.
It was still a daunting prospect for her, though. She’d had a rocky ride with antidepressants she’d been prescribed a few years back for depressive symptoms.
“I was terrified of taking medication,” admits Tricia, a Missouri mother of two.
With her eyes on the prize of stability, Tricia plowed ahead despite her reservations. Like many people with bipolar, she’s had to test-drive a number of new prescriptions in pursuit of the best results.
“We’re still trying to find the perfect combination of medication for me,” she says.
In the bipolar community, having a conflicted relationship with your psychiatric meds is a familiar story. For one thing, many people resist their diagnosis at first and dismiss the need for pharmacological treatment. Others simply don’t want to rely on pills on principle.
Bipolar Disorder and Medication Adherence
A meta-analysis published in 2021 showed that 50 percent of people with bipolar disorder don’t adhere to their medication regimens. Furthermore, those who don’t adhere to their meds are 3.7 times more likely to experience a return of symptoms compared to individuals who take their medications as instructed by prescribers.
The analysis noted that factors impacting medication adherence include “medication side effects, lack of insight into the illness, cognitive dysfunction, regimen complexity, and substance use.”
The bottom line: The more you give your meds a chance to work, the better your chances of maintaining stability. The odds of strengthening your overall wellness improve once you figure out what gets in the way of medication adherence and come up with solutions that work for you.
Finding the Right Medication Schedule
Synching when you take your medication with where you need to be and what you need to do at any given time is a common challenge.
Tricia ran into problems taking her nighttime med because it was making her drowsy.
“My kids are normal 13- and 11-year-old farm boys. If I took it too early, I didn’t have family time,” she explains.
Wait too long, though, and she would fall asleep without taking her dose. Wake in the night and take the med then, and she would oversleep or feel groggy in the morning.
“It’s been a real trial to figure out the right times,” she says.
Things improved after Tricia started setting a reminder alert on her phone for the ideal evening hour. She also switched over to meds that had a less sedating effect.
She’s prepared to make whatever accommodations it takes to stick with her treatment plan.
“You gotta do what you gotta do to stay healthy for your family, if not for yourself. They are what kind of keeps me going,” Tricia says.
Finding the Right Bipolar Medication for You
Fear of side effects may be the biggest factor pushing people away from medication. The inability to tolerate side effects may lead to going off a med in midstream. At the least, it calls for starting from scratch with another option.
Paul Y. of Rhode Island can tell quite a story about that, thanks to an evolving diagnosis (ultimately arriving at bipolar 1) and a susceptibility to side effects. He spent more than a decade cycling through a multitude of medications at different dosages. In 2019, he and his doctor figured out an approach that worked for him.
People naturally vary in their reactions to medications of all kinds. Paul falls at the far end of the response spectrum. There didn’t seem to be a mix that would bring his symptoms to a manageable level without causing him undue distress.
Paul kept searching for a formulation that would keep his mood from spiraling upward and prevent psychosis, but not result in nausea, sluggishness, and other side effects he couldn’t live with. In his case, the answer was to pare back his regimen to a single mood stabilizer and establish safeguards against infrequent manic eruptions.
“This is the best I’ve ever felt,” he says. “It’s still a struggle, but nothing else has worked. This is what I need to do … and I will do it with every ounce of my being.”
His experience illustrates how standard treatment protocols often need to be adapted and individualized. The hard truth is there may not be a “perfect” pharmacological solution.
Holistic recovery emphasizes finding your personal sweet spot — being able to pursue a fulfilling life with the least possible disruption from bipolar symptoms. Psychotherapy and self-care play vital roles in fostering stability, along with medications.
Paul has made his peace with incomplete symptom control in exchange for improvement in his overall quality of life.
“I’m more alert now. I’ve rediscovered my love of piano, as well as enjoying a more creative and artistic lifestyle,” he says. “I’m also able to communicate better and maintain a solid relationship with the love of my life.”
Keep Open Lines of Communications With Your Doctor
You should have the final say on what goes into your body. Still, it’s not wise to skip doses or stop taking medication altogether without looping in your prescribing practitioner.
If your practitioner doesn’t know you’re not taking the full course of a medication, it’s impossible to properly evaluate how well the treatment works, notes Chris Bojrab, MD, a distinguished fellow of the American Psychiatric Association and president of Indiana Health Group.
Without the full story, a practitioner may increase the current medication dose rather than look at other choices that might better suit your situation.
Ideally, your input should be met with respect and a willingness to problem-solve and explore alternatives. If not, you need to find a way to be an assertive self-advocate.
In his own practice, Dr. Bojrab encourages asking questions and airing concerns. As he sees it, “You’re the captain of the boat. I’m the expert navigator.”
Remembering to Take Your Bipolar Meds
If remembering to take medication makes it hard to follow your regimen, ask about options such as a long-lasting injection. A new innovation, known as digital medication or “smart meds,” incorporates a sensor to electronically track (via a phone app) whether you’ve taken your daily dose.
You could also enlist allies from your support circle who will back up your wellness efforts and step in when you’re slipping off course. Be aware that this kind of relationship can be tricky to establish, Bojrab says, because you’re inviting someone to place their judgment of how you’re doing on par with, or sometimes above, your own.
Psychotherapy can be a good place to problem-solve around issues with your meds, including body image issues from weight gain. It may even be a more comfortable setting for airing your discontent, says Elisabeth Bennett, PhD, a professor of counselor education at Gonzaga University in Spokane, Washington.
“The therapist often sees [you] far more than the doctor does,” Dr. Bennett says so that the relationship may feel more personal.
Having more in-depth knowledge of an individual’s changes and challenges week to week means “the therapist can provide important input … that can help the prescriber to adjust meds accurately,” Bennett adds.
Your pharmacist can be a helpful resource, says Megan Ehret, PharmD, a professor at the University of Maryland School of Pharmacy — for example, if a tried-and-true medication becomes unavailable.
“We’ve had a lot of shortages come and go with older medications,” Dr. Ehret says.
In those cases, the pharmacist would work with the prescriber to find a suitable replacement.
Understanding Medications for Bipolar
Setbacks sometimes occur from giving up on a prescription too soon — either from discouragement or overconfidence.
“Many medications take several weeks to reach effectiveness … and [people] get hopeless before the meds have a chance to work,” Bennett says.
People also overlook the fact that medications for chronic illness — conditions that can be managed but not cured, such as bipolar disorder — need to be continued on a maintenance and preventive basis, not just during an “acute” episode.
Denise H., who lives in Southern California, observed that phenomenon while attending a peer support group at her church.
“There were about 10 to 12 of us. Several stopped taking their medicine because they were feeling good,” she recalls. “Then they relapsed.”
Denise herself has stuck with a successful mélange of four medications since her bipolar diagnosis decades ago, although she’s had to make some adjustments in her routine along the way.
After years of misdiagnosis and ineffective treatment before her bipolar disorder was identified, Denise wasn’t going to waffle about staying on meds that actually helped.
“I have never really had a problem with taking my medication,” she muses. “Once it helped me, I felt like, ‘This is the magic here.’”
Editorial Sources and Fact-Checking
Loots E et al. Interventions to Improve Medication Adherence in Patients with Schizophrenia or Bipolar Disorders: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. October 2021.
Metabolic Side Effects of Psychiatric Medications. National Alliance on Mental Illness. April 2023.
UPDATED: Originally printed as “Rx for Success,” Fall 2019
The post How to Get the Max From Your Bipolar Meds appeared first on bpHope.com.
