Medications and Supplements

Take Charge of Bipolar Disorder: A 4-Step Plan for You and Your Loved Ones to Manage the Illness and Create Lasting Stability
by Julie A. Fast, John Preston, Psy.D.

Many people diagnosed with bipolar disorder are sent home with the name of a doctor and prescription drugs. But few are able to manage their often out-of-control emotions with medication alone. Written by Julie A. Fast, who was diagnosed with bipolar disorder at age thirty-one, and bipolar disorder specialist John Preston, Psy.D., Take Charge of Bipolar Disorder offers a unique, personalized approach that teaches people with bipolar disorder and their loved ones to manage the illness and achieve daily stability. Fast and Preston's groundbreaking program combines medication and supplements, lifestyle changes, behavior modifications, and other indispensable management tools.

Readers will learn how to:

• Understand the behaviors caused by bipolar disorder
• Work with their doctors to find the right medications
• Develop a bipolar-friendly diet and exercise program
• Recognize the triggers and signs of major bipolar disorder symptoms to stop the mood swings before they go too far.

Chapter 1

Medications and supplements represent the first section of the treatment plan. This is a difficult and often frustrating part of having bipolar disorder for many people. How many medications are you taking to manage bipolar disorder? Do you sometimes feel overwhelmed with the thought that you will have to take these medications for the rest of your life? Maybe you feel it's unfair. Maybe you have trouble staying on medications because of side effects. Maybe you go through periods in which you pretend that bipolar disorder isn't real and that it will go away if you just ignore it ... but then you get sick again and have to restart the medications to find stability, and the cycle is repeated.

All of the above behavior is normal. Accepting the bipolar disorder diagnosis is hard enough. Having to accept that you will probably need some form of medication for the rest of your life can be pretty daunting and depressing.

Many, if not most, patients with bipolar disorder experience a significant amount of confusion regarding medical treatment and often receive very little information about the drugs they're taking. Inadequate compliance with medication treatments is the number one reason that there are often negative outcomes for people with bipolar disorder. The goal of this chapter is to offer concise and practical information on the medications currently used to treat bipolar disorder, how they work in your system, and why you need medications in order to stay stable. There is a good reason why this is the first section of the treatment plan: Medications are an essential part of bipolar disorder treatment, and the more you are willing to accept this fact, the better the outcome can be. This chapter does not make light of the significant problems and frustrations people with bipolar disorder have with medications. When you finish this chapter, you will have a clearer idea as to why you truly need the medications, and will also have some tips on how to manage these medications so that they treat bipolar disorder instead of taking over your life.

For Family and Friends As a family member, it may be up to you to help a loved one manage medications, especially if he or she was just diagnosed or is recently out of the hospital. The more you know about the medications used to treat bipolar disorder, the better you can help your loved one. People with bipolar disorder often stop taking their medications, for various and often understandable reasons (for example, because of unpleasant side effects). Appreciating this will give you some perspective when your loved one either goes off medications or refuses to take them. This chapter will give you some tools to help your loved one stay on the medications until he or she finds the right combination with the fewest side effects. Please note that it's very dangerous for you to encourage your loved one to get off medications and learn to manage the illness alone. It's fine to use supplements and other lifestyle changes to manage bipolar disorder, but to do this without at least some help from medications can be quite difficult and dangerous - especially for people with Bipolar I and serious mania mood swings.

Understanding What Happens in the Brain When You're Sick

When you're sick, it feels so personal and emotional that it's probably hard for you to remember that being sick simply means that your brain isn't working correctly and needs to be regulated. The goal of bipolar disorder medications is to get your brain back on track so that it can operate more normally and effectively. If you approach medications this way, they may not seem so troublesome and difficult to understand.

The human brain is a tremendously complex organ that carries out two primary roles:

1. Monitoring and regulating the functioning of the body (for example, regulating body temperature, respiration, and hormone levels).

2. Ensuring survival.

Regarding survival, the brain is continuously scanning the environment for potential dangers. It also plans for the future and is in a constant state of readiness to launch adaptive responses. Human beings are capable of remarkable abilities to cope with a host of stressful situations. Like shock absorbers, most people periodically encounter difficult situations, feel the impact, react emotionally, cope to the best of their ability, and then, once the stress is over, bounce back, returning to a less stressful state. Successful coping depends on a number of things, particularly including the ability to think clearly, to problem-solve, and to maintain some measure of emotional control. When episodes occur, people with bipolar disorder lose these faculties and therefore lack the ability to bounce back.

Understanding Why the Bipolar Disorder Brain Is Different

The problem is that your brain doesn't always do what it's designed to do. People with bipolar disorder have brains that are less resilient and simply don't respond correctly to the environment. At times, your brain doesn't monitor and regulate the functioning of the body the way it should. Your bipolar brain often creates problems instead of helping you cope with them. Often it simply isn't possible to think clearly, problem-solve, and maintain an appropriate measure of emotional control, because certain brain structures that regulate emotions lose their ability to function appropriately. This appears to be due to abnormal chemical regulation of these brain mechanisms. It can also be caused by actual brain damage, which can begin to gradually occur when people with bipolar disorder either do not get treatment or have poorly controlled, recurrent episodes. What is becoming increasingly clear is that not only do many of the medications used to treat bipolar disorder reduce symptoms and help people maintain emotional stability, but some have what are called neuroprotective properties: They are able to protect the brain from being damaged by the illness, and may actually activate natural mechanisms for the growth of new nerve cells. This has been demonstrated with the mood-stabilizing drug lithium. Lithium promotes the production of a protein, BDNF, which has been shown to activate the birth of new nerve cells in certain areas of the brain (this process is referred to as neurogenesis). Unfortunately, some people view psychiatric medications as a "crutch" that operates only to make or suppress symptoms. Although the drugs do help to control symptoms, in a very real sense they also operate to protect and assist the brain in carrying out certain functions in a more normal and adaptive way (for example, by controlling emotions and mood swings). In much the same way that insulin does not cure diabetes, these drugs do not cure bipolar disorder - but can help normalize biological functioning.

About 30 percent of people who take bipolar disorder medications experience minimal to no side effects, but the truth is that the majority of people do encounter side effects, and often these are considerable. Bipolar disorder medications are often tough to deal with; not only are their side effects difficult to live with, but the medications can also take a number of weeks or even months to start working. However, if you look at the alternative - the fact that a brain with bipolar disorder often has severe functioning limitations - the medications start to look more appealing. It is critical that family members and friends be supportive of these much-needed medications. Getting completely off medications should not be your goal, as it almost always leads to disasters. Asking for help in finding the right medications at the right dose is much more realistic.

Copyright © 2006 by Julie A. Fast and John Preston, PsyD.

About the Author

Julie A. Fast is the founder of Bipolar Happens, a popular online resource, and lives in Portland, Oregon.

John Preston, Psy.D., is a board certified neuropsychologist and lives in Shingle Springs, California.