Bipolar Disorder Medications, Part 2

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.

(Page 4 of 7)

Tracking Your Medications and Supplements

When introducing new medications and supplements, especially if you are taking more than one, it's imperative that you keep a record of what you're taking, the dosage, and when you take the medications. There is a chart in appendix C called "Track Your Medications." This record can be invaluable for both you and your doctors as you create your comprehensive treatment plan. It will help you to remember your dosage and the different medications and supplements you have tried. There is also a section in which you can chart your side effects and write any questions you may have for your next doctor's visit. Remember, many people take up to a year or more to find the right medication combinations. If you're in the first few months of treatment, give yourself time for you and your doctor to get it right, but be vigilant about charting your medications, your supplements, and their side effects.

You may be taking one drug from each category mentioned earlier in the chapter; this is normal, especially in the first stages of treating the illness. For many people, some of these drugs can be reduced or eliminated as the current episode subsides and more effective management skills are mastered. In every case, however, it's essential that you know what medications you're putting in your body. You should be able to answer the following questions about each medication you take:

• What is the normal dose?
• When should I take the medications?
• What are the side effects?
• Are there any potential drug interactions?
• Do I need any lab tests?
• How long does the drug normally take to work?
• Are there special foods I need to avoid?

Your health care provider, the library, and the Internet are good resources for answering these questions. A family member or friend can also be a great help if you're just too worn out to do a lot of research.

What to Do If You're First Medications Don't Work

It's normal if you have to try a few medications before you find the right combination - the one that helps you find stability. It can take some time to see what medications will work for your specific biological makeup. You must anticipate that it is extremely common for doctors to make initial medication choices, begin treatment, and then, during the following weeks or months, make what are often frequent changes in the doses or medications prescribed. You or your family members may become worried as you begin to encounter side effects or experience what seems like an endless number of lab tests or changes in medications or doses. Many people become concerned that such changes suggest that their doctor may not be competent, or that their case of bipolar disorder is especially treatment-resistant. These worries can lead to discouragement and pessimism.

The reality is that the pathway to recovery and good outcomes, more often than not, is complicated. The rule, not the exception, is trying several (often many) medications in the search for just the right drug or combination. Frequent changes in medications are not necessarily a reason for concern. While it's important to be informed and not to just try medication after medication without questioning your health care professional, the fact is that bipolar disorder is challenging to treat, and systematically trying various medications in the search for the right combination is a time-consuming process.

Why You Need To Take Your Medications Even When You Feel Well

Taking medications when you feel well flies in the face of common sense. You must remember, however, that bipolar disorder is recurring, and over a period of time there is a tendency for episodes to become increasingly severe and harder to treat. And as noted earlier, some research indicates that untreated or poorly treated bipolar disorder can ultimately result in lasting damage to the nervous system, while ongoing treatment with bipolar medications may prevent this.

What to Do If You're Thinking of Stopping Your Medications

First of all, it's important to know that one very common symptom of bipolar disorder, especially in mania or hypomania, is poor insight. This is an inaccurate awareness of the need to stay on medications. And this is often understandable in the early stages of a manic episode since people may feel very happy and upbeat. It's a catch-22, because the best way to prevent severe episodes is to stay on your medications and yet the thoughts created by the illness itself can tell you that you don't really need medications. Medication treatments are far from perfect, but they offer the kind of effectiveness that can substantially reduce suffering, keep families together, avoid catastrophes, and save lives.

Unfortunately, the facts show that there's a good chance that there will come a time when you will want to stop your medications. What can you do to prevent this? Some tips include using this book to significantly reduce your symptoms so that you may, in the long run, be able to take fewer medications or lower doses (always with your doctor's supervision). You should also constantly remind yourself what life is like for you when you don't take medications and ask for help from your loved ones in maintaining your medications. And finally, simply stopping your medications can lead to some very serious withdrawal symptoms including suicidal thoughts and extreme physical discomfort. The checklist on pages 50 and 51 can help remind you of why you need medications to treat bipolar disorder.

For Family and Friends If your loved one does stop his or her medications, you may feel scared, incredulous, angry, and frustrated. Unfortunately, this is a very normal part of bipolar disorder. Side effects can become too strong to live with; the illness itself can also tell people that they are fine and don't need medications. If you had been depressed for months and then suddenly felt better, wouldn't you want to get off the medications? It's normal that people with mania feel that the illness is cured. And although it's often dangerous and destructive, it's very normal for people to go off and on medications until they find the right combination. Anyone who suspects that loved ones are ready to stop or want to stop medications should have them read this section again. They do have options. Going off medications can be catastrophic both for them and for the people in their lives. Remind them that they can change medications, try microdosing (explained later in the chapter), and use the tips in this book to reduce their symptoms and hopefully reduce their need for medications. Going off medications is not really an option, especially for those with troubling mania or suicidal thoughts.

Look over the following lists and check the entries that are true for you. You will probably have a few positive experiences when off medications, but the point of this exercise is to see that the bad outweighs the supposed good.

Life Before Medications

___ Relationship problems.

___ Lots of crying.

___ Unhappiness.

___ Recklessness.

___ Restlessness/craving constant change.

___ Spending issues.

___ Inability to work effectively.

___ Bombardment with too many ideas.

___ Dangerous behavior.

___ Inability to know how you really feel.

___ Constantly feeling up and down.

___ Feeling misunderstood.

___ Inability to stay in one place or stick with anything.

___ Racing thoughts that don't stop.

___ Constant irritability.

___ Expanded creativity.

___ Excessive anxiousness.

___ Ability to work abnormally long hours when manic.

Life After Medications

___ Greater stability.

___ Fewer worries.

___ Better able to connect with people.

___ Ability to work and support yourself.

___ Worrying about being dulled by medications.

___ Ability to live life again.

___ Less anxiety.

___ No longer hearing voices.

___ Worrying about being less creative.

___ Ability to think about one thing at a time.

___ Being told that others find it easier to be around you.

___ Wondering if this is the "real you."

___ Wondering if the medications are changing your personality.

___ Less destructive behavior - for instance, drinking less.

It helps if you look at the alternatives before you make the decision to stop your medications. The remainder of this chapter gives you more ideas on how to reduce side effects and find alternatives to stopping your medications.

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.