Side Effects

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.

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The Reality of Side Effects

All medications have side effects, and, unfortunately, the drugs used to treat bipolar disorder are known to produce side effects for the majority of people taking them. Side effects are at times mild and easy to tolerate. But often they are more noticeable, and in rare instances they can be dangerous.

When people take medications for any medical condition, the drugs enter the circulation and travel to every cell in the body. Drug companies have attempted to develop medications that pinpoint their actions in certain parts of the nervous system while having little impact on other bodily tissues, but the reality is that many bipolar disorder medications affect the whole body. To date, there have been some improvements (especially with the newer antidepressants and antipsychotics), but we still have a long way to go. You can't harpoon a drug into the brain and keep it there. The drug molecules go everywhere. Many bodily tissues are responsive to the same molecules that are active in the nervous system. One notable example is that a number of antidepressants and mood stabilizers increase the amount of the neurotransmitter serotonin. This action may account for the antidepressant action in the brain. However, more than 90 percent of serotonin-responsive cells reside in the gut. Thus, a lot of people develop gastrointestinal side effects such as nausea, diarrhea, and gas when they take these medications.

It's well documented that even when a current episode has subsided, people with bipolar disorder must continue to take medications in order to prevent or reduce the likelihood of recurrence. Unfortunately, up to 90 percent of people who start treatment for their first bipolar disorder episode will recover from this episode but, within weeks or months, will simply stop taking their medications, against medical advice.

The most common reasons for doing so are understandable:

Problematic side effects. Many people start to think, Why should I stay on the pills if my episode is over and all the pills seem to do is cause side effects?

In addition, many people conclude that the episode they experienced was not really bipolar disorder but just an unfortunate single episode that won't recur.6 It's hard to accept a lifelong illness, and people can and will often talk themselves out of taking the medications, even when the symptoms return almost immediately.

Once again, these reasons are understandable, but they almost invariably lead to the emergence of more episodes. What does this information mean to you? Statistics can seem remote, but if up to 90 percent of people with bipolar disorder tend to go off medications, it's time for you to take note. Unless you have a plan in place to prevent this behavior in yourself, there's a good chance you will do the same.

For Family and Friends How can you as a family member or friend help with side effects? The first step is education about the drugs your loved one is taking. Can you list them? What is each one for? What are its specific side effects? It also helps if you understand that the drugs that help the brain can absolutely wreck the body. Problems can range from weight gain and hair loss to muscle and dental issues. If your loved one had cancer and went through chemotherapy (often defined as the use of chemical agents to treat or control disease), you would certainly understand the physical side effects of the drugs. You would expect hair loss, vomiting, diarrhea, muscle pain, vision problems, shaking, excessive tiredness, weight issues, sleep disturbances, and more. And yet when a person with bipolar disorder takes drugs, the side effects are often downplayed by family members and friends. "Why don't you just take your medications like you should? Don't you want to be stable? What are you thinking? The side effects can't be that bad." The reality is that the side effects can be that bad, which is why it's so important that people with bipolar disorder find the correct drugs at the right dose. Bipolar disorder medications affect brain chemicals, and the brain controls the function of the body. These drugs are serious, and you need to take them seriously if you want to help your loved one.

Managing Side Effects

The good news is that many side effects can be managed by dosage adjustments or by switching to other medications. This is one reason that most people will need to go through trials on a variety of medications to determine which ones are the most effective and best tolerated. It's also important for you to know as much as possible about the medications you're prescribed. Family members need to be in on this process, too, because they are often the ones who help the person with bipolar disorder deal with side effects. In the past, doctors prescribed medications and patients quietly complied, but times have changed - for the better. These days, more and more people have become informed consumers. There is a lot you can do to learn about current medication treatments (the pros and the cons), and you have a perfect right to ask any and all questions you may have about medications prescribed. The more that people are actively engaged as collaborators with their doctor, the better treatment outcomes become. In other words, don't be scared to talk with your doctor about your medication issues, including the desire to stop medications.

Unfortunately, some people have had the experience of speaking with a physician and asking questions, only to encounter defensiveness, impatience, or resistance. Clearly this does happen, but appropriate medical treatment requires open lines of communication between the patient and the doctor. Openness to legitimate questions is also a compassionate way of treating fellow human beings, especially those struggling with bipolar disorder. If you cannot successfully speak with your doctor due to his or her own defensiveness, then maybe it's time to find a more open-minded physician.

Every effort should be made to find the right medication or medication combination in an attempt to minimize side effects. And often this can be accomplished. Still, many people simply end up having to tolerate some side effects; it's not pleasant, but it's ultimately necessary to reduce or eliminate severe mood swings. And, unfortunately, a very small number of people are just unable to tolerate any current bipolar disorder medications at all. (If this describes you, don't give up hope. You can continue to work with your doctor, use the tips in this book to stay stable, and keep trying new medications as they are released on the market.)

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.