Side Effects, 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 6 of 7)

Talking with Your Doctor About Side Effects

There is always a time period before drugs begin working. This can range from days to weeks to months, so it's important that you know when to expect a drug to start helping your symptoms. You can research this information and then talk with your doctor about your concerns, especially if you feel the dose is too high or too low.

As the weeks go by on a new medication, you may experience some symptom improvement, but if it's not dramatic or if you're having trouble with noticeable side effects, it's natural that you will want to talk with your doctor about changing medications. Many times you will be told to just stay with the medication, giving it enough time to work. There often is a good reason for this - many people do benefit if they stay on medications long enough for the clinical effect to kick in. Although some symptom changes may be seen within the first week, true resolution of mood episodes takes a long time. This may be discouraging, but you need to know what to expect. A recent study conducted by the National Institute of Mental Health indicates that, on average, it takes ten to twelve weeks to recover from a manic episode, nineteen weeks for a depressive episode, and up to thirty-six weeks to recover from mixed mania.7 It must be emphasized that substantial reduction in painful emotional symptoms often occurs much earlier than these time frames indicate, but true recovery simply takes a long time.

Many people encounter a combination of unpleasant side effects and a lack of quick response. While it's understandable that this can lead to discouragement, those who stop taking the medication against medical advice often get sicker, ultimately having to start all over again.

Taking charge of your own treatment while still remaining reasonable is essential and will help you communicate with your doctor. You have to decide what you can and can't tolerate in terms of side effects. There's a fine line between what's considered normal for side effects and what's unacceptable. If you're sleeping fourteen hours a day and have gained forty pounds, then it's time for you to talk with your doctor. If you can't live your life because of a certain specific side effect, such as a respiratory problem or a serious rash, it's time to talk with your doctor. This may be difficult - as it's often hard to get an appointment and may be quite intimidating to stick up for yourself - but it has to be done, especially if you're thinking of missing doses or stopping your medications.

The following suggestions can help you to talk with your doctor about medications:

Can you please tell me why I'm on this particular medication?

I know that it's important that I stay on medications and I'm willing to do that, but these side effects are simply too strong for me right now. I can't function normally if I am sleeping all day or constantly running to the bathroom because of diarrhea. What are my options?

How long do you think I need to wait to see results from this medication, and what if I can't wait that long?

What ideas do you have for reducing side effects?

Are there any new medications coming out that will work with fewer side effects?

I could really use help with this. Do you have any suggestions on where I can find more help?

If you're at that place where you're unwilling to stick with your medications, you must find a way to effectively communicate your feelings to your doctor by saying something along the lines of the following: "I understand that your recommendation is to just keep taking the medication. I believe that it's important for me to be able to be open and honest with you about my treatment. I need you to know that I'm at a point where I'm probably just going to stop the medication on my own, and I'd like to ask you to please consider other options. Would you be willing to let me know other medication choices that you think might be an alternative to what I'm currently taking?"

Dealing with side effects is a large part of living with this illness. When you're on a combination of drugs, it makes sense that you would encounter a combination of side effects. Look over the following list and see if you have experienced any of the listed side effects. Put a check mark next to those you're experiencing now and share this information with your doctor.

___ Tiredness and fatigue.

___ Weight gain.

___ Tremors and shakiness.

___ Nausea or diarrhea.

___ Rashes.

___ Memory problems.

___ Menstrual irregularities.

___ Rapid cycling.

___ Suicidal thoughts.

___ Irritability or anger.

___ What seems like a bottomless pit of hunger.

___ No appetite at all.

___ Excessive sleeping.

___ Agitated sleep.

___ Trouble concentrating.

___ Hair loss.

___ Teeth problems.

___ Skin problems.

___ Vision problems.

___ Muscle fatigue.

___ Increased thirst and urination (with lithium).

___ Trouble reading or writing.

Many of these side effects can be quite debilitating if they're allowed to continue. Of course, there are some side effects you simply have to live with in order to stay stable, such as a dry mouth or milder versions of the issues listed above. You're the one who decides when the side effects become too difficult to manage. The point of this section is to remind you that there are steps you can take to get help with these problems. Stopping your medications does not have to be the first step. Doing your own research and then asking for help with medication management is an option.

Here are some more tips for managing side effects:

Talk about reducing the dose or changing medications with your doctor. Be honest about how you feel and ask for help. If you're thinking of stopping the medications, explain why.

Work on the things you can change by using the ideas in this book to reduce bipolar disorder symptoms, so that you may need fewer medications or a lower dosage.

Use the diet and exercise tips in chapter 2 to help you reduce side effects including weight gain and strengthen your body so that it can accept the medications.

Learn your triggers (covered in chapter 4) so that you can reduce your need for medications.

Learn about new drugs, their side effects, and how they work; ask to try them, if appropriate.

Work with a naturopath familiar with bipolar disorder and ask for help with the medication side effects.

Focus on how the medications help you.

Know that self-medicating with alcohol or other recreational drugs will always affect the way your body accepts the medications. Ongoing alcohol or other recreational drug use and abuse is one of the most common factors leading to poor treatment outcome. You must take this issue very seriously.

Talk with your doctor about a concept referred to as microdosing. This is a strategy for people who are very sensitive to medication side effects in which medications are started in tiny doses and very gradually increased until they reach a therapeutic level. This can really make a difference if you have a lot of trouble with side effects.

There may come a time that you will have to accept certain side effects if it means staying stable.

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.