Side Effects, Part 3

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 7 of 7)

Amanda's Story Age 31 It took me years to find the correct combination of medications and lifestyle changes. When I was first diagnosed, I remember thinking, Everything's going to be fine now. All it takes is the right medications and I can get back to my life. I can do my job well. My relationships will get better. I'm a changed woman! It didn't work. I was on a roller coaster of medications for two years and gained fifty pounds, lost my hair, and was even more depressed. My doctors kept saying to me, "Just wait. You'll find something that works." I believed them. I had made a lot of lifestyle changes during the years I was on medications. But they just were not enough to give me the quality of life I needed. I was always hoping for a miracle - that one day I would just take this magic pill and the bipolar disorder would go away. With my doctor's help, I decided to try a new mood stabilizer. I was not very hopeful. As every month went by, I kept thinking, This is pointless. I'm never going to find relief from medications. I'll always have these side effects. Then, after five months of starting with a really small amount and then increasing the dose to the right level, the drug started to work. I got more used to the side effects. Many of them went away after about five more months. For the first time in my life I remember lying in bed with an empty brain, something that I don't think anyone who doesn't have bipolar disorder can understand. It really did feel like a miracle. I have to admit that the drug doesn't take care of everything. In fact, it really only takes care of about 50 percent of my symptoms. But I'll take the 50 percent. It works for me because I use my treatment plan to take care of the other 50 percent. I wish the medications were the only thing I needed. It takes a lot of time to manage this illness, but I know without the medications it would take all my time, and I'm thankful I was patient and gave the drugs a chance to start working. I wish the bipolar disorder would just go away and that I didn't have to worry about medications and watching what I eat and taking care of myself so vigilantly. But I feel the burden is less now that I have a medication that helps.

For Family and Friends If you see your loved one having considerable trouble because of side effects - significant weight gain, shuffling instead of walking, drooling during sleep, sleeping all day, getting much more irritated than normal, experiencing suicidal thoughts, or experiencing a lot of physical problems such as teeth pain and hair loss - it is fine to contact his or her doctor yourself if your loved one is not able to do so. (It's also acceptable for you to take part in your loved one's treatment if he or she is well enough to do it.) Side effects are a reality with these drugs, but excessive side effects where the person is no longer functioning normally are not acceptable. This may be difficult, because too many health care professionals ignore family members and certainly do not understand the role a friend can play. Your loved one may be too drugged to function. Maybe you have a son or a roommate who is a zombie from overmedication. This is simply not okay, and there needs to be an intervention from family and friends to get the person with bipolar disorder critical help. Your intervention should be well researched and methodical. You may have to wait a few months for the drugs to work and the side effects to calm down, but if they don't you have the right to get help for your loved one. In contacting your loved one's health care professional, it may be helpful to say something like this: "My [son, friend, partner, husband, what have you] is so drugged he no longer functions normally. I know this is considered better than being manic and out of control (or depressed and suicidal), but lying around all day is not acceptable. I would like to work with you to find the best medication combination that can help my loved one stay stable and have a normally functioning life." Contacting a loved one's doctor with your concerns must be done delicately, but it can help you find a balance and help your loved one - especially in the case of a young child. Please note: Family members and friends must check state laws to find out how much access they have to their loved one's treatment plan, medical records, medications, and diagnosis.

What Is Microdosing? Microdosing may be helpful for people who can't tolerate the side effects on a normal dose of medications. Microdosing works on the concept that those who experience excessive side effects do not metabolize medications as quickly as other people. This means that with even low doses, they encounter high blood levels of the drug and then significant side effects. One solution is to try minute doses of the medications in order to find the balance between effective help and minimum side effects. As a drug is tolerated and the body becomes accustomed to it, it can be very gradually increased. Talk with your doctor about microdosing if you have trouble with side effects.

Letting Go

It's hard to let go of some of the "good" things about bipolar disorder. Family members are often the ones who see your behavior realistically while you are just looking for a way to feel good again. Maybe you feel that depression is a natural state since the world is a stressful place, and by treating the depression with medications you won't be as sensitive as a friend or partner. Or maybe you miss the creative highs of the first stages of mania. It's easy to get addicted to your own bipolar disorder behavior. The best way to deal with this is to look at the whole picture rationally. Is the creative high you get while manic worth maxing out your credit cards, driving dangerously, taking a trip without telling anyone where you're going, or losing the respect of others because of your wild and erratic behavior? Is the poetry or music you write when depressed worth the risk of not being able to feel love for yourself or others, a lack of sexual desire, or the possibility of suicide? How does your bipolar disorder behavior affect the people in your life or your ability to work and support yourself?

All of these questions have to be asked before you even think of stopping medications and try to treat the illness naturally. When you look at the consequences of untreated bipolar disorder, the medications are worth it. It can be hard to find the real you after you get a bipolar disorder diagnosis and start medications, but if you give it time, the real you can emerge; you'll see that many of the things you did while sick were actually bipolar-disorder-influenced and didn't represent the real you, anyway. Nostalgia for mania can be especially hard to break, but the more you learn to live a normal and stable life, the easier it can be to let go of the past.

Acceptance

Once you accept that you have an illness that needs medical treatment, accepting medications can get easier. One reason acceptance is difficult for many people is that bipolar disorder doesn't have obvious physical symptoms - it's much easier to treat a broken leg or a nonfunctioning kidney than it is to fix an ill brain. It's essential that your doctor is someone who will work with you until you find the right combinations of medications. If you can let go and not fight the reality of medications, you have a better chance of finding what works for you. This is hard and it may take some time, but making the decision to change is the first step. Instead of being unrealistic and saying, "My goal is to beat this illness and never take medications again," it may be better to say, "My goal is to manage this illness effectively so that I can find medications that work in smaller doses with limited side effects." This is a realistic and reachable goal, and you can do it. People with bipolar disorder can work with family members and friends for support. Working as a team can really make a difference.

Don't Give Up On Medications

The first step of the Take Charge 4-Step Treatment Plan encourages you to really explore all of your medications choices for bipolar disorder. It may take you a long time to find the right medication, but when you do, it can be like having a new life. Keep trying until you find the medication that helps you reduce your symptoms so that you can use the ideas in the rest of the book to truly find stability.

Your Toolbox Knowledge about bipolar disorder. A correct diagnosis. A list of your major symptoms. Medication knowledge. Help with side effects.

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.