If you have bipolar disorder, medication will most likely play a big part of your treatment plan. Medication can help bring mania and depression under control and prevent relapses once your mood has stabilized. But taking medication is just one aspect of treatment. Your lifestyle, support network and other forms of therapy are also important in helping you to successfully manage your symptoms. Finding the right drug can be tricky, so it’s important to work closely with a specialist and re-evaluate your medication regularly, as the optimum dose may change over time.
IN THIS ARTICLE:
- The role of medication
- Finding the right medication
- Taking medication responsibly
- Anticonvulsant mood stabilizers
- Antidepressant medications
- Antipsychotic medications
- Other medications
The role of medication in bipolar disorder treatment
If you have bipolar disorder, medication will likely be the foundation of your treatment plan. Medication can bring mania and depression under control and prevent relapses once your mood has stabilized. You may not like the idea of taking bipolar medication long term, especially if you’re struggling with unpleasant side effects. But just as a diabetic needs to take insulin in order to stay healthy, taking medication for bipolar disorder will help you to maintain a stable mood. However, do not expect medication alone to solve all your problems. There are plenty of other actions you can take to manage your symptoms and reduce the amount of medication required. Medication is most effective when used in combination with other bipolar disorder treatments, including therapy, self-help coping strategies, and healthy lifestyle choices.
BIPOLAR HK TIPS FOR GETTING THE MOST FROM YOUR MEDS!
Take advantage of natural mood stabilizers
Your lifestyle has an impact on your symptoms. If you make healthy daily choices, you may be able to reduce the amount of medication you need. Mood stabilizers that don’t require a prescription include keeping a strict sleep schedule, exercising regularly, practicing relaxation techniques, and developing a solid support system.
Watch your antidepressants
The treatment for bipolar depression is different than for regular depression. In fact, antidepressants can sometimes make bipolar disorder worse or trigger a manic episode when used on their own without a mood stabilizer. However, if you are bipolar, your psych doctor is extremely unlikely to prescribe just antidepressants.
Add therapy to your treatment plan
Research shows that people who take medication for bipolar disorder tend to recover much faster and control their moods better if they also get therapy.Therapy gives you the tools to cope with life’s difficulties, monitor your progress, and deal with the problems bipolar disorder is causing in your personal and professional life.
Continue taking medication, even after you feel better!
The likelihood of you having a relapse is very high if you suddenly stop taking your bipolar medication. It is especially dangerous if you take lithium. Talk to your doctor before you make any changes, even if you believe you no longer need medication. Your doctor can help you make any adjustments safely.
Finding the right bipolar disorder medication
It can take a while to find the right bipolar medication and dose. Everyone responds to medication differently, so you may have to try several bipolar disorder drugs before you find the one that works for you. Be patient, but don’t settle for a bipolar medication that makes you feel lousy, either. Once you’ve discovered the right bipolar disorder drug or drug cocktail, it may still take time to determine the optimal dose. In the case of mood stabilizing medications such as lithium, the difference between a beneficial dose and a toxic one is small. Frequent office visits to re-evaluate your bipolar medication needs and careful monitoring of symptoms and side effects will help you stay safe.
Learn about your bipolar disorder medication
When starting a new medication for bipolar disorder, educate yourself about how to take it safely.
Questions to ask your doctor about any new prescription include:
- Are there any medical conditions that could be causing or exacerbating my mood swings?
- What are the side effects and risks of the medication you are recommending?
- When and how should I take this medication?
- Are there any foods or other substances I will need to avoid?
- How will this drug interact with my other prescriptions?
- How long will I have to take this medication?
- Will withdrawing from the drug be difficult if I decide to stop?
- Will my symptoms return when I stop taking the medication?
How often should I talk with my doctor?
During acute mania or depression, most people talk with their doctor at least once a week, or even every day, to monitor symptoms, medication doses, and side effects. As you recover, you will see your doctor less often; once you are well, you might see your doctor for a quick review every few months. Regardless of scheduled appointments or blood tests, call your doctor if you have:
- Suicidal or violent feelings
- Changes in mood, sleep, or energy
- Changes in medication side effects
- Need for over-the-counter medication (cold or pain medicine)
- An acute medical illness or need for surgery, extensive dental care, or changes in other medicines you take
- A change in your medication situation, such as pregnancy
[Source: Treatment of Bipolar Disorder: A Guide for Patients and Families]
Generic vs. Brand-Name Drugs
Generic drugs have the same use, dosage, side effects, risks, safety profile, and potency as the original brand-name drug. The main reason why generic drugs are cheaper than brand-name drugs is that the generic drug manufacturer does not need to recoup huge expenses for developing and marketing a drug. Once the patent for the original drug has expired, other manufacturers can produce the same drug with the same ingredients at a markedly lower cost.
Occasionally, brand-name drugs have different coatings or color dyes to change their appearance. However, in some cases, these extra ingredients will make the generic form of the drug less tolerable. So if your condition worsens after switching from a brand-name to a generic drug, consult your doctor immediately. In a lot of cases, however, generic drugs are just as safe and effective as brand-name drugs, and a lot easier on your wallet.
Taking medication for bipolar disorder responsibly
All prescription drugs come with risks, but if you take your bipolar disorder medications responsibly and combine them with therapy and healthy lifestyle choices, you can minimize the risks and maximize your chances of treatment success and living a happy, successful and healthy life.
Take your bipolar medication as prescribed!
You may be tempted to stop taking your bipolar disorder medication if you’re experiencing side effects. Or, conversely, you may want to stop taking your pills because you feel great and don’t think you need them anymore. WRONG! Stopping maintenance medication comes with a high risk of relapse. Stopping cold turkey is even more risky with serious side-effects. Before you make any bipolar medication changes, talk to you doctor. If you don’t like the way the drug makes you feel or if it’s not working, there may be other options you can try. And if you decide that medication is not for you, your doctor can help you taper off the drugs safely.
Keep track of side effects
Track any side effects you experience. Using a log, keep a record of your symptoms, when they occur, and how bad they are. You can download an app called “Mood Diary” for your phone and set it to bleep an alarm to remind you to take your meds. You can answer the multiple choice answers on how you are feeling and easily keep a track of your symptoms. It only takes a minute! Bring the phone/ worksheet to your doctor. He/ she may have suggestions for minimizing the side effects. If side effects are severe, your doctor will most likely switch you to another drug or change your bipolar medication dose. So don’t waste time worrying about it!
Be aware of potential drug interactions
You should always check for drug interactions before taking another prescription medication, over-the-counter drug, or herbal supplement. Drug interactions can cause unexpected side effects or make your bipolar disorder medication less effective, or even dangerous. Mixing certain foods and beverages with your bipolar medication can also cause problems. Talk to your doctor about special precautions for the bipolar medication or medications you’re taking. You can also learn about potential interactions by reading drug labels or talking to your pharmacist.
Tips for managing bipolar disorder medications
- Use a daily reminder/medication saver system to make sure you are taking all of the necessary medications.
- Download Mood Diary app to your phone and create alerts for medication times.
- Throw away old medications or those you are no longer taking.
- Realize that medications work best when you are making other healthy choices.
- Don’t expect a pill to fix a bad diet, lack of exercise or an abusive or chaotic lifestyle.
- Reduce or discontinue the use of alcohol. Alcohol is a depressant and makes recovery even more difficult. It can also interfere with the way your medication works.
- Avoid overly processed foods. They are full of additives and these can also affect your medication’s ability to work successfully. If you can, always eat fresh, organic produce. If you can’t, check out the cheap and easy recipes in our Nutrition section! Remember frozen veg is cheaper to buy and just as nutritious!
[Source: Depression and Bipolar Support Alliance]
Lithium: The first mood stabilizer for bipolar disorder
Mood stabilizers are medications that help control the highs and lows of bipolar disorder: They are the cornerstone of treatment, both for mania and depression. Lithium is the oldest and most well-known mood stabilizer. It is highly effective for treating mania. Lithium can also help bipolar depression. However, it is not as effective for mixed episodes or rapid cycling forms of bipolar disorder. Lithium takes from one to two weeks to reach its full effect.
Common side effects of lithium
The following side effects are common on lithium. Some may go away as your body adapts to the medication.
- Weight gain
- Weakness or fatigue
- Excessive thirst; increased urination
- Stomach pain
- Thyroid problems
- Memory and concentration problems
The importance of regular blood tests for lithium takers
If you take lithium, it’s important to have regular blood tests to make sure your dose is in the effective range. Doses that are too high can be toxic. When you first start taking lithium, your doctor may check your blood levels once or twice a week. Once the right dose has been determined and your levels are steady, blood tests will be less frequent. However, it’s still important to get blood tests every two to three months, since many things can cause your lithium levels to change. Even taking a different brand of lithium can lead to different blood levels.
Other factors that influence your lithium levels include:
- Weight loss or gain
- The amount of sodium (salt) in your diet
- Seasonal changes (lithium levels may be higher in the summer)
- Many prescription and over-the-counter drugs (e.g. ibuprofen, diuretics, and heart and blood pressure medication)
- Caffeine, tea, and coffee
- Hormonal fluctuations during the menstrual cycle and pregnancy
- Changes in your health (for example, heart disease and kidney disease increase the risk of lithium toxicity)
- Lithium users keep calm & drink your water
What can I do to avoid toxic lithium levels from developing?
- Make sure that you go for the blood tests whenever they are needed.
- Don’t suddenly change the amount of salt in your diet; it is especially important not to suddenly reduce your salt intake.
- Make sure that you drink enough fluids, especially if you are exercising heavily or in hot weather when you will sweat more.
- Remember that alcoholic drinks can make you lose water overall. This is particularly important to bear in mind if you are on vacation in the sun: you may feel like drinking more alcohol, and the weather may be hot so you sweat more.
- See a doctor straight away if you get any of the physical illnesses or symptoms listed above. Always tell any doctor or pharmacist that you are taking lithium before you are prescribed, or buy, any new medicines.
Please remember you are very unlikely to have every negative side-effect simultaneously and a lot of us have no negative side-effects!!!
Anticonvulsant mood stabilizers for bipolar disorder
Anticonvulsants are used in the treatment of bipolar disorder as mood stabilizers. Originally developed for the treatment of epilepsy, they have been shown to relieve the symptoms of mania and reduce mood swings.
Valproic acid (Depakote)
Valproic acid, also known as divalproex or valproate, is a highly effective mood stabilizer. Common brand names include Depakote and Depakene. Valproic acid is often the first choice for rapid cycling, mixed mania, or mania with hallucinations or delusions. It is a good bipolar medication option if you can’t tolerate the side effects of lithium.
Common side effects include:
- Weight gain
Other anticonvulsant medications for bipolar disorder
Other anticonvulsants that can be used as mood stabilizers include:
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal)
- Topiramate (Topamax)
Antidepressant medications for bipolar disorder
Although antidepressants have traditionally been used to treat episodes of bipolar depression, their use is becoming more and more controversial. A growing body of research calls their safety and efficacy into question.
Antidepressants should be used with caution
A major study funded by the National Institute of Mental Health (USA) showed that adding an antidepressant to a mood stabilizer was no more effective in treating bipolar depression than using a mood stabilizer alone. Another NIHM study found that antidepressants work no better than placebo. Antidepressants can trigger mania in people with bipolar disorder. If antidepressants are used at all, they should be used in combination with a mood stabilizer.
Treating bipolar depression with mood stabilizers
The new focus in bipolar depression treatment is on optimizing the dose of mood stabilizers. If you can stop your mood cycling, you might stop having depressive episodes entirely. If you are able to stop the mood cycling, but symptoms of depression remain, the following medications may help:
- Lamictal (lamotrigine)
- Seroquel (quetiapine)
- Zyprexa (olanzapine)
- Symbyax (a pill that combines olanzapine with the antidepressant fluoxetine)
What should I do if I’m currently taking an antidepressant?
Don’t panic! And DO NOT stop taking your antidepressant!!!!
You will probably be taking it in conjunction with a mood stabilizer anyway! Talk to your doctor about any concerns. If you do decide not to take antidepressants, the tapering process should be done very slowly, usually over the course of several months, in order to reduce adverse withdrawal effects. Only stop taking antidepressants immediately if symptoms of mania develop.
Antipsychotic medications for bipolar disorder
If you lose touch with reality during a manic or depressive episode, an antipsychotic drug may be prescribed. They have also been found to help with regular manic episodes. Antipsychotic medications may be helpful if you have tried mood stabilizers without success. Often, antipsychotic medications are combined with a mood stabilizer such as lithium or valproic acid.
Antipsychotic medications used for bipolar disorder include:
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ariprazole (Abilify)
- Ziprasidone (Geodon)
- Clozapine (Clozaril)
Common side effects of antipsychotic medications for bipolar disorder
- Weight gain (this is not always true – some people LOSE weight on antipsychotics!)
- Sexual dysfunction
- Dry mouth and frothing
- Blurred vision
Dealing with antipsychotic-induced erectile dysfunction
Sexual and erectile dysfunction is a more possible side effect of antipsychotic medications, one that often deters bipolar disorder patients from continuing their medication. However, a recent study has shown that the medication Sildenafil citrate (Viagra) is both safe and effective in the treatment of antipsychotic-induced erectile dysfunction in men.
[Source: The American Journal of Psychiatry]
Other medications for bipolar disorder
While you’re waiting for the medication to kick in, your doctor may prescribe a benzodiazepine to relieve any symptoms of anxiety, agitation, or insomnia.
- Mood stabilizers can take up to several weeks to reach their full effect.
- Benzodiazepines are fast-acting sedatives that work within 30 minutes to an hour.
- Because of their high addictive potential, however, benzodiazepines should only be used until your mood stabilizer or antidepressant begins to work. Those with a history of substance abuse should be particularly cautious.
Calcium channel blockers
Traditionally used to treat heart problems and high blood pressure, both of which bipolar people are at a higher risk of developing in later life. They also have a mood stabilizing effect. They have fewer side effects than traditional mood stabilizers, but they are also, unfortunately, less effective. However, they may be an option for people who can’t tolerate lithium or anticonvulsants.
People with bipolar disorder often have abnormal levels of thyroid hormone (overactive). Thyroid dysfunction is particularly prevalent in rapid cyclers. Lithium treatment can also cause low (under active) thyroid levels. In these cases, thyroid medication is added to the drug treatment regimen. While research is still ongoing, thyroid medication also shows promise as a treatment for bipolar depression with minimal side effects.
Bipolar disorder medication alone is not enough!
Bipolar medication is most effective when used in combination with other bipolar disorder treatments, including therapy, self-help coping strategies, natural mood stabilizers, and healthy lifestyle choices.
People who take medication for bipolar disorder tend to recover much faster and control their moods much better if they also get therapy. Therapy gives you the tools to cope with life’s difficulties, monitor your progress, and deal with the problems bipolar disorder is causing in your personal and professional life. If you can’t afford therapy (or even if you can) it’s especially important to attend Bipolar Support Groups on a regular basis. Support groups offer peer mentoring and this offers you the opportunity to swap stories and knowledge with other bipolar people in your area. Click HERE to read about Hong Kong’s First English Language Bipolar Support Group.
Getting regular exercise can help beat bipolar disorder symptoms and help us to stabilize mood swings. Exercise is also a safe and effective way to release the pent-up energy associated with the manic episodes of bipolar disorder. Can’t afford a gym? Hey, guess what? WALKING is one of the best forms of exercise for us bipolar types. So forget that cab and climb the steps!
Stable sleep schedule
Studies have found that insufficient sleep can precipitate manic episodes in bipolar patients. To keep symptoms and mood episodes to a minimum maintain a stable sleep schedule. It is also important to regulate darkness and light exposure as these throw off sleep-wake cycles and upset the sensitive biological clock in people with bipolar disorder.
Omega-3 fatty acids may lessen the symptoms of bipolar disorder. Weight gain is a common side effect of many bipolar medications, so it’s important to adopt healthy eating habits to manage your weight. Avoid caffeine, alcohol, and recreational drugs, as they can adversely interact with bipolar meds. Equally, try and avoid foods that have copious amounts of additives hidden in them. Additives can interfere with our bipolar medications and have even been suggested by some experts as the cause of the rise in bipolarity. The other obvious reason for maintaining a good, healthy lifestyle and diet is that our bipolar meds are seriously strong shit!!! It is especially important not to neglect our physical health when we’re trying to maintain our mental health.
Social support network
Living with bipolar disorder can be challenging. Having a solid support system in place can make all the difference in your outlook and motivation. Joining a support group can assist mental health recovery by providing an opportunity to share your experiences, connect to and learn from others. Support from loved ones also makes a huge difference, so reach out to your family and friends. They care about you and want to help.
Natural mood stabilizers for bipolar disorder
There are many things you can do to stabilize your mood. The way you live your life is as important as the meds you take. Making healthy choices for yourself can make a powerful difference to your mood.