In-Depth: Living with Bipolar Disorder
It’s common for patients to try several medications before finding the best combination, which often includes a mood stabilizer and an antipsychotic (to help with sleep) or an antidepressant (if depressive symptoms are debilitating), said Melvin McInnis, M.D., a psychiatrist and professor of mood disorders with the Department of Psychiatry and the Depression Center at the University of Michigan. It’s important to note that “about 20 to 30 percent of patients will develop some mood instability” when taking an antidepressant, he said.
When choosing medication, many physicians and patients dismiss lithium, “because it’s an older medication that has largely fallen out of favor,” Dr. McInnis said. Years ago, doctors administered lithium at higher doses, which caused more side effects. Nowadays, however, patients take lithium at lower doses, minimizing side effects, he said. In fact, Dr. McInnis views lithium as “singularly one of the best medications for bipolar disorder” and uses it as the first line of treatment.
How quickly medication takes effect depends on the type. For instance, antipsychotics “work relatively quickly” and “often there will be a calming effect that is appreciated in a few days,” Dr. McInnis said. Achieving mood stability, however, can take several weeks or even months.
Using the following strategies can help you maximize your medication’s effectiveness:
- Communicate with your doctor. “The key is to have an open dialogue with the person who is treating you,” Basco said. All experts emphasize that finding the right mix of medication is a collaborative process, and doctor and patient should work as a team. Before starting medication, talk to your doctor extensively about the side effects and what you can expect.
- Give feedback. Once you’ve started taking your medication, “you should feel comfortable about giving the doctor feedback,” and “you shouldn’t feel like a passive participant,” Reilly-Harrington said. “It helps if you can say what you don’t like upfront rather than not taking your medication secretly because you’re unhappy with it,” Basco said. It can be something as simple as saying, “This medication is making me gain weight and I don’t like that.”
- Monitor progress. The reality is that doctors might not have much time to evaluate your progress with a medication. Instead, track your own progress. Dr. McInnis suggests keeping a diary of your mood, quality of sleep and energy levels and finding a good self-report scale to monitor your symptoms (such as the Beck Depression Inventory or the Patient Health Questionnaire, which assess depression). You can also record symptoms on scale of 1 to 10. Show these materials to your doctor, who then will have a better barometer of your progress.
- Take medication consistently. Patients might stop taking medication because they can’t tolerate the side effects or because they’re feeling better. However, “If you miss doses or fiddle with how much you take, you don’t maximize the medication’s effectiveness,” Basco said. Even worse, not taking your medication puts you “at high risk for relapse,” Dr. Swartz said.
- Be disciplined. If you often forget to take your medication, Reilly-Harrington suggests using behavioral tools to remind you. This can include setting alarm clocks and packing medication in your carry-on luggage.
- Combat weight gain. Because medication can cause significant weight gain, Reilly-Harrington recommends weighing yourself regularly. It’s much easier to manage your weight after gaining five pounds vs. 30, which might seem overwhelming. Also try to maintain an exercise regimen and avoid emotional eating.
- Avoid drugs and alcohol. Whether you’re self-medicating or kicking back with a few drinks, these substances can interfere with your mood and medication. They dilute the efficacy of medication and destabilize the individual, sending moods swinging, Dr. McInnis said.
- Attend support groups. People share their own experiences with medication along with tips to get around side effects, so patients see they aren’t alone, Brondolo said.
Combating Common Triggers
Two triggers common to both manic and depressive episodes are stress and stopping or reducing medication, Basco said. Even everyday stress or excitement can incite an episode. Most startling to people is how seemingly low-stress the event can be, Brondolo said.
Triggers for mania include sleep loss — whether it’s pulling an all-nighter or skipping several hours — different time zones and seasonal changes (typically springtime). Fall and winter tend to trigger depression. Substance abuse can also encourage, extend and exacerbate mania.
In addition to these common triggers, every person has a unique set of stressors, said Basco. If certain life events, such as relationship or financial problems, seem to trigger your depression, then you know these are your unique stressors. At first, these triggers might seem arbitrary; however, you can learn to anticipate episodes. Here are several strategies:
- Even if you aren’t sure why a previously simple task is now a stressor, consider the reasons it was so tough or unnerving for you, Brondolo said.
- Try to maintain the same sleep schedule every night. Remember the importance of keeping a regular routine for all daily activities.
- “Don’t abruptly reduce your medication, unless you work out a safe way to do this with your doctor,” Basco said.
- Learn how to problem solve, so when a stressor comes up, those skills are ready, Basco said. It’s also good to learn techniques to relieve tension and calm your thoughts and emotions.
- Know yourself well enough to identify the early signs and get help quickly; don’t try to tough it out, Basco said. Controlling mild symptoms increases the chance they won’t become major ones.
Tartakovsky, M. (2016). In-Depth: Living with Bipolar Disorder. Psych Central. Retrieved on February 19, 2017, from https://psychcentral.com/lib/living-with-bipolar-disorder/