Bipolar Disorder Medication Alone Is Not Enough
Bipolar medication is most effective when used in combination with other bipolar disorder treatments, including:
Therapy. 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.
Exercise.Getting regular exercise can reduce bipolar disorder symptoms and help 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.
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.
Healthy diet.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 drugs as they can adversely interact with bipolar medications.
Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. Reviewed by Damon Ramsey, MD
How Long Does It Take To Work
In certain cases, the antidepressant and antimanic benefits of lamotrigine are noticed pretty early on in the treatment cycle, says Dr. Aiken. “For some other patients, though, effects are seen after about a month of being on lamotrigine treatment. But there will always be others that take a bit longer to experience the positive effects.”
What Is Bipolar Disorder
Bipolar disorder is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns and behavior. These shifts can last for hours, days, weeks or months and interrupt your ability to carry out day-to-day tasks.
There are a few types of bipolar disorder, which involve experiencing significant fluctuations in mood referred to as hypomanic/manic and depressive episodes. However, people with bipolar disorder arent always in a hypomanic/manic or depressive state. They also experience periods of normal mood, known as euthymia.
Manic episodes
A key feature of bipolar I disorder is manic episodes. To meet the criteria for bipolar I disorder, you must have had at least one manic episode in your life for at least a week with or without ever experiencing a depressive episode.
Mania is a condition in which you have a period of abnormally elevated or irritable mood, as well as extreme changes in emotions, thoughts, energy, talkativeness and activity level. This highly energized level of physical and mental activity and behavior is a change from your usual self and is noticeable by others.
People with certain types of bipolar such as bipolar II disorder experience hypomania, which is a less severe form of mania. It doesnt last as long as manic episodes and it doesnt interfere with daily functioning as much.
Depressive episodes
- Feelings of worthlessness and hopelessness.
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Finding The Right Medication
Finding the right combination of medications to treat bipolar disorder can take some time. A doctor considers all of a persons symptoms and tries to find the right medications to match them. A person should be open with their doctor about any new or changing symptoms and side effects. The doctor can then adjust the treatment accordingly.
Common Bd Medications And Their Side Effects
Many people with BD take more than one medication at a time, or transition from one drug to another. Lithium, for example, is a commonly prescribed mood stabilizer, but it doesnt work right away. Doctors may suggest taking an antipsychotic medication for an acute manic episode to give lithium time to do its job.
Another example is antidepressants. Clinicians generally only recommend people with BD take antidepressants along with a mood stabilizer or antimanic drug to avoid the risk the antidepressant might trigger an acute manic episode.
The most common medications for BD, used alone or in combination, include:
- Mood stabilizers. These include lithium, divalproex/valproic acid, and carbamazepine.
- Atypical antipsychotics. These include aripiprazole, asenapine, cariprazine, lurasidone, paliperidone, quetiapine, risperidone, ziprasidone, and olanzapine.
- Antidepressants.
Each of these has possible side effects. For some people, these side effects can be a barrier to continuing treatment. A 2019 study of people who took antipsychotic medication found that 70 percent had tried to stop the medication, and 64 percent of them cited side effects as the reason why. If youre troubled by side effects, it may help to know other people also have this experience.
Its important to keeping open communication with your doctor, adds Dr. Patricia Celan, MD, a postgraduate psychiatry resident at Dalhousie University.
Below are some side effects of medications for bipolar disorder.
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Which Bipolar Medicine Is Best
Doctors use many types of drugs to treat bipolar disorder. Some fight the extreme highs of mania and others treat the lows of depression. You might take one drug at a time or a few at the same time.
The best bipolar medicine is the one that works best for you. Work with your doctor to decide on the medication plan that helps you the most.
You may keep taking these medications for years or decades, even if itâs been a long time since your last manic or depressive episode. This is called maintenance therapy and helps prevent recurrence of symptoms.
What Are The Side Effects Of Bipolar Disorder Medications
Side effects of bipolar disorder medications are common and vary by medication. Its important to talk with your healthcare provider about what you can expect when taking certain medications. Its also important to tell them if youre experiencing side effects.
Never stop taking your medication unless your healthcare provider tells you to do so. Abruptly stopping medication can cause severe side effects and trigger severe episodes.
The most common side effects of bipolar disorder medications include:
- Akathisia feelings of restlessness and agitation with a compelling need to move, rock or pace.
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Screening Procedures And Data Collection
Participants were identified by Schlesinger Group, a firm specializing in recruiting research participants. Schlesinger Group collaborated with three organizations, each running a pre-existing panel of individuals interested in participating in survey research assembled using in-person, phone, and online recruitment strategies. Initial membership surveys, including demographic, medical, and lifestyle information, were collected from all panel members. The panel administrators employed regular validation procedures to ensure the quality and authenticity of panel members . For this survey, Schlesinger Group identified adult panel members with a self-reported diagnosis of BD and invited them to participate via email. The invitation email contained a link to the secure webpage hosting the ICF.
To optimize representativeness to the larger population of BD-I patients, enrollment quotas for age and gender were instituted . The target distribution included a female to male ratio of 3:2 so that neither gender exceeded 120 participants, and age distribution of no more than 30% of participants under age 30 and at least 20% of participants over age 50.
I Think My Bipolar Meds Are Making Me Feel Worse
Seeking treatment for bipolar disorder can be hard. Even just figuring out that you have bipolar disorder is hard enough! Taking the first steps to get better is really brave. But it can be really discouraging when you start a treatment only to discover that its actually making you feel worse!
First off, know that this isnt unusual. Many people experience side-effects from their medications. Its also not the end of the roadwhen you know what doesnt work, youre one step closer to finding what does work. Its all part of the recovery process.
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Taking Bipolar Disorder Medication 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.
Take your bipolar medication as prescribed. Before you make any changes to your bipolar medication, 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. Using a log, keep a record of any side effects you experience, when they occur, and how bad they are. Bring the log to your doctor, who may have suggestions for minimizing the side effects, decide to switch you to another drug or change your bipolar medication dose.
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. As well as being a depressant, alcohol can also interfere with how your medication works. Talk to your doctor or pharmacist and read drug labels carefully.
Tips for managing bipolar disorder medications
Selective Serotonin Reuptake Inhibitors
The typical course of treatment for depression initially begins with a prescription for a selective serotonin reuptake inhibitor .
When the brain doesnt make enough serotonin, or it cant use existing serotonin correctly, the balance of chemicals in the brain may become uneven. SSRIs work to change the level of serotonin in the brain.
Specifically, SSRIs block the reabsorption of serotonin. By blocking the reabsorption, neurotransmitters may send and receive chemical messages more effectively. This is thought to increase the mood-boosting effects of serotonin and improve depression symptoms.
The most common SSRIs include:
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Straight Talk On Managing Bipolar Disorder
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Temporary Bipolar Medication Side Effects
Many of the side effects initially considered extremely bothersome will diminish over time. While medications and individuals are all different, bipolar medication side effects that tend to diminish include:1
- Rapid heartbeat
Any side effect of bipolar medication could be a symptom of a larger issue and should always be reported to a doctor.
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Understanding Bipolar Disorder Medication
Bipolar disorder is a serious, chronic mental health condition that involves having extreme mood swings.Someone with bipolar disorder can swing between periods of depression and periods of feeling constantly high, irritable, agitated or excited, which is known as mania or hypomania.
If you have bipolar disorder, treatment can help make the episodes of depression and mania shorter, easier to get through and less likely to happen.
Most people with bipolar disorder are treated with a combination of medication and psychotherapy. Psychological treatment on its own is usually not enough. Medication plays a vital role and is used to:
- treat episodes of depression
- treat episodes of mania or hypomania
- prevent these episodes from happening again
Treatments To Alleviate Side Effects
Doctors monitor people taking BD medication for side effects. In many cases, your doctor can help you make changes to your treatment plan so symptoms are easier to manage.
One strategy is the timing of the dose, Israel tells Healthline. If the medication is sedating when it is peaking in the system, best to take before bedtime. If a medication is causing nausea or upset stomach, best to take with food.
The dosing can impact the side effects, Israel says. Your doctor might suggest a decreased dose or dose divided into a twice-a-day regimen if that means you will tolerate the medication better, provided its still effective.
Your doctor can recommend what changes work best for you. If appropriate, they may prescribe an adjunctive medication to help counter side effects. For example, when people experience restlessness from antipsychotics, the clinician may consider lowering the dose or prescribing a beta blocker in addition.
13 weeks in a 2010 study.
A paper presented at the 2021 annual meeting of the American Psychiatric Association found that patients experiencing bipolar mood episodes who took a combination of lithium and antipsychotic medications had hospital stays that were an average of 2.8 days shorter. Stays ranged from 1 to 3 weeks.
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Treatment Options For Bipolar Disorder
If a person is not treated, episodes of bipolar-related mania can last for between 3 and 6 months.
Episodes of depression tend to last longer, often 6 to 12 months.
But with effective treatment, episodes usually improve within about 3 months.
Most people with bipolar disorder can be treated using a combination of different treatments.
These can include 1 or more of the following:
- medicine to prevent episodes of mania and depression these are known as mood stabilisers, and you take them every day on a long-term basis
- medicine to treat the main symptoms of depression and mania when they happen
- learning to recognise the triggers and signs of an episode of depression or mania
- psychological treatment such as talking therapies, which help you deal with depression and provide advice on how to improve relationships
- lifestyle advice such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep
Most people with bipolar disorder can receive most of their treatment without having to stay in hospital.
But hospital treatment may be needed if your symptoms are severe or you’re being treated under the Mental Health Act, as there’s a danger you may self-harm or hurt others.
In some circumstances, you could have treatment in a day hospital and return home at night.
The Importance Of Regular Blood Tests
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 it, your doctor may check your blood levels once or twice a week. When the right dose has been determined and your levels are steady, 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.
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Controversy Surrounding Antidepressant Use
In terms of the efficacy of antidepressants in BD-D, several reviews and meta-analyses have come to differing conclusions, likely reflecting differences in statistical techniques and inclusion criteria and pointing towards a need for further investigation. Two of the most recent meta-analyses found no significant benefit of adding antidepressants to mood stabilisers for the treatment of BD-D. In agreement with these findings, the STEP-BD trial, which included 4360 patients, found that adding antidepressants to mood stabilisers did not result in better clinical outcomes than those achieved with mood stabilisers alone. In contrast, naturalistic studies suggest that there is likely a sizeable subgroup of patients who respond to a mood stabiliser plus an antidepressant with no increase in switching. Interestingly, there is more consistent evidence of benefits when antidepressants are added to SGAs. Whether this reflects additive effects of antidepressants combined specifically with SGAs or some other factors is unknown. A separate meta-analysis comparing different antidepressants found no significant difference in rates of clinical response between antidepressants, but it did report lower switch rates for bupropion when compared with sertraline, venlafaxine and desipramine. Importantly, the analysis concluded that the results are significantly limited by lack of high-quality studies.
Stick To Your Treatment
Medications for bipolar disorder are powerful drugs, and you must take them exactly as your doctor recommends. Don’t stop taking a medicine without your doctor’s approval. It can be dangerous.
When you’re feeling good, you might decide that you want to stop taking your medication. But that’s a bad idea unless your doctor agrees. Treatment only during mood episodes may not be enough to prevent symptoms from coming back. In most people, maintenance treatment between mood episodes makes mania and depression happen less often and makes them less severe. If you’re feeling good now, that’s likely because your medication is working. So stick with it.
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Side Effects Associated With Psychotropic Medications In Patients With Bipolar Disorder: Evidence From Two Independent Samples
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Bipolar Ii Disorder In Adults: A Review Of Management Options
Assistant Professor for Pharmacy PracticeFlorida A& M University College of Pharmacy and Pharmaceutical SciencesTallahassee, Florida
Interim Associate Dean for Academic Affairs and ProfessorFlorida A& M University College of Pharmacy and Pharmaceutical SciencesTallahassee, Florida
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Bipolar disorder is characterized by pathologic variations in mood, with periods of mania, hypomania, psychosis, and depression. The two most common types, bipolar I and bipolar II, differ in the presentation of mood variations. The course of bipolar II is less well studied and less understood than bipolar I disorder. Patients with bipolar I disorder have episodes of full mania alternating with episodes of major depression,1,2 whereas patients with bipolar II disorder pre-sent with one or more episodes of major depression with at least one hypomanic episode.1 Bipolar II can also manifest itself as a mixed state, which is the presence of both depressive and mood elevated symptoms simultaneously.3 Patients with bipolar II disorder display fewer manic symptoms than those with bipolar I disorder both conditions may have an equivalent impact on quality of life and may also be associated with increased suicide risk.3 Patients may also present with rapid-cycling bipolar disorder, which consists of at least four discrete episodes of mania or depression in a single year, demarcated by clear periods of remission or by switches to episodes of opposite polarity.4
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