One reason to discuss your bipolar medications with your healthcare provider is that you may have begun new behaviors -- such as quitting smoking, beginning an exercise plan, or practicing stress reduction techniques -- that impact the necessary dosage of your medication. For example, regular exercise may reduce dependence on medications for diabetes, heart conditions, anxiety, depression, or mania. Eating foods rich in omega-3s or taking omega-3 supplements may improve mood in some people and therefore reduce the need for mood stabilizers.
Given this new information, your provider may want to adjust your dosage.
Some questions you may want to ask your doctor when discussing bipolar medication with your mental health provider are as follows:
1. Why am I taking this medication rather than any of the other medications that could be prescribed for this condition? 2. What are some of the side effects I will likely experience, and is there anything I can do to alleviate or prevent some of them from occurring? 3. Are there any possible interactions among the medications that I'm already taking? Is there any way to alleviate or prevent these interactions? Would substituting another medication alleviate or eliminate these interactions? 4. Are there any nutritional supplements, dietary considerations, or behavioral changes that could reduce my dependence on a particular medication? 5. Are there any foods or activities I should avoid while taking these medications? 6. Please give me complete medical information on all the medications you're prescribing for me (if this was not already done or you no longer have that information).
Once you know and consistently take the prescribed medications for bipolar disorder, you may want to have some discussions with your medical provider about the effectiveness and side effects. Some side effects are more problematic for some people than for others; for example, whereas one person may be okay with weight gain, others may find it intolerable.
On a regular basis (annually or every six months), talk to your healthcare provider about the drugs you're taking. At these intervals, discuss side effects, effectiveness of symptom reduction, or any changes in your behaviors. Also ask about any new scientific information on the effectiveness of the drug or any new side effects or risks that have been discovered. You may want to try new drugs that have come onto the market to see if they work better for you. However, you may want to stick with the medication that works for you rather than risk episodes or new side effects by trying something new.
The goal of this exercise is to educate you (and inform your mental healthcare provider) about all the medications you're taking, whether for bipolar disorder or other conditions. For each drug you're taking, you'll record some detailed information. You can use a table format or simply have a paragraph for each drug. Here's the information you'll record:
1. What's the chemical (generic) name of the medication? 2. What's the brand name (if applicable; that is, if it's not a generic drug) of the medication? 3. How much of the medication are you taking? (For example, the number of pills you take each time you take the medication and the amount of medication in each pill) 4. How often do you take the medication? (For example, twice a day or every four hours and so on) 5. What's the health problem for which this medication was prescribed? 6. How long you have been taking this medication? 7. What side effects do you think you may be experiencing as a result of taking this medication?
Bring your answers to your prescribing provider so that possible interactions can be avoided and prescribing can be based on as much information as possible. Be honest in reporting your compliance with medications, because if it's prescribed but you aren't taking it, this must be taken into account when new prescriptions are made or when your medical provider tries to understand the nature of your symptoms. If you've taken other drugs previously for the same condition, it would be useful to list the names of the drugs you took prior to the current one and why you stopped taking them. Finally, also answer these questions for any alternative medications or nutritional supplements you're taking. All this information helps develop the medication regimen that works best for you.
To take your bipolar medications as prescribed and trust that they'll work, you must know the medications you're taking and their possible side effects so you can distinguish medication side effects from other medical problems you may have and from symptoms of the illness itself.
In addition to asking your healthcare provider, you can do your own research on your medications. One good source of information is the online version of the Physicians' Desktop Reference (PDR) (also found in print at your local library). The PDR is based on information provided by the U.S. Food and Drug Administration (FDA). Simply typing in the name of your medication will get you other names, side effects, actions, indications, how the medicine is supplied, special warnings, and possible food and drug interactions. It's easier to search by brand name than the generic name of the medication. There's also a picture of the medication. For example, when searching for lithium, the PDR shows Eskalith (one of the trade names for this chemical) and lets us know that it's available in pill and capsule form.
Another resource is the Consumer's Guide to Psychiatric Drugs (Preston, O'Neal, and Talaga 2009), or A Concise Guide to Medical Treatment for Bipolar Disorder in Adults and Adolescents (a Kindle eBook), which describes medical treatments for bipolar disorder in detail.
Even mental health professionals get confused about the myriad options available for treating bipolar disorder. Many manic or depressive episodes are triggered from noncompliance with medication due to either inadvertent or deliberate misuse of prescribed medications. Despite the frustration of finding the right mix of medications, however, pharmaceutical treatment is still the best way to maintain balanced moods in someone with bipolar disorder.
There are simple systems for ensuring that you take your medications for bipolar disorder. These can include some of the following strategies:
Create text messages to be sent to yourself periodically as a reminder. Some cellular phones and personal digital assistants (PDAs) can be programmed to send text messages at set times. You can also use one of several software programs, such as your e-mail program (Microsoft Office Outlook or Gmail by Google, for example) to remind you, either by e-mail or phone.
Set your watch or cellular phone alarm to remind you to take medications.
Some people put a note on the bathroom mirror to remind them to take their medications, especially if they have to take them at morning and night, which are the two times they are most likely to be in their bathrooms.
Put a note on your front door that says, "Did you take your meds today?"
Note the times for your medication dosage as an appointment in your daily calendar or PDA.
Purchase a pill dispenser that helps remind you of the medication you need to take each day. A pill dispenser also facilitates taking your medication with you in your purse or briefcase so that if you don't go home on a given night or some emergency separates you from your medications, you'll always have a supply of medication with you.
For people who travel frequently, when crossing borders, it's best to keep your medications in their prescription bottles so that, if you're traveling with controlled substances such as Klonopin (clonazepam), you won't risk being arrested for importation of a controlled substance, because the prescribing information will be on the containers. Put your medications in your carry-on luggage so that in case your bags get lost, your medications won't be lost with them.
A medication log (which tracks all the medications you are taking), can help motivate you to take your medications regularly while keeping track of side effects and your intake of other substances that may interact with your medications.
Any changes in bipolar medication should be done in consultation with your healthcare provider. Trying it on your own will likely lead to a bipolar episode and all the life-disrupting outcomes that ensue. The good feelings that often are a part of the experience of mania or hypomania lead some people to stop taking their medications, which triggers or exacerbates an episode and may lead to increased severity of symptoms. The goal of treatment is to stay healthy and get off that emotional and psychological roller-coaster ride.
Some people with bipolar disorder find that the number of pills they have to take and the importance of taking certain pills at certain times of day can be frustrating. It's easy to forget to take a dose, which may begin to trigger manic or depressive episodes. Daytime drowsiness is a major problem with many mood stabilizers and often interferes with compliance because it gets in the way of daily responsibilities, such as work, chores, child care, and so forth.
If you find that you have trouble remembering to take your prescribed doses at certain times of day or that certain medications have negative effects at certain times of day (for example, you feel drowsy in the morning after taking lithium), speak to your provider about rearranging your medication schedule to better fit your lifestyle. You may be able to take different dosages at different times of day, change your medications to alleviate daytime drowsiness, or change medications altogether.
Many psychotropic medications for bipolar disorder, such as lithium, Depakote (divalproex), and Zyprexa (olanzapine), may cause liver and/or kidney damage. Your prescribing provider should schedule quarterly (at minimum) blood tests to monitor your liver and kidney functions. He or she will discuss these results with you and make any adjustments to your medication regimen as needed.
Most bipolar medications can cause sedation and daytime fatigue. Often these side effects are seen to occur during the first few days or weeks after starting the medication. This side effect can be problematic, but can also be helpful, if the sedation occurs at night (and thus can help a person fall asleep). However, if the sedation lasts into the day, this may interfere with feeling alert (impacting one's ability to work or go to school). It is very rare that the sedation can interfere with the ability to drive safely.