What to Do If Your Bipolar Meds Aren’t Working

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Medication is a key part of managing your bipolar disorder. If you feel like it doesn’t work as well as it should, doesn’t help at all, or has side effects that are too much for you, don’t quit. Instead, tell your doctor.

“There are many treatment options for bipolar disorder,” says Megan Schabbing MD, a psychiatrist at OhioHealth in Columbus, Ohio. “Your doctor can work with you to find a new medication or combination of treatments.” And that can get you back to feeling better again.

Signs It’s Time For a Switch

If you have bipolar disorder, you should work closely with your psychiatrist and medical team. They can help you keep tabs on whether your treatment is on track.

It’s important for you to notice how you’re doing, too. Let your doctor know if you:

  1. Have a lot more energy than usual
  2. Are running low on energy or feeling really sad or hopeless
  3. Notice your mood changing quickly several times in a single day. You might go from feeling happy, energized, or on an even keel one moment to feeling blue or depressed the next moment.
  4. Wonder whether people are watching you or are out to get you (for example, gossiping about you or stealing your money)
  5. Feel really guilty for no real reason
  6. Can’t fall asleep, stay asleep, or are waking up really early in the morning
  7. Are overwhelmed with new ideas for big projects, or are making plans but having trouble meeting deadlines or doing what you said you would do
  8. Do risky things (having unprotected sex or using drugs, for example) or act without thinking
  9. Have trouble with your relationships with friends, family, or co-workers. For example, you may notice you’re arguing with others a lot more than usual.
  10. Notice physical changes, such as weight gain, headaches, a rapid heartbeat or problems with your blood sugar. These can be signs that your medicine is causing physical problems and you may need to try a different prescription.

When It’s Time for a Transition

“If you suspect your medication isn’t managing your bipolar disorder the way it used to, or you just don’t feel good, see your doctor right away,” says Michael F. Grunebaum, MD, a research psychiatrist at New York State Psychiatric Institute in New York City.

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Important: If you suspect something’s really wrong -- for example, you’re hearing voices, you want to hurt yourself, or you’re having severe pain in your midsection (which can be a sign of kidney or liver issues) -- go to an emergency room right away.

Your psychiatrist will talk with you and may recommend certain tests, such as blood tests, to figure out how your medications are affecting you.

Chances are, you won’t go off your medication right away.

“Research shows that the safest way to stop is gradually over the course of several weeks, or even months,” Grunebaum says. “Abruptly stopping bipolar medication can cause a mood episode.”

What if you do have to stop taking medication ASAP -- because it’s causing kidney or liver problems, for example? “There are medications that can be used in the short term to control symptoms while you wait for the longer-term medication to begin working,” Schabbing says.

ECT May Help

Your doctor may also recommend electroconvulsive therapy (ECT). With ECT, a physician delivers a small electrical current to your brain while you’re asleep under anesthesia. It causes brain effects that can improve conditions like depression and bipolar disorder.

Unlike most medication, ECT often works fairly quickly, although its effects usually aren’t long-lasting. To prevent relapses, you may need to take a medication or else get ECT long-term for maintenance.

Tips to Make the Switch Easier

It’s important to stay involved with your health while you’re changing medications or treatment. To make the transition smoother:

See your psychiatrist regularly. “It’s important to find a psychiatrist you can trust and feel comfortable seeing often,” Schabbing says. “You want to see her when you’re healthy and not experiencing bipolar symptoms so she knows what to aim for with treatment.”

Consider talk therapy. Cognitive behavioral therapy and other forms of talk therapy (also called psychotherapy) can help you manage your mood, both during and after the transition. If you already have a counselor you meet with, you may need to go more often during the transition.

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Get supported. Support groups can be helpful, too -- not just for you, but also for your friends and family. “Your loved ones may not understand that changes in mood or irritability, for example, are not choices; they’re symptoms of bipolar disorder,” Schabbing says. A support group can help them understand what you’re going through, and let them know how to help you. You can find both types of groups through the Depression and Bipolar Support Alliance (www.dbsalliance.org). Or ask your psychiatrist for a recommendation.

Take care of yourself. Step up all the habits that help you be well. “It’s crucial to get good sleep, because lack of sleep can contribute to manic symptoms and mood instability,” Grunebaum says. Regular exercise, a balanced diet, and managing stress are important, too. While they won’t make your bipolar disorder go away, leading your healthiest life can make it easier for you to follow your treatment and stay well.

WebMD Feature Reviewed by Joseph Goldberg, MD on November 21, 2016

Sources

SOURCES:

Megan B. Schabbing MD, psychiatrist, OhioHealth, Columbus, Ohio.

Michael F. Grunebaum, MD, research psychiatrist, New York State Psychiatric Institute; associate professor of psychiatry, Columbia University Medical Center.

University of Michigan Department of Psychiatry: “Electroconvulsive Therapy Program.”

National Institute of Mental Health: "Psychotherapies."

Depression and Bipolar Support Alliance: “DBSA Chapters/Support Groups.”

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