My mood episode is under control, when can I stop taking these pills??

The following question was posed by one of our blog readers: 

“If I start taking medications for bipolar, will I have to be on them my whole life?”

The answer, unfortunately, is often yes. There are some great treatments for bipolar disorder that can keep the illness under control, and maintaining that control is the best thing you can do for your health, your relationships, and hopefully your life overall.  

We can learn about the natural course of untreated bipolar disorder by looking at how the illness progressed back in the days when there were no medications to treat it at all.  Observations showed that some people would end up spending ten or more years in a depressive episode.  As the illness progressed over time there would be more and more episodes, with shorter and shorter periods of healthy stable mood in between. Luckily, this no longer has to be the case.

 

But it can be a scary and daunting thought to imagine taking a medication for your whole life, especially when there are side effects that you are having difficulty with. 

On the positive side, many studies have shown that the earlier and more comprehensive the treatment for a mental illness, the better the response.  This isn’t too different from what we would expect from any other chronic illness, like diabetes or heart disease.  Studies have also shown that mood stabilizers are actually good for the brain and can protect it. For example, lithium increases the amount of gray matter in the brain (i.e., brain cells) of bipolar patients.

Here is an article that talks about this in a bit more detail.

However, if the side effects are just too intolerable for you to imagine a life on your particular medication, that probably means it’s not the right medication for you. I always hope that my patients will be honest with me about how they really feel about the medication—I won’t take it personally if you hate what I prescribed you!  Your doctor should make you feel comfortable to express your opinions about the medications, and you should always discuss with him or her before making any changes or stopping any medications-- to be on the safe side.

Dr. Mednick

Medication Tips!

Having bipolar disorder means that you probably have to take medications every day, which can be hard to remember and stay on top of!

Those day-of-the-week medication boxes from the drugstore are really useful! If you take more than one medication per day, it's much easier to fill the box once a week than to open several bottles every day. And if you're prone to forgetting your medications, it's easy to look back later in the day to see if you missed a dose! Remember to discuss with your doctor how often you remember to take your medication, even if you tend to forget! It's important for your doctor to know.

If you take medications from doctors other than your psychiatrist, it's really important to let your psychiatrist know!  

Medications can interact with each other in your body and change how effective they are - you could take your medication as prescribed, and it could be less effective, or too much for you!

Avoid those situations by keeping a list with you, in your wallet or purse, with your medication names, doses and how often you take them, something like this:

Lisa Smith
Aspirin, 81mg, one tablet daily

Those medication names can be hard to remember off the top of your head, so avoid all of that by keeping a list!

Medication Non-compliance is Frustrating For You and Me!

One of the most frustrating situations a clinician encounters is dealing with a client who is habitually non-compliant with their medications.

It's frustrating for me as a clinician because when someone is non-compliant with their medications, they put

 themselves at risk for relapse, decompensation, and possibly hospitalization. I spend a lot of time talking to my patients about medications options, alternatives, and side effects. After spending all of this time with them, I feel cheated when they start to become symptomatic because they didn't take their medications the way I prescribed them. Sometimes patients are honest with me about not taking their medications, other times I find out about their non-compliance when I get the results of their blood work.

Non-compliance comes in several forms:

• Failing to fill the prescription.
• Forgetting or choosing not to take the medication.
  
• Taking a dose that is too high or too low.
  
• Taking the medication at the wrong time of day.
  
• Taking the drug only when feeling symptomatic.

Some common reasons for non-compliance are:

• Unpleasant side-effects from the medication.
• Not wanting the medication to interfere with the "high" when starting a manic cycle.
  
• Feeling that because the symptoms have subsided, there's no need for medication.
  
• Difficulty accepting that bipolar disorder is a chronic illness.
  

The often neglected medicine cabinet

Not taking medication as instructed is one of the most common factors in relapse of the illness. Sometimes people with bipolar disorder don't comply with their treatment because they do not understand the chronic nature of their illness, and sometimes, family members don't understand the illness either.



Your doctor is one of your closest allies in dealing with your illness. Your doctor's goal is to keep you well, and to help you get the most out of life that you can. If you don't like the medications you've been prescribed, or you don't understand why you need to take the medications, the best thing to do is to set up an appointment with your doctor to talk about these issues. Give your doctor the opportunity to help you make to make the best choices concerning the treatment of your bipolar disorder.

Medication Adherence

Working with patients over the last several years has taught be that while the medications that we prescribe on a daily basis have many positive effects they also can be harmful when taken erratically.

Not taking your medication regularly or taking too much at times (doubling or tripling up when you've missed a dose) can have severe side repercussions.

The fact is that we live in an imperfect world where we are constantly finding new effects of commonly used drugs.

Careful monitoring is an essential part of good clinician practice. While doctors have the responsibility to check in with patients about possible side effects and educating them on potential risks/benefits/ and alternatives of medications, it is also the responsibility of the patient to be compliant with medications.

Keeping a medication alarm has been a tip that I have heard from a few patients that prevents them from missing doses as well as sets a routine.     

                                                              
Also carrying a small number of pills in your bag or purse ensures that if by chance you're unable to get home, you can also take your medications on time.