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

KEEP A MOOD DIARY

Keeping a Mood Diary is a very helpful tool for managing your bipolar disorder. It not only helps you track your symptoms on a daily basis, but over time it will help you to see how your mood patterns emerge. 

• It may help you identify the onset of a new mood cycle, and guide you in taking preventative actions.
• Further, a mood diary will make speaking with your doctors easier, because when they ask you how you’ve been doing, your can pull out your mood diary and show them the actual record of how you’ve been doing mentally and physically, over the last few weeks or months.  
• Lastly, a mood diary will help you stay focused on day-to-day coping strategies, as well as long-term life goals. Keeping a mood diary helps you maintain control over your bipolar symptoms, while reminding you that you have life to live outside of your bipolar disorder.

Here are some things you might include in your Mood Diary.

Mood Chart: Create a scale of your daily mood from 1 to 10 with 5-6 being normal, 1 being very severely depressed, and 10 being severely elevated. Next to the numerical value for that day, write some words that describe how you’re feeling that day. Examples include: energized, annoyed, important, full of ideas, talkative, impulsive, spending, sleepy, sleepless, guilty, drained, apathetic, indecisive, inadequate, hopeless, suicidal.

Anxiety Chart: Chart you level of anxiety and/or irritability. Use a scale of 1 to 4 with 1 being not very anxious/irritable, and 4 being severely anxious and irritable.

Events Chart: Make notes of important events in your life. Include joyful events like a birthday celebration, and stressful events like getting reprimanded at work. Also make a note of how your mood that day had a positive or negative impact on that event.

Coping Chart: If you’re experiencing mood symptoms, either depression or elevation, chart something that has helped you cope with these symptoms in the past. Examples include: contacting your doctor or family/friends, identifying the triggers, avoiding drugs and alcohol, maintaining your normal activities, maintaining good sleep habits, identifying any changes in medications that may be impacting your mood.

Sleep Chart: Chart the time you went to sleep, the time you woke, and rate the quality of your sleep on a scale from 1 to 10, with 1 being very poor sleep with frequent awakening, and 10 being very deep sleep with difficulty awakening.

Medication Chart: Keep a record of your current meds and their dosages and whether you took them, forgot to take them, or chose not to take them.

Body Chart: Rate how you feel physically on a scale of 1 to 3, with 1 being feeling bad, 2 being feeling ok, and 3 being feeling good physically. Also write a word that describes how you feel that day. Examples include: sick, sleepy, sore, strung-out, stable, strong, sexy. Record your weight every day, and for women, chart your period.

Goals Chart: Every month set a goal, or continue to pursue an existing goal. Each day write down anything you did that moved your closer, or further away from achieving that goal.

Notes: Be sure to leave a little space at the bottom just for notes that you’d like to remember about that day.