Be Meds Smart

"Be Meds Smart"

By Steven A. Weisblatt, M.D.

Treating someone with bipolar disorder without meds is as primitive as treating a patient with a seizure disorder without medication. If anyone advises you to avoid medication, run, do not walk, away from such dangerous counsel. Although not by any means the only ingredient in a comprehensive strategy to live a life free of any bipolar symptoms, it is an essential and necessary component. What follows are some answers to common questions about medication treatment that may make your path to remission faster and more comfortable:

What is the goal of treatment with meds?

Optimally, the goal is getting rid of all your symptoms over the long-term (remission) while having no adverse effects. Meds may give you partial relief from symptoms within several days or weeks, but full remission can take months or even years of active treatment.

What if my meds don’t work?

If you feel this way, rest assured it’s not usually because your disorder is failing to respond to appropriate treatment. More often, I see the problems as being misdiagnoses, clinicians who may be unfamiliar with specifically helpful combinations of meds and patients who are challenged in their ability or willingness to follow through with treatment.

Aren’t meds dangerous in the long term?

Appropriate medication therapy may be lethal in one patient out of two hundred thousand (the same odds of getting hit by lightening). In contrast, people with untreated or partially-treated bipolar disorder have up to a 25 percent lifetime risk of suicide. Far more have lost years of their lives, jobs, friends and family connections due to ongoing symptoms. It’s a bit of an unreasonable comparison to claim that one doesn’t want to take medication due to the risks, when not taking medication itself increases the risk of suicide – let alone the risk of other losses. Weigh risks and benefits fairly.

Why can’t I just take one medicine?

Don’t assume that a single medicine will do the trick. Lithium therapy alone (at appropriate blood levels for at least six to eight weeks) achieves complete remission in less than forty percent of patients. That doesn’t mean that it should be stopped if you haven’t achieved remission. In fact, a sequential layering approach is often best to maximize beneficial effects and limit adverse effects. Similarly, layering is the current approach to treatments for hypertension, seizures, asthma and diabetes.

Is it ok to miss my meds occasionally?

Compliance is key. Assuming your illness is in remission and you are having no adverse effects, there is little reason to consider altering your treatment, except in certain circumstances of weight change, aging, pregnancy or specific medical treatments. Just as in controlled diabetes, where any change in insulin dose (or missed doses!) is likely to result in instability, the same is true in bipolar disorder. Unlike diabetes, where blood sugar will stabilize quickly when meds are resumed, in bipolar disorders a medication that was previously effective may no longer work.

Do I need to do more than take meds to achieve and stay in remission?

You can do to a lot more! Along with lifestyle changes like Interpersonal Social Rhythm Therapy (IPSRT), exercise, yoga and healthy eating, various supportive individual, family and group psychotherapies are associated with better short- and long-term outcomes.

Do I really have to tell all my clinicians about all the medicines I’m taking?

Absolutely! The reason for this is that there are many effects of non-psychiatric medicines on bipolar disorder (e.g. steroids, antihypertensives, etc.) as well as interactions between other medicines and psychiatric medications that are not necessarily available for review in texts or on the web, but will hopefully be familiar to your clinician. It is critical to avoid nutritional supplements, over-the-counter medications – or even prescribed medications! - until the prescriber has reviewed the new medicine with your psychiatric clinician.

Can I still have a drink from time to time?

That’s a really bad idea. Although unpopular, it is important to abstain completely from alcohol, illegal substances, herbal medicines and even caffeine. These substances can actually make you more ill, in addition to confounding the question of whether or not you can be treated to remission with less medicine. You will be relieved to know that chocolate is still ok!

As always, active treatment requires collaboration between an engaged and informed patient and a psychiatric clinician skilled in the treatment of bipolar disorders. You can increase the odds of being treated properly by being well-informed and actively participating with your clinician at regular appointments.