Why your bipolar treatment may include multiple medications — and how to ensure each one still makes sense.
Key Takeaways
- Medication changes are common with bipolar disorder, especially after a mood episode or hospital stay.
- Ask your treatment team whether each medication is still needed and how it fits into your care.
- Watch for concerns such as sedation, interactions, irritability, or mood changes.
- Don’t stop or change medication on your own. If you have concerns, ask questions or consider a second opinion.
Managing medications for a chronic condition like bipolar disorder often involves adjustments over several years. It’s common to take medications from several different classes to maintain stability. For example, you might use an antipsychotic added during an acute episode of mania, a mixed state, or depression, or for longer-term management of symptoms.
You may also have an antianxiety medication added at a time of particular stress, an antidepressant added during a substantial challenge with depression, or a mood stabilizer as a mainstay and preventive strategy to keep episodes at bay.
While combining medications can help manage complex mood patterns, there are also risks to consider.
At regular intervals, it is wise to review the overall medication management plan and simply ask: “Are we on the right track?” This is particularly important if you’re taking multiple medications from several classes on a regular basis.
Why New Medications Are Added in the Hospital
During hospitalization, there is pressure to find solutions to immediate concerns. Adding a new medication that helps, even in the short term, is common. Yet existing medications are often continued. The result is a plethora of medications upon discharge. While your outpatient team will often touch base to ensure renewal prescriptions are in place, they may not have sufficient time for a comprehensive review of the overall treatment plan and strategy.
Do I Really Need All These Medications?
The management of bipolar, as with any medical condition, involves a collaboration between you, your family, and your healthcare team. A successful strategy combines the care team’s expertise with your engagement to form a therapeutic alliance that manages the illness over time.
Your questions to the treatment team can be straightforward: “Why am I taking medication “x”? What are the risks and benefits?”
Occasionally, one medication may interfere with the metabolism of another, so be sure to ask about interactions. Age is also a factor, as older individuals are often more sensitive to medications, and too many medications can cause confusion and delirium.
What Else Should I Ask My Treatment Team About?
As you review your treatment strategy with your providers, it’s helpful to know not only if all the medications you’re taking are necessary, but also whether any could be causing problems.
Antipsychotic medications can be a lifesaver during an acute manic or depressive episode, and continued use of this class of medications can be highly successful in ongoing care and maintenance. But if the doses are kept too high or if you’re taking more than one medication from this class, the result can be over-sedation.
RELATED: 6 Things I Didn’t Realize About Taking Antipsychotics
The use of antidepressants requires caution, as these may cause unstable moods or irritability or precipitate an episode of mania. The use of stimulants, likewise, may cause mood instability. The mainstay of living well with bipolar disorder is mood stabilization, and there are many medication options available to discuss with your treatment team.
How Can I Learn More About Medication Management?
These days, it’s easier than ever to stay informed. Two authoritative and credible websites I can recommend are the Canadian Network for Mood and Anxiety Treatments and the National Institute of Mental Health.
If you have a question for your treatment team, write it down and ask it early in the appointment to allow time for discussion. Don’t be shy about asking for clarification or advice.
What if I Don’t Agree With My Doctor?
If you have a disagreement with your providers, ask them to explain their recommendations. It’s often a good idea to ask for a second opinion. It’s not a good idea to do something (e.g., stop medication) on your own — but if you do make a change, always inform your treatment team.
UPDATED: Originally printed as “Ask the Doctor: Medication Management,” Fall 2020
