1. Stopping Medication When You Feel Better Most importantly: You should never increase, decrease, or stop taking prescribed medications without consulting with your doctor first.e60dc2a1-f33c-4a05-9b50-8e3e8e597629613a9703-d545-4ef1-996a-8fb006b70fd1 Feeling stable for weeks or months at a time, however, can make it seem like medication is unnecessary. In a small study of 179 people, researchers found that in about 12 percent of follow-up assessments, participants with bipolar disorder said that they sometimes skipped medication doses because they were feeling better.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295de37f1a-c2b6-4d0f-8ca2-23d55f933179 It’s one of the most common mistakes people make, says Jonathan Terry, DO , a psychiatrist and the assistant dean of community clinical education at California Health Sciences University College of Osteopathic Medicine in Clovis, California. “Feeling stable is usually a sign the medication is working, not a sign you’re done with it,” Dr. Terry says. “These medications work best when they’re in the system steadily, day in and day out. It’s a lot like blood pressure medication. You don’t feel it working, but it’s doing its job quietly in the background.” Stopping medication abruptly can increase the risk of symptom relapse.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294530e1de-44c4-44a7-acc5-5c2986d9ba08 If you want to stop, talk to your psychiatrist about whether that makes sense for you and how to do it safely, Terry says. “Wanting to come off medication is a real and legitimate conversation to have. Sometimes it’s the right move, but it needs to happen with your psychiatrist,” he says.
4. Keeping Side Effects to Yourself Weight gain , sleepiness, increased thirst, nausea, or tremors may be common medication side effects, but they still deserve a conversation with your doctor.e60dc2a1-f33c-4a05-9b50-8e3e8e59762964ce5287-7c9d-4837-9709-468643fd4349 “Staying quiet is one of the biggest missed opportunities in treatment . I’d much rather hear about a side effect early than have you quietly decide the medication isn’t worth it and stop,” Terry says. Sometimes the symptoms are linked to a medication , but in some situations other factors need to be considered, Peay says. “It may be that you haven’t been sleeping for several days, or that you’ve been drinking a lot of caffeine, or even taking a sleep aid during the daytime,” she says. “We want to know about [side effects], then we’ll ask more questions to see what else could be contributing.” Ask which side effects need urgent care. If you’re taking lithium, confusion, slurred speech, vomiting, or worsening tremors may signal toxicity, so any of these symptoms require immediate medical attention.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291e71be6e-3f3e-47b2-8b23-afa35a11d583 In the case of lamotrigine, a rash, hives , sores in your mouth or around the eyes, and blistering or peeling skin are concerns that require emergency care. Do not wait for a routine appointment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629705a4dfd-ef52-47aa-92a5-1c7aa6f0efc0
6. Not Disclosing Other Medications and Supplements Tell your psychiatrist about every prescription, over-the-counter medicine, vitamin, and supplement you take, including the dosages of each one. Other prescribers also need to know about your bipolar medications too, Peay says.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a5146291-bf0c-490b-b9d6-3f280d34b4f7 That’s because other drugs — including alcohol and nicotine — may prevent bipolar disorder medications from working properly, potentially worsening symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292a9e86ca-64b9-4b92-a0e6-cf6d15f42a56 Nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin), should be avoided when taking lithium, for example.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291e71be6e-3f3e-47b2-8b23-afa35a11d583 “If another doctor doesn’t know what you’re taking, they may prescribe something, not realizing that can cause an interaction ,” Peay says. That includes treatment for conditions that may seem unrelated to your mental health. Keep an updated list of everything you take and check with your pharmacist or prescriber before starting or stopping another medication or supplement, Peay says.
7. Skipping Blood Tests and Follow-Up Appointments Depending on the medication you’re prescribed, your doctor may order baseline health checks, including urine tests, blood tests, and an electrocardiogram , Terry says. But follow-up tests are necessary too. The tests vary, depending on your prescription, age, and heart history. Lithium requires blood tests to measure medication levels, as well as calcium levels and kidney and thyroid function.e60dc2a1-f33c-4a05-9b50-8e3e8e59762977a4bebe-e8d3-4a0e-9c42-ec084074e6b9 If you’re taking quetiapine (Seroquel, Seroquel XR), an antipsychotic, your doctor may order blood tests to check your cholesterol, blood sugar, and hemoglobin A1C, which is a measure of blood sugar over time.e60dc2a1-f33c-4a05-9b50-8e3e8e59762947adf700-0b62-4a22-a60e-169ba15a715f Ask your prescriber which checks you need and how often. Follow-up appointments also give you another opportunity to discuss any mood changes, side effects, or difficulties taking medication. “Follow-up is a real part of these treatments, not an afterthought,” Terry says.
3. Deciding Too Soon That Your Medication Isn’t Working Improvement can take time, depending on your medication and the severity of your symptoms, says Khendra Peay, MD , a psychiatrist and the founder of Capital Area Child and Adolescent Psychiatry in Washington, DC. Some treatments used during a crisis act quickly, while others, like antidepressants and mood stabilizers, can take weeks to work, she says.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915fb51dc-edd4-4971-9786-c971db1abdbc With certain medications, such as lamotrigine (Lamictal, Lamictal XR, Subvenite), your dosage will be increased slowly over several weeks before reaching a therapeutic dose, Terry says.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290d93cac9-435a-4631-8473-8672b5dfd26e Talk to your doctor if you have questions about your prescription — or you’re worried it’s taking too long to take effect. “This is where it’s important, again, to let your doctor know, so that there can be a conversation of what timeline to expect,” Dr. Peay says. And if you’ve been taking a medication as prescribed and have given it a reasonable amount of time to work, talk to your doctor about adjusting the dose or trying something else. “Finding the right medication, dose, or combination is often a process of fine-tuning, not a one-shot deal. Needing to adjust doesn’t mean you’re failing or that treatment won’t work,” Terry says.
Resources We Trust Cleveland Clinic: Bipolar DisorderMayo Clinic: Bipolar Treatment: Are Bipolar I and Bipolar II Treated Differently?American Psychiatric Association: What Are Bipolar Disorders?NYU Langone Health: Medication for Bipolar DisorderMental Health America: Bipolar Disorder
Whether it’s mood stabilizers, antipsychotics, antidepressants, or a combination of those, medication is the cornerstone treatment for bipolar disorder .e60dc2a1-f33c-4a05-9b50-8e3e8e597629a5146291-bf0c-490b-b9d6-3f280d34b4f7 Sticking with treatment isn’t always straightforward: You might encounter disruptive side effects , improvements may take longer than you’d hoped, and feeling better may leave you wondering whether you still need your prescription. Knowing how to handle these challenges if they come up can help you stay on track with managing bipolar disorder. From changing your dose on your own to keeping concerns to yourself, here’s a look at seven common medication mistakes to avoid — and what to do instead.
5. Overlooking Therapy and Self-Care Psychotherapy is often recommended alongside medication, but it’s an underused resource, Peay says.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dcd068df-5543-4f3d-a9a0-4850231fd772e60dc2a1-f33c-4a05-9b50-8e3e8e597629b2c7216f-c992-48d3-a0c4-3c409facf624 Its approach can be tailored to your medical history and current needs. Someone living with bipolar disorder and obsessive-compulsive disorder, for example, may benefit from a different type of therapy than someone whose main concern is depressive episodes or a history of trauma, Peay says. Options include cognitive behavioral therapy , dialectical behavior therapy , family-focused therapy , and acceptance and commitment therapy, among others.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294083c921-dea4-4c8e-90c7-0bf7d039b2b8 Therapy is a helpful checkpoint for both you and the provider handling your medication. You may note patterns in thinking, triggers, symptoms, or side effects during your therapy sessions, Peay says, which you can then share during medication management appointments to help your provider assess how the treatment is going. “It’s a form of [symptom] tracking because there’s someone who’s checking in on a regular basis,” she says. Practicing self-care and building healthy daily routines can support treatment too, Peay says. Tactics like sticking to a regular sleep schedule, limiting alcohol and caffeine, and making time for exercise may be helpful.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295bd00a02-b7aa-46cd-bdd5-8820831928ff Some people with bipolar disorder also make activities like exercise, tai chi, yoga, and relaxation techniques part of their treatment plan.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fcc53a1d-44d6-45d5-8aa6-8faf1b07e306
2. Changing Your Dose or Doubling Up on Your Own If your symptoms worsen, it may be tempting to take more medication to regain control of how you’re feeling. But increasing your dose without consulting with your psychiatrist can also cause problems. “The problem is that more medication isn’t automatically better, and with some of these drugs, it can be genuinely dangerous,” Terry says. He points to lithium (Lithobid) as a prime example: There is a narrow margin between an effective dose and a toxic one, and taking extra can cause serious harm.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f3d7af0-6078-490e-9523-46d39d699eade60dc2a1-f33c-4a05-9b50-8e3e8e5976291e71be6e-3f3e-47b2-8b23-afa35a11d583 Instead of doubling up on doses, tell your doctor about your worsening symptoms. It may indicate that your dose needs adjusting, or it may be an early sign of a mood episode that you can catch quickly, Terry says. Missed doses can happen. If it’s almost time for your next dose, just skip the missed one, because doubling up can cause side effects, Terry says.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fbb10201-8b6a-4b1a-97ea-287c0846b31c “Because the specifics vary by medication, the best move is to ask your psychiatrist or pharmacist ahead of time what to do for your particular prescription, so you already know the plan before it happens,” he says. If forgetting is a pattern for you, use tools like pill organizers, phone reminders, or linking the dose to another daily habit , he says, like always taking your medication with breakfast (if it can be taken with food).
7 Common Mistakes to Avoid When Taking Bipolar Disorder Medication
