To understand when your bipolar medications work well and when you might need a change, it helps to keep track of your symptoms and side effects.
Your Symptoms Aren’t Getting BetterIn a perfect world, your bipolar medications would work immediately, but in reality, your body can take time to respond fully to a new drug.
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If your mood symptoms keep going strong after several weeks, or you don’t see any improvement in your daily functioning, the medication at its current dose may not be effective for you and may need to be adjusted, says Christina Lee, MD, a psychiatrist and the medical director of mental health services at Kaiser Permanente in Baltimore.
“Or if you’re already on the maximum dose, that would be an indicator that it should be changed,” says Dr. Lee. “Many people with bipolar disorder need to take a mood stabilizer every day, and it can take trying several medicines to find the best combination.”
You may not always know if your symptoms have improved, but your provider and loved ones can help you figure it out, says Charles “Ken” Dunham, MD, a psychiatrist in private practice in Virginia Beach and the executive director of medical operations for behavioral health at Sentara Health. For example, “very often, a patient doesn’t see themselves getting better, but the spouse does notice,” says Dr. Dunham, who recommends getting a loved one’s opinion before considering a medication change.
Side Effects Become UnmanageableSide effects offer another sign that you may need a medication switch.
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All bipolar medications come with side effects, but if their negative symptoms outweigh their benefit, let your provider know.“Common early side effects include sedation, gastrointestinal upset, tremor, and [weight gain],” says Dunham. Most bipolar medications also cause drowsiness, and many can prompt uncontrollable movements (extrapyramidal symptoms).
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Atypical antipsychotics increase your risk of high blood sugar and cholesterol, and lithium can cause a variety of side effects, including heart problems, kidney problems, changes in thyroid function, and confusion, among others.
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Many side effects resolve within a few weeks, says Lee. “Mild issues like feeling dizzy or sleepy, or having an upset stomach, often improve as your body adjusts.” But if those symptoms don’t fade after several weeks, your medication may not be a good fit, says Lee.
Tracking side effects requires a good relationship with your psychiatrist, so you can voice your concerns and weigh the risks and benefits of your medication, says Suraj Modi, MD, a child and adolescent psychiatrist with Orlando Health Medical Group Behavioral Health in Florida.
You Have Significant Breakthrough Symptoms
If you have frequent breakthrough symptoms — like mania or depression — your medication or dose may need a change, says Dr. Hurd.
Mood episodes can happen when you have bipolar disorder, even if your medication typically works well.
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But frequent manic, hypomanic, or depressive episodes can increase your risk for suicide, decreased daily function, challenges with employment, and social withdrawal, which highlights the importance of treatment change when needed.
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You may not have to change medications — just the dose, says Hurd. “Some patients may have control of some symptoms on medications, and that often means a dose adjustment is needed because of a partial but not full response,” she says.