How Can I Tell if My Bipolar Medication is Working?

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Reader’s Question

How can you tell if your bipolar meds are working? How can you tell the difference?

Psychologist’s Reply

I can provide some general information, but the provider who prescribed the medication to you is probably in a better position to answer this question for you. You both know the set of symptoms that characterized Bipolar Disorder for you personally and can track the changes over time.

First, a bit of information about bipolar disorder. Bipolar disorder used to be called manic depression, and is characterized by the presence of depressive episodes and at least one manic episode in a person’s lifetime. During the depressive episodes, people with bipolar disorder might find themselves experiencing the symptoms of depression, including sad or irritable mood, fatigue, sleeping more than usual, feeling very slowed down, having difficulty concentrating, and possibly having suicidal thoughts. In contrast, manic episodes typically begin with symptoms of hypomania, in which a person may experience elevated mood and a general sense of well being, social confidence, and increased productivity. Sensuality or increased sexuality may also occur, as well as feeling energetic with less sleep than usual. Hypomania can actually feel pretty good to someone experiencing it; it is not uncommon for people to be unaware of the fact that they are experiencing a hypomanic episode or even want to ‘keep’ these symptoms, as they are not typically experienced as distressing or difficult to the person. Manic symptoms are more severe and can include, in addition to elevated or irritable mood, decreased need for sleep (e.g. 3 hours), uncontrollable speech (pressured or rapid speech), racing thoughts, reckless or impulsive behavior, hypersexuality, and false beliefs (delusions). Delusions can be persecutory (e.g. someone is watching me or out to get me) or grandiose (e.g. I will be chosen by the president for an award due to my special qualities). Medication for bipolar disorder is usually either a mood stabilizer, such as lithium, or an atypical antipsychotic, such as olanzapine (brand name Zyprexa). Sometimes anticonvulsant medications, such as valproic acid (brand name Depakote) are used as mood stabilizers.

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How would you know if your medication was working? This is a great question because it may not be easy to tell. Depending on the medication, it can take a few weeks or even a couple months to build to a therapeutic dose, or for the medicine to take full effect. Even then, the benefit from medication can be difficult to notice. One reason for this is that it is typically harder to identify the absence of something than to notice something happening. With bipolar disorder, medication in part prevents a manic episode or controls symptoms of mania. So what you might notice is that you do not cycle into hypomanic or manic symptoms when you are taking your medication regularly, or that manic episodes are more mild. What would that look like? It might just mean that you are able to live life, do what you need to do, and stay relatively clear of mood cycling.

At times, even on medication, symptoms can occur. Commonly this phenomenon is referred to as having ‘breakthrough’ symptoms. Breakthrough symptoms do not mean that you are taking the wrong medication, necessarily, or that the medication is not working at all. Your psychiatrist can modify medications or dosages or add medication to treat breakthrough symptoms. Trial and error is unfortunately a part of the process of finding the right medication for you.

The irony of medication treatment for this particular disorder is that some symptoms of mania, for example the symptoms of elevated mood, confidence, decreased need for sleep, hypersexuality, and grandiosity, can be enjoyable to the person experiencing them. It is counter-intuitive that the treatment goal is actually to prevent these experiences from occurring, however to the extent that they indicate the onset of mania or lead to behaviors that are reckless or harmful, prevention is beneficial.

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