Treating bipolar disorder can be challenging. Medications that might help someone manage mania (the highs of bipolar disorder) may not be the most effective when it comes to depression (the lows of bipolar disorder).
Sometimes, medications may help improve bipolar symptoms a bit, but not completely. And many common bipolar disorder medications come with their own unwanted side effects.
The result is that a person with bipolar disorder can end up on more than one medication to manage the ups and downs of their condition, and they may experience side effects from each medication as well as some symptoms of their condition.
This is frustrating and can understandably leave someone feeling hopeless about medication. In my experience as a psychiatrist, it’s this frustration and hopelessness — rather than any single side effect — that causes some people to either abruptly stop taking their medication or take their medication infrequently and not as prescribed.
But both of these decisions can be dangerous and cause a new, additional set of problems, such as rebound symptoms and potentially fatal reactions.
Here are the five most common frustrations I hear when it comes to bipolar medications — as well as safer alternatives to just stopping your medication altogether.
Frustration 1: “Please, Just Don’t Make Me Depressed.”
Although most people associate bipolar disorder with mania, it’s often the depression that impacts people living with this condition the most. In fact, most people with bipolar disorder spend the majority of their illness time in a depressive episode, rather than a manic episode, according to research published in the journal Bipolar Disorders.
Many well-established treatments for bipolar disorder, such as lithium, have good evidence for the treatment and prevention of mania but are less effective at treating bipolar depression. And unfortunately, most of the medications we turn to for depression come with caveats in the treatment of bipolar depression. For instance, antidepressants can potentially induce mania or psychosis in people with bipolar disorder.
This struggle is well known among those who live with this condition. When I discuss treatment options with a patient with symptoms of mania, it’s typical for them to say to me, “Please, just don’t make me depressed.”
This fear of becoming depressed — and the reality of sometimes becoming depressed after being treated for mania — causes some people to stop taking their medication.
Although getting to the middle ground between the highs and lows can be a challenge with treatment, it is achievable over time. But if you abruptly stop taking your medication because you feel a low coming on, you risk starting the cycle all over again.
Instead, be open with your doctor about your treatment goals and why you think your current treatment is not supporting you in those goals. Ask your doctor how they are assessing treatment success and make sure you are both on the same page about what success looks like. This discussion should take place when choosing treatments, both medication and psychotherapy, and in follow-up appointments when determining whether those treatments are helpful for you.
Frustration 2: “I’ve Gained So Much Weight.”
Weight gain is a common side effect of many medications used for bipolar disorder. A review of the metabolic side effects of psychiatric medications, published in October 2020 in Frontiers in Endocrinology, found that the majority of people prescribed lithium, valproic acid (Depakene), olanzapine (Zyprexa), and quetiapine (Seroquel) — all commonly used as mood-stabilizing medications — gain weight.
If you are concerned about weight gain, talk to your provider. This same review found that there are some medications — namely lamotrigine (Lamictal), oxcarbazepine (Trileptal), and lurasidone (Latuda) — that are associated with less weight gain.
If you and your doctor decide to switch your treatment, it’s typically best to slowly lower the current medication while adding the other treatment. This can help prevent relapse while switching treatments, so talk to your provider rather than just stopping.
If switching treatments is not a good option for you, either because the treatment you are on is otherwise working well or because one of these other treatments is not appropriate for you, your doctor can still help. They may be able to share nutritional tips for maintaining a healthy weight, provide you with resources, or refer you to a nutritionist or dietitian.
Frustration 3: “I Feel Like a Zombie.”
Feeling foggy, sedated, or out of it is not an uncommon experience when it comes to bipolar medications. I have heard this comment from patients, as well as family members who may be happy that their loved one is no longer experiencing as many symptoms of their illness but are now concerned that they seem less engaged in day-to-day life.
This issue can occur with a range of medications commonly used for bipolar disorder, including mood stabilizers such as lithium and valproic acid, as well as antipsychotic medications used as mood stabilizers, such as olanzapine and quetiapine, among others.
Nobody wants to replace an illness that interferes with everyday life with a side effect that interferes with everyday life, so definitely speak up to your doctor if you’re having this experience. If you just recently started the medication, your doctor may suggest waiting to see if this side effect improves, which can happen. But if it does not improve, a different medication or a lower dose of the same medication may be helpful for you.
Frustration 4: “I Want to Have a Baby.”
Because the usual age when someone first experiences bipolar disorder is before 30 years old, family planning often comes up during treatment. Some people may not want to discuss family planning for a range of reasons and may be tempted to just stop taking their medications abruptly. However, stopping your bipolar medication like this can be dangerous for you, as well as your pregnancy.
Talk to your doctor about your plans and your concerns. You may be pleasantly surprised that the medication you’ve been prescribed is safe to continue during pregnancy, or you may learn the pregnancy risks associated with your medication are very low. Alternatively, you may need to switch medications and can work with your doctor to get on pregnancy-safe medications prior to pregnancy.
If your psychiatrist is not comfortable with managing medications during pregnancy, there are reproductive psychiatrists who specialize in this kind of treatment. If you have a long history with your doctor and don’t want to switch doctors, you can opt to just have a consultation with a reproductive specialist, who can then provide recommendations to your doctor.
The most important thing to know is that there are many options for having a healthy pregnancy while being diagnosed with bipolar disorder. The first step is talking to your doctor so they can describe all of the risks and benefits of each option. Together you can find the right solution for you.
Frustration 5: “What Will This Do to Me in the Long Term?”
Sometimes, a certain medication works great for someone. They experience a long period of time where they’re symptom-free and don’t experience any unmanageable side effects. Still, they may be tempted to stop taking the medication out of concern for how the medication will impact them in the long term.
This can especially come up with lithium, which can be highly effective in treating bipolar disorder but is known to impact the thyroid and kidneys over time. Lithium most commonly causes hypothyroidism and goiter, or an enlargement of the thyroid. Lithium can also cause kidney damage, as well as a condition called diabetes insipidus, which happens when your kidneys stop responding to a specific hormone — called antidiuretic hormone — like they normally do, causing excessive urination and thirst.
The truth is, for some relatively newer bipolar disorder treatments, we don’t yet know all of their long-term side effects. This is important to know, discuss with your doctor, and consider when choosing a treatment.
For a treatment like lithium, which is more well established for bipolar disorder, the long-term impact is better known. Your doctor will continue to monitor your lithium levels, your kidney function, and your thyroid function while taking the medication. If an issue arises, you can discuss with your doctor whether to lower the dose of medication, switch medications, or manage the side effect while continuing lithium treatment.
Ultimately, it’s also important to weigh the long-term risks associated with any bipolar disorder medication with the long-term risks associated with untreated bipolar disorder. If you and your doctor agree that trying to stop treatment is a good option for you, there are safer ways to stop medication, which are typically slow and over time.
The Bottom Line: Don’t Stop Bipolar Disorder Medication on Your Own
Often, it’s not just one of these issues that makes someone stop taking their medication. Rather, it’s the whole frustrating experience of not feeling helped or heard. So if you feel frustrated or unhappy with your bipolar disorder treatment, talk to your doctor.
If you still feel unheard, don’t just stop your medication abruptly or try to manage your medication on your own, because this can be dangerous for you. Abruptly stopping medication can cause a relapse — meaning the return of manic or depressive symptoms after you’ve been well for a while — and a wide variety of other issues, depending on the medication.
Additionally, many medications for bipolar disorder are started at a low dose and slowly increased for a reason. Not only can this help with acclimating to the medication but certain medications, such as lamotrigine and carbamazepine, can cause a rare but serious reaction called Stevens-Johnson syndrome in some people. This is a medical emergency that begins with flu-like symptoms, followed by a painful, blistering rash.
Bipolar medications are started slowly to make sure doctors can properly monitor for these reactions. If medication is just stopped and restarted without properly being increased, it can make you sick.
Instead of abruptly stopping your medications, consider looking for a different doctor who you may have a better relationship with. Treating bipolar disorder can be a challenge, but through a combination of therapy, medication, and lifestyle changes, it can be done. It’s essential to find a provider you feel comfortable discussing all of your concerns with so that you can find the right combination for you at each stage of your life and illness.