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Getting Through a Major Medication Change

For many of us who have had bipolar disorder for several years, we may need to undergo a medication change for various reasons.  When you are taking medications over the long term, they may stop working as well as they did initially.  Or a new drug might come out with less side effects and a promise of higher quality of life. 

I am currently undergoing the last steps of a major medication change.  This scared me at first because a previous med change years ago triggered mania followed by depression to such a degree that I had to take 6 months off work. So when my psychiatrist suggested we switch meds again, I was very unsure of how this would affect me. But the promise of better control of my anxiety (which had not been controlled at all on the previous medication) seemed to be worth the risk of the disturbance in my mood that could happen with changing meds again. The new medication also has better control of insulin resistance, which had been exacerbating my other medical problems. I have Polycystic Ovarian Syndrome which can cause infertility, all related to insulin levels. Getting pregnant for my daughter took 6 years of trying various fertility treatments and my husband and I wanted another child. I discussed the medication changes with my husband, who has been my best friend and partner in fighting my illness which kicked in right after we married. We decided that changing meds was best for my health and our family as a whole. 

Like with any big change in the life of a person with bipolar disorder, planning in advance can really make a difference. For myself, with every big life change I have experienced, such as having my first child, planning ahead and making a commitment to stick to my plan got me through the change without a major relapse of my bipolar symptoms. So I knew that if I planned ahead and committed to doing what I have learned works for me in times of stress and change, that I could handle what was coming. 

My psychiatrist knew that previously when changing meds, doing it quickly did not work for me. So we set out a plan to adjust the medication over the course of 4 months by changing from the old one to the new one in small increments. In fact, I am still going through the last few changes and hope to soon be on only the new medication.  I would suggest taking this approach if you and your doctor are considering a medication change. Slow and steady seems to be the best way for myself to manage these changes. Although we are all different, I feel that major changes in our lives that happen quickly can trigger relapse for many of us. 

The biggest problem I encountered is that this new medication does not have the same sedative effects as the old medication.  So I have had to work hard to maintain my sleep schedule.  Going to bed at roughly the same time every night has helped, although life gets in the way and sometimes you stay up later than you know you should. Keeping a consistent routine at bedtime can help. Doing the same bedtime ritual each night helps your body and brain shut down for the night. I try to do my best to stick to my tried and tested routine. 

Almost four months later, I have already seen major results in making this change. The change came at a risk, to be sure, but in the long term I have seen that this was the right choice. I went from having severe social anxiety to almost none, and I have already noticed better control of my insulin levels. I lost weight, and recently became pregnant with our second baby. I am still working out what to do about losing the sedative effects of the previous medication, but overall this change impacted me in such a positive way that I know it was worth it. 

 If you are considering making a major medication change, make sure that you plan it out thoroughly with your doctor, and involve that person in your life that you rely on. Take it slow and remember that if you start to relapse, your doctor can help but only if you are honest with your doctor about your symptoms and how you really feel. Remember that what has worked for you in the past to control your symptoms such as a good sleep routine, proper nutrition, and using the supports you have in your community will help you get through this change. Sometimes we cannot control major changes in our lives but this kind of change, if well thought out and taken on slowly, can be a positive one. 

Comments

Thank you for this. I am finding the conversation around this topic to be either minimal or aggravated. Successful changes can be made and symptoms can be controlled with planning, support and mindfulness. I have been in transition for seven of eight weeks of medication change and titration. I am finding resilience through Yoga and meditation, patience and awareness of symptom changes without judgement - not good, not bad. I stay curious by owning my experiences fully and addressing them quickly. Adding insult to injury by fretting over symptoms that already mimic anxiety can be devastating... and avoided by observing and not reacting, but by responsible responding. Congratulations on your wish coming true for another child, and for your resilience!

I also just went through a med change and it was the hardest thing to do, however my results went from bad to good to worse I'm still working on it. So nice to hear your story.

I so appreciate the above commentary on med changes. So far no changes have been not necessary (4 yrs into treatment) but I admit the reality of a change would really be scary. I am a senior and my evening medication is one that he has mentioned probably wouldn't be the best fit as I age. So happy it worked for you and congrats on the upcoming bouncing baby!

Thanks, I'm going thru it now. But unfortunately for me they did it too fast. I feel like crap. 1 week on hospital now out and trying to cope. doing outpatient treatment but it's tough. A feeling i never had. So bad even my eyesight is blurry. GREAT ADVICE.

Your story was great i am going to be seeing a new doctor March 1. After reading your article you gave me some ideas,

I have been on 17 different meds over a period of 6 years. I have gained 60 pounds to show for. I'm frustrated and disappointed. Better luck to you all.

I just had a major med change done inpatient and then released. Going from a very high dose of anti-depressant, mood stabilizer and anti-psychotic to a lower dose of anti-depressant and next to nothing of a mood stabilizer. I feel horrible...I don't know what to do. Hoping to find answers soon.

Thank you so much for sharing your med change expirence.I'm about to go through one and I'm very scared.you gave me alot of hope.

I have been through it all. Diagnosis, denial, meds with bad side effects, New meds worse side effects, stopping all meds, begging to be put back on, delusional thinking I'm cured, manic episodes & self medicating. I cry when I think about med changes. I've been stable on my current med for about 2 years but my worst fear is hearing the words, "Lets try this." I'm just glad to know you've found method to change that doesn't disrupt your whole life. Thanks for sharing.

I have been on seizure meds for 30 years addicting weaning off that one which I woke up Groggy upping another drug which seems to be helping my sleep but I am feeling a bit dizzy one of the side effects I up my dose on new drug and lower my meds on other drug. I hope in time the side effects will lessen totally different drug one was a sedative the new one blocks it . I just do what I have to for now so I can get through this. Any advice appreciated.

Ahhh yes.. The bipolar med game. I know it well. Allow me to expound:

Stats on me:
Diagnosed BP Type 1 and 2, 2005.

Initial meds in 2005: 5 different ones. Cannot remember all the names.
2018: 2 meds - lithium (600 mg, down from 1500 mg 3 years ago) and lamictal (400mg)

I've had 3 doctors, all men, all who had different personalities, but, in the end, were great guys. I lucked out BIG TIME in that department.

I did call one of them once during a manic episode and blame him for the downfall of humanity using REALLY nasty language, but we kissed and made up. (Thanks, Dr. W. Love ya, man. Happy retirement!)

I just tried to adjust meds again to help mitigate creeping weight gain.

See, back in 2005, I weighed 160 lbs at my lightest. Now, I weigh 290 lbs. I weighed 345 at my heaviest in 2017. So, I went from about 160 to 185 to 200-225. Then after 225, ballooned up to 300 by 2016. Then, up to 345 by April of 2017. And now, after KILLING myself in the gym, I am down to 290.

Meds and stress have taken my weight on a roller coaster for years.

I am 40 now, married, homeowner, own a well-performing business I started and manage, am proud of my mental progress, but ashamed of my weight.

I do what I can to mediate it, but like I tell friends, family, and doctors: don't you DARE even whisper one word to me about gyms and supplements and trainers, OK?

I've spent hours and $15,000 in last few years on it all.

I even checked into the weight loss surgeries. All except the VERY extreme gastric bypass won't have any effects because of the nature of my meds.

Bottom line: For most people with BPD, the MEDS win the battle for your waistline.

The whole "skinny and crazy vs. fat and sane" stereotype is true, so it's time that the medical and fitness community cut out the malarkey, preaching at you about how "diet and exercise" can mitigate the medicines' effects. Yeah, right. Good ole' diet and exercise. I have done so much exercise that I am 40, can bench press 275 lbs, curl a 45 lb dumbbell 12 times in a row for 3 sets, and do 25 push ups and 100 crunches... I just look like I have a damn tire around my waist!

I joked with my doctor once that he and my physical trainer probably refer clients to one another. He didn't deny it.

So, yeah, I get it, you guys. The med/weight game sucks big, fat, donkey bum. Ups and downs, innit?

The themes of the lives of people with BPD are "ups and downs", just trying to find room to breathe in a world of "normal" people who are all so well adjusted and comfortable to destroying one another with words online over what political party they belong to and/or buy blowing each other away with guns in the real world.

I was in Panera the other day, ordering a 400 calorie breakfast (you know, because I am fat so I MUST stuff my face with grease every meal, right?)

Anyways, I am struggling to get my card into the credit card reader because every year that goes by, I lose some hand coordination. The manager, this really cute woman with a bright smile, plaid shirt, and jeans that just really fit her very, very well says to me: "The struggle is real."

She said it with this tone in her voice like it was some universal internet thing, like a meme or whatever. Since I have long since waved "bye-bye" to anything that is cool, I smiled at her and said "What do you mean? Struggle?"

And she just pointed at the whole world around her and said "You know, dude... the struggle."

She had no idea I was bipolar. I was actually having a good energy day that day, so she definitely had no idea. I looked as normal as a white boy with a huge gut and tank-sized shoulders with tattoos all over his arms and a custom bowling shirt with company logo and all on it could that day.

It warmed my heart to see her smile and hear those words.

Yes, wise, gorgeous Panera manager, how right you are. The struggle IS real.

It's just that most people can't see below the surface. She could.

It was a good day after that.

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