Very loosely we know that bipolar II is caused partly because of problems with the brain’s neurotransmitters. However, these problems are specific to an individual, so medication becomes a system of trial and error in order to find the best method to manage an individual’s particular symptoms. Julie Fast & John Preston make a true statement when they say, “Each person is an individual and it is impossible to know ahead of time which specific medication will be effective” (p40). Bipolar medications change the brains chemistry and impact the body. There are a number of medications that can be helpful, and knowledge in this area continues to grow.
There are 4 main categories of medications used to treat bipolar disorder: antianxiety medications, antipsychotics, antidepressants, and mood stabilizers. There are a few medications outside these categories that are sometimes used to treat bipolar, but I will not be discussing those in this piece.
Antianxiety medications, or benzodiazepines, are also known as minor tranquilizers. These medications take effect within 30 to 60 minutes, and carry a risk for addiction as well as tolerance development. They are used to treat acute anxiety, agitation, and insomnia during episodes of mania, as well as anxiety disorders like PTSD, panic disorder, and generalized anxiety disorder. Some examples are Lorazepam (Ativan), Clonazepam (Klonopin), Diazapam (Valium), and Alprazolam (Xanax).
Atypical antipsychotics are medications like Zyprexa, Abilify, Seroquel, Risperdal, Geodon, and Saphris. They are called “atypical” to differentiate from the antipsychotics produced in the 1950’s and 1960’s. The 1950 and 1960 antipsychotics managed psychotic symptoms and caused significant side effects. The newer generation atypical antipsychotics are considered safer, and they are tolerated better.
Antidepressants are approved for treating major depression and severe anxiety, panic attacks, and obsessive-compulsive disorder. Examples are Prozac, Paxil, Zoloft, Wellbutrin, and Pristiq to name a few. Antidepressants usually take six weeks to take effect.
Mood Stabilizers/anticonvulsants were originally used to treat epilepsy and were accidentally discovered to have an ability to treat mania. Mood stabilizers are typically the first line of treatment for bipolar disorder. A few examples are Divalproex (Depakote), Carbamazpine (Tegretal), Oxcarbazepine (Trileptal), Lamotrigine (Lamictal), Topiramate (Topomax), and Gabapentin (Neurontin). Lithium is the oldest medication used to treat bipolar, and in 2016 remains the front of the pack for success in managing symptoms. Lithium is used to treat mania and bipolar depression. It takes 7-10 days to begin working and requires blood levels to be monitored regularly.
Pristiq: My Medication Roller Coaster, The Ride through Hell Begins
I talk a bit about my experience starting Pristiq, as well as stopping this medication, in my post “Can I come into the out now.” I talked about how it silenced my mind in a way that for the first time allowed me to realise that my mind had been so noisy. However, by the end I described it in “Can I come into the out now” as follows: “There were days when I laid down on the cool floor, clinging to it and hoping to stop the swaying motion and quiet the zapping. I would lay there and force my body against the floor in an effort to stop the motion and just pray for the end.”
Looking back I realise how distant from my own self I was. The unfortunate result of this medication for me was a zombie effect, a heavy clouding that blanketed all aspects of me. Sadly, it was so mentally heavy that I was unable to lift the blanket enough to peek out or find words to whisper from underneath it for a long time.
A gamut of other things started occurring while I was on this medication: hair loss, my hair turned dull & brittle, my skin went grey & dry, I started getting cyst like pimples along my jaw, weight gain at the very thought of food, and my impulse control was shrinking, my aggression was growing, and the list of negatives goes on.
This just wasn’t the right medication for me.
Top 5 Reasons People Stop or Make Changes to Medications:
- Problems with side effects
- Denial about Bipolar Disorder
- During an Episode (Depressive or Mania/Hypomania)
- Lack an Inclusive Treatment/Support Plan and therefore relay on medication alone
- Negative stigma attached to Bipolar diagnosis
After I flushed the pristiq from my system I decided that I needed to try something more natural. I did some research and I visited a naturopath. It was a great experience. She was able to fix some hormonal imbalances and menstrual problems completely. She also diagnosed some dietary issues I hadn’t even been aware which were causing under laying issues. In terms of managing my anxiety and bipolar II symptoms we weren’t as successful, and any disruption to my schedule would send me spiraling. However, this was still a marked improvement from my rapid up and down, and long downs on the pristiq. The side effects of the pristiq were reversing and I was functioning 3 sometimes 4 out of 7 days a week now.
I used homeopathic medication for several months. It was during a wait period while I tried to get myself a new psychiatrist, one that was supportive of me and my decisions.
There were a number of deciding factors for me with my decision to try prescription medication again. Without getting into all of the deciding factors, I will share one of the bigger factors because it made the most sense and it was the final turning point for me. It was something I was reading that explained when bipolar is properly managed small changes to routine will not cause major upheavals in moods.
Lamotrigine and Me
I held the tiny white pill in the palm of my hand, and I just stared at this sphere shaped white tablet smaller than the head of a pen. For a long time I just stood like that, sort of lost in the struggle between wanting to help myself but fear about the right way to do it. The creases in my palm started to look surreal cupped around that ivory pellet. Then it was just gone.
The change in me wasn’t that scary “bang I feel good” that I woke up with on the pristiq. This was a gradual awareness that I was starting to function in my own person and like my own person again, and I started to slowly feel human again. This happy realization was occurring while the medication was still being adjust and unfortunately my system had other ideas about how this was going to play out.
Side effects started to take hold, and still being fairly new to the world of medication I brushed this aside as just how it is supposed to go. I could live with some acne and cysts, amongst some of the other side effects that were starting to arise. However, what I initial thought was a slight sunburn starting on my chest and back after a dose increase turned out to be a life threatening skin rash. Angry patches of solid red covered large portions of my body, and the areas that didn’t look scarlet were covered with crimson polka-dots. I had a sore throat, my air way was tight and I was using otrivin and Ventolin to breath. Without going into that horrifying episode in detail, I will say it obviously ended well but it was terrifying.
Lamotrigine has a risk for a life threatening skin rash.
Given how things went with the pristiq and then my scare on the lamotrigine I surprised myself by willingly accepting my next trial prescription for Depakote. I had gotten a taste of feeling okay, and remembering what it was like to be myself felt so good that I craved having it back again. Holding on to that desire helped me with my next experience.
With two trial and error periods already mindfully behind me I quickly became aware that Depakote was not helping to stabilize me the way that lamotrigine had. I actually experienced a hypomanic episode while first titrating up on the Depakote. The clincher with this medication though was the hair loss.
I would stand in the shower and cry as handfuls of my hair came out every time I showered. I would have what looked like a small hamster in my hand, and it was just a ball of lost haired. Of all the places that women readily remove hair from their bodies only my head (the one place I want my hair) was suffering this massive hair loss. This type of hair loss is not a side effect, it is an allergic reaction.
When I started topiramate I thought I was going to die of thirst. I couldn’t go to the end of my driveway without taking a water bottle with me. I am happy to say that this leveled off when I stopped increasing the dose at 1 month. Once again though I found myself thinking of the feeling of being me that I experienced on the lamotrigine, and I still wasn’t experiencing that. With side effects at a leveled out point instructions were to titrate up as needed. Unfortunately, titrating up brought aggression and hair loss. Returning back down to the original dose thankfully stopped any aggressive symptoms, but the hair loss was irreversible.
The Way Back to Me
Now what, where does that leave me?
Fast & Preston state that, “It’s important to point out that it’s usually a trade-off between side effects and mood swing reduction” (p4). Unfortunately, 2/3 of bipolar medications cause weight gain. Some other side effects are sleep problems, and sexual side effects. These medications requires an open mind, and a need to be given a chance in order to work. The goal of medication is minimal side effects, and no allergic reactions. The trial and error period can be lengthy. Be future orientated.
“Bipolar disorder medications are among some of the most difficult of all psychiatric medications to prescribe and manage” (p40 Fast & Preston). It is important to note that all side effects have to be listed. What this means is that every side effect that shows up during trials, even if only 1 person in ten thousand experienced the side effect, it legally has to be listed. In relation to that, be aware of where you are gathering your information. Try to avoid gathering information from places that might be sensationalizing it. Mayo clinic is a good site as well as WebMed. I am told that the National Institute of Mental Health is also a good site.
When discussing medication with your doctor be proactive and assertive. It is okay to ask about alternatives if side effects are significant. It is also important to be open minded, and to give a medication a reasonable chance to work.
Please note that in this particular piece my focus is on bipolar medication. I am aware that 35% of people with bipolar have ADHD, and a large % of people with a bipolar diagnosis have a dual diagnosis with anxiety disorders, or substance abuse, and/or some other health issue. However, this piece is about bipolar medication only. In the case of stimulants, it is my understanding that being stabilized on bipolar medication first is important. Again, medication is just one tool for managing bipolar, and is shown to have best results when used in combination with CBT, EMDR, and other tools…
All the best. Stay positive, and take care of you!
By Shari Marshall – 2016
- BP II Disorder Work Book by Stephanie McMurrich Roberts PhD, Louisa Grandin Sylvia PhD, & Noreen A Reilly-Harrington PhD
- Loving Someone with Bipolar Disorder 2nd Ed by Julie A Fast & John D Preston, PhD