Psychiatric medication ends up becoming a fairly major part of the lives of most mentally ill. There are ways to stimulate chemical production in your mind or simply supplement the shortcomings with medication. I am not a fan of “all natural” approaches or products. Bipolar Disorder is not a new mental illness. There is records of it reaching back further than 500 years to a time when it was referred to as the “Circular Disease”. I'm inclined to think that if there was a natural “cure” that someone would have found it by now. Does that mean you should not use natural means to try and balance yourself out? Not at all. If it works, it works. Getting well is all that matters.
Those of us that do take medication, are contemplating it, or are afraid need a strategy behind their approach. The following is a suggestion based on what I feel to be the most effective way to shore up the shortcomings that plague us in our pursuit. This should not be taken as a medical advice. Always speak to your physician or psychiatrist about any potential changes for your pursuit of wellness. It is impossible for me to know your personal needs, other medical issues, and so forth. The idea behind this strategy is to keep you moving and looking forward even when things are not going well. Meeting your goals is more about tenacity than anything else.
But before we get into the body of the text-
WARNING: Do not, under any circumstance, stop your psychiatric medication suddenly! The sudden change of consistency of the medication in your blood can cause very drastic swings that are commonly beyond what you normally deal with. Side effects? Call your doctor. Can't afford the prescription? Call your doctor. If they don't return your call within a few hours, call again. This is your life and mental health! You do not have much room for error without drastic consequences.
I. Determining Your Medication Goals
I enjoy asking people why they are taking a particular medication. The answers are varied but a pretty common canned response is, “Because I'm”. That's a very vague answer and it's just not good enough. If you don't know why you are taking a medication then how are you supposed to know that it is working for you? The first step in the strategy is to determine your goals for taking the medication. These goals will be based off of how the Disorder affects you specifically. The following is an example based off of myself.
As a Type 2 Bipolar, I experience hypomania with severe depression.
My symptoms when hypomanic are:
- Extreme, irrational anger.
- Erratic thinking, can't chain thoughts together.
- Overly grandiose thinking.
- Cannot sleep more than 4 hours per night.
My symptoms when depressed are:
- Self-destructive thoughts.
- Utter apathy to everything- bills, eating, bathing, friendships, working.
- Mind is lethargic. Every action requires excessive energy.
- Excessive emotional numbing.
If you compare my list of symptoms to what are considered normal indicators, you will notice that it isn't a word for word reproduction. Each of us experiences Depression or Bipolar Disorder in our own way. Now that I have identified how Bipolar Disorder affects me specifically, I can determine what I need my medication to do for me.
I will declare the mood stabilizer successful when the following items are met:
- Escalations should either cease altogether or be manageable.
- I must be able to control my thought processes and not undertake reckless behavior.
- A working mood stabilizer should prevent 4 hour nights without being tired.
I will declare the antidepressant successful when the following items are met:
- I must be able to feel normal emotions. Happiness, not mania. Sadness, not depression.
- My baseline level of thinking should raise to the point that I can be productive.
- There should be no self-destructive thoughts.
- Side effects must be manageable. Trading one debilitating condition for another is NOT a solution.
Looking at the above, I now have a very clear idea of why I am taking medication and what I need it to do for me. It is important to be flexible on some points. You may find a medication that hits a number of your goals but misses one or two. If the misses are things that you can handle then there really isn't a reason to continuously change medications or dosing.
II. Ensuring Your Future Stability
The life of a Bipolar person can be extremely erratic. We can't know the situation we will be in five minutes or five years from now. Therefore, we want to take some precautions to ensure our future stability in regards to our medication.
1. Ask for generic equivalents for your medication.
The pharmaceutical industry does not follow the same methods of traditional retail. When a company develops a medication, they are granted a limited time patent to attempt to recoup the money they spent on development and turn a profit. That is why some medications are hundreds of dollars a month and others are not.
Generic medications are exactly the same chemically and often produced by the same manufacturer after that period of time expires. These medications are typically subsidized by pharmacies and the manufacturers to make them available to a larger demographic of people.
You may be employed and insured now, but what about a year from now? Personally, I've had about 25 jobs. It was never part of my mindset that I would ever have insurance or anything of the sort for an extended period of time. If I lose a job, do I want to be trying to scrape up 300 bucks for medication I need to stay stable? Why do that when you can get generic medications at a lot of major retailers for $4 for a 30 day supply or $10 for 90 days?
If you lose your job or your insurance; you don't need the additional chaos that is going to come with trying to maintain your mental stability in that time period.
2. If you are employed, look into short-term/long-term disability insurance.
Disability insurance is available from a number of different companies. This insurance will issue a monthly payout in the event that a disability, or a matter relating to a disability, prevents you from working. Disability insurance will protect you if your medication needs adjustment, changed, or other drastic circumstance involving the Disorder prevents you from working. Bipolar Disorder is legally defined as a “disability” by the United States government. Any complications thereof are protected under any legalities involving the protection of people with disabilities; such as the Americans with Disabilities Act of 1984. (I apologize to people in other countries that may be reading this. I suggest doing some research to find out how your local government treats these Disorders.)
3. If you are unemployed, check into social services, charity, and manufacturer assistance.
Not a lot of people realize that there is more help out there than just Social Security if you are in dire need of assistance. There are a variety of charities that will help you secure the medication you need from the manufacturer. Quite a few of them specialize in a specific company. Many of those manufacturers also have their own assistance programs in place to assist those living with little to no wage.
I will conclude this section with the following point; it sucks to not be able to afford a house payment, car payment, food, and medication. Many of the manufacturer programs are geared to people that are scraping the bottom. Don't bother wasting your anger if you get turned down. Just keep looking. Yes, it's not fair. Yes, it sucks. Unfortunately, it's the hand we are dealt. Play it as best you can.
III. You, Your Doctor, and Medication
By now, we know what we are hoping to accomplish with our medication and have taken whatever steps are available to ensure we will not have to disrupt it later on. The next step is to consult with your doctor on what you actually want to start with. The choice will generally boil down to your personal health situation and any side effects you cannot live with. (ie. Excessive tiredness for parents, weight gain for people that want to avoid it or with heart conditions.)
If you want to find the right medication -for you-, you need to take full responsibility for the choices surrounding it. You need to make educated choices. I do not recommend asking other people how a medication affected them. This source of misinformation is so common because people do not look at psychiatric medication as they should. Your brain chemistry is as unique to you as your fingerprints. The doctor is only make an educated guess on what she thinks will work. It does not matter if one person had a bad reaction when it helped 10,000 other people. Why? Because there is no medication that does not have some kind of side effect. It all boils down to what you are comfortable with trying and can live with.
A better approach is to just start Googling the medication names. Look for news items, research, or other published studies in reputable places. Be wary of any information gleaned from a website with a product to sell. That kind of information is often written in a way that is not completely dishonest but does leave out important points. It's immoral but not illegal.
Your next best resource is the print out pamphlet that comes with all prescriptions that details all the relevant information of the medication. Look at the side effects and ensure you understand how to identify if they are occurring. You must conquer your fear of what may or may not happen if a serious side effect does occur. Do this by having a clear plan of action on how to handle them. No matter what medication you try, there will be risk. Does the risk outweigh what you deal with day in and day out?
IV. Determine A Clear End For Medication That Is Not Working
I have ran across so many people that have been taking antidepressants or other medications even months after they should have been ruled ineffective. Thus, I recommend setting a clear-cut goal to determine when a medication should be changed at maximum.
Example: The antidepressant I'm taking should be fully functional in my system within 4-6 weeks. If after 6 weeks the symptoms I outlined in my goals are not gone or significantly reduced; it is time to either increase the dosage or try a different medication. Discuss this strategy with your doctor so you can pursue it in a healthy way that will minimize potential unwellness.
Don't screw around with it. Don't wait three months after the fact. Develop a schedule based on how the medication is supposed to take root in your system and function. Taking psychiatric medication is an educated guess at best. The only way you are going to find what works for you is to keep trying different dosages and medications. If the antidepressant is not working after the six weeks that it should be, it's probably not going to be working three months after that at the same dosage. It's just a waste of time.
V. Determining The Effectiveness Of Your Mood Stabilizer (For Bipolars)
There is no greater point of importance than to have a functional mood stabilizer in your system before introducing an antidepressant. Without the mood stabilizer, the antidepressant can rocket you to new extremes in the mania side of the spectrum. It almost never ends well. Therefore, you want to make sure that the mood stabilizer in your system is working as intended and controlling the upper end of the Disorder like it should be.
The following method is what I use on myself to test this. I would like to clarify that this may not be the best approach for everyone, consult with your doctor, loved ones, and the people that provide you support if you decide you agree with the approach.
The only effective way to tell if a mood stabilizer is working is to be in a position that would cause you to escalate. Rather than waiting for however long it will take for those circumstances to come together, I choose to expose myself to my triggers to see how my brain reacts to it once the medication should be working. The movie Unbreakable features a home invasion scene that I could not get out of my head after I saw it. For three months after seeing that movie, I would curl up around my ex-Fiancee in bed and just stare at the front door- waiting. I would stay awake until 6 or 7 in the morning, get up about 10 or 11 in the morning, and repeat. I was hypomanic.
Conversely, that same exFiancee broke up with me after we had finished watching the Simpsons movie. Even though I love the Simpsons, I have only ever seen that movie once because it is so closely tied into my brain with that break up. It is a very drastic, borderline suicidal depressive trigger for me.
If I believe a medication is established in my system, it's time to break out those movies and see how my mind reacts to them. Do I escalate or get depressed? How severe is it compared to what I normally experience? What exactly happens? Anything? If nothing happens, that is a pretty good indicator that the respective medication is functioning correctly.
On the one hand, I'm sure a reasonable person would look at this and go, “Why would you put yourself into a situation to get unwell?” The difference is that I have already informed the people around me what I was doing, have my doctor informed as to what is going on, and I'm testing it in a controlled fashion. The only possible way to tell if a mood stabilizer is controlling the mania is to see if you can be manic. Is it not better to do it in a way that is informed with both eyes open rather than get blindsided by it? To me, I feel it is an acceptable method because the sooner I can determine effectiveness the sooner I can confirm or eliminate the medication from my wellness plans.
If you can determine a better way to approach it for you; great! I'm not suggesting my way is the only way to do things.
VI. Medication Further Down The Road
I once had someone tell me that “Bipolar Disorder is one of the few illnesses that will convince you that you do not have it.” It is a very true point. We start feeling better, feeling good about ourselves, and often forget that we are balanced due to our efforts. It is not uncommon for a Bipolar to stop taking their medication regularly because they feel alright. There are also those among us that only take their psych medication when they are feeling off because it “makes them feel better”. That's a dangerous game to play.
The level of medication in your bloodstream significantly affects your mentality. By taking the medication regularly, you are slowly increasing the presence of it in your bloodstream. That is why it typically takes weeks for the medication to hit a level where it is actually doing something for you. If you do not take it regularly, it will just create spikes in your system. Your body will not handle that intermittent presence well because it will be trying to adapt to what is presently in your system.
To put it another way- the oil system in a car functions the same way as a bloodstream. It is circulated through moving parts of the engine to keep everything moving smoothly. What happens when you run low on oil? The car will start running inefficiently and can overheat. What happens when your car runs out of oil completely? The engine seizes. Optimally, you want to have the appropriate amount of oil in the car. Not too much and not too little lest you wind up doing irreversible damage to the engine. Psych medication very closely mirrors this metaphor, except the engine is your brain and you can't get it rebuilt should it blow up.
When you finally find what works for you, don't fall into a false sense of security. Take your medication so you can maintain your stability. I promise you- it will lash back hard if you take it lightly.
V. Having A Useful Check Up
What is the answer you give your doctor when they ask you how you are doing? Is it “Fine”? Fine is not an answer. It's a dismissive pre-programmed response we are used to using to get other people to shut up and not pry into our minds. Your pursuit of wellness is going to require meaningful answers for your doctor to actually know what is going on with you. Chances are pretty good that you will be on a fairly regular schedule for medication maintenance. It is pretty much required for Bipolars due to the drastic effects some medications can have on us.
That means you should have plenty of time before your appointment to sit down and come up with a meaningful answer. A concise, written list is a great way to communicate what you are going through so you do not forget things in the moment. Include the following, plus whatever you feel is important;
- Concerns about your medication or a side effect you are experiencing.
- Have you been manic or depressed since the last visit?
- What symptoms did you show and how severe were they?
- Have you been taking your medication regularly? If not, note why.
- If you have someone close to you going through it with you- ask them to write their opinion on how you have been since the last visit.
VI. About Lithium...
A person that asks me what I think about a medication will normally come away disappointed. Why? Because it does not matter what I think or what the medication did to me. There is no guarantee that it will mean a damned thing to that person. They need to try it for themselves.
Lithium, however, is a sole exception. A person looking for a mood stabilizer with a good chance of working that is affordable should ask for lithium. It is the single most successful mood stabilizer out there and often used as a benchmark to compare newly developed stabilizers to. The use of lithium in medical applications began in the late 1800's and continues even today.
Now- why would a drug that works effectively for mood stabilization not be a gold standard for doctors to start with? That is a very complicated answer. It's far past the scope of my ability to really understand it and explain it myself. It's easy to say greed or the weight that pharmaceutical companies carry. Employees need paid and research does not conduct itself. I don't really see a point in being angry about a business pushing for profit.
Doctors are human and fallible. They can make stupid, bad, or uninformed decisions like anyone else. Additionally, they are expected to have an encyclopedic knowledge of every injury, ailment, and medication they may come in contact with. It's a pretty safe assumption that not all of them are going to know everything. In fact, none of them will. That is why -you- need to develop a deep understanding of your mental health issues.
Lithium can have serious side effects. Be certain to review them with your doctor in conjunction with your present medical situation. The combination of a high success rate, 10 dollars for a 90 day supply, and a proven track record make lithium a very attractive block in the foundation of mental wellness for a Bipolar.
VII. About Buproprion (generic Wellbutrin)...
I typically advocate to just keep trying medications until one works for you. The only one I tell people to absolutely stay away from is buproprion, the generic equivalent of name brand Wellbutrin. The complaints about the ineffectiveness and harmfulness of the generic are so prevalent that it has inspired at least two FDA investigations in addition to independent inquiries. Visit any pharmaceutical website and you will find page after page of people discussing how this medication did not work or made things worse for them. This is far past the normal scope of people complaining on the internet.
Users report increased suicidal thinking, deeper depression, higher anxiety, and drastic weight gain in addition to a list of other minor things. Generics are the same formula as name brand but for whatever reason, buproprion doesn't function the same. I advise avoiding it until such a time that a competent inquiry comes up with an answer. In one of the FDA inquiries, the data they gathered and used was from users of the 150 mg dose rather than the 300 mg which is where a majority of the complaints are. For those not familiar, they might as well be two entirely different medications.
VIII. An Affirmation...
Finding wellness with medication is a challenge unto its own. You're going to screw up at some point. You're going to forget doses, get frustrated and stop taking the medication, silence yourself and not communicate with your doctor. It happens. We all do it. The important thing is how you address these things when they finally do happen.
You cannot be a passive participant in your pursuit for mental stability. A doctor, therapist, or medication is meaningless without your drive to actually go to the appointments, monitor your moods and side effects, and pick yourself up when you falter. You're human. It will happen. Just make sure you stand back up and keep going. You've made it this far after all.
Wellness is waiting for you. Keep moving forward. Put one foot in front of the other until you reach your destination.