Bipolar Medication Mindfulness

[David Baxter PhD]

Note: Taking medications regularly and properly as prescribed is important for any medical or mental health condition, but it is especially important with bipolar disorder. The mood swings and emotional instability characteristic of bipolar disorder is bad enough without adding inconsistency in your medications into the mix.

Bipolar Medication Mindfulness
By Candida Fink, MD , Bipolar Beat
March 3, 2017

Living with bipolar disorder often means taking medications regularly. That alone is a tough pill to swallow. Finding the right medicine ?cocktail? often involves a month (or longer) journey of trials and adjustments. But once you find the right medicine and dose(s), taking your medication every day, as prescribed, drives the recovery and mood maintenance engines. Missing medicine or taking it at wildly different times each day makes it hard for the medicine to do its job and for you and your doctor to get a clear picture of what?s working, what?s not, and which medication may be causing undesirable side effects.

Coming to terms with taking medication daily and remembering to take it every day is not easy, especially when starting a new medicine. Building a new routine into your day takes practice. It?s even harder if you take medicine more than once a day. Some simple steps can be very helpful in keeping you on track with your medications, allowing the medicine to be as effective as possible and reducing potential problems from missed doses.

These steps start at the doctor?s office and follow you home.

Before you leave the doctor?s office

• Understand names and doses of your medications.
• Be sure you understand any titrations or tapers ? exactly how and when you are supposed to increase or decrease doses of a medicine.
• Be clear on the timing for your medicines ? when to take and how long to wait between doses.
• Ask about special instructions:
  • Should I take this with food or on an empty stomach?
  • Is this okay to take with coffee/tea?
  • Is it okay for me to drink alcohol with this med? If yes, how much is okay?
  • What if I need a cold medicine or pain reliever ? are these okay?
  • Do I need to avoid any supplements or over the counter (OTC) medicines?
  • Are there certain foods I need to avoid?
• Ask your doc to give you a written sheet of instructions with these details- there is a lot to remember and more than will be on the medicine bottle. She can give you more details this way, and you have something to remind you of what she said.
• Ask your doctor to put her contact information on that sheet. Know how to reach her if you have questions or concerns about medicine.
• Take a picture of this sheet of instructions in case you lose it. And/or ask your doc to email you a copy.

At home

• Use a medication box that you fill each week. This keeps track of the medicines and lets you know if you missed a dose.
• Use a separate medication box for each time of day ? a morning box and an evening box, for example.
• Keep your medication box near something you do every day. Put it next to the coffee maker or your toothbrush, your phone, or where you charge your phone.
• Use your phone/computer/tablet to set alarms to remind you.
• Change your phone alarm sound every week or so; otherwise your brain may get used to the sound and ignore it.
• Go old-school and put sticky notes on your bathroom mirror, fridge door, coffee maker (can you tell I like coffee?).
• Keep a backup medication box in your car, purse, backpack, or briefcase.
• Recruit friends or family members to remind you or double check that you took meds (assuming you can find medication buddies who are competent without being overbearing).
• Consider using a medication reminder app on your phone. Some apps will text you and won?t stop texting until you have acknowledged taking your medicine. Some can text both you and your medication buddy(ies).

Remember that what works for someone else may not work for you. And you may have to try different strategies to find the best solution for you. Think of this as an active process that will need to change and adjust over time. Communicating with your doc is most important, and she may well have some other techniques and tips about medication mindfulness. If you continue to have trouble remembering to take your medicine, don?t be afraid to let your doc know! She may decide to make changes on her end ? the med, the dose, the timing ? that can help you. But she can?t make those changes unless she knows you are struggling.

 

[Clancey]

You know David, I have heard that it is traditional for Bipolars to mess with, or titrate their own "cocktail." The prescriber uses a standard that isn't true for everyone. I started Lithium in 2006 and was very good about taking it faithfully for several years. At the start of 2017, I was in a severe depression and begging for an anti-depressant. The prescriber declined my request out of fear that I would ascend into mania. (Stands to reason.) However, I wasn't getting any relief. I stopped taking lithium and climbed into a beautiful hypomania. The problem was I kept climbing.

I caught myself at the point where I was focusing on conspiracy theories which for me is a trigger, or enlightenment that I have gone too far in the opposite direction. I found myself decreasing and increasing lithium, trying to stay close to hypomania. I had a long talk with the prescriber who now allows me to adjust it with the promise that I take a minimum dosage each day and agree to blood work more often.

Is it the right way? I don't know, but lithium pulls me downward and when I am in a cyclic depression, it compounds the affect on the mood. I am curious to know if anyone else has tried adjusting their meds based on their moods and trigger points and how they know when they have gone too far, one way or the other.

 

[David Baxter PhD]

It is always best to consult fully and regularly with your physicians if you're considering titrating medication doses. To be blunt, it is not wise to trust your own judgement with bipolar disorder. The lure of hypomania or mania can be pretty powerful and it's easy to forget how transient that can be or to forget that a hypomanic or manic phase is always, ALWAYS going to be followed by a significant to severe crash sooner or later. And at times, self-awareness and insight (anosognosia) may be significantly impaired.

It is true that for some bipolar individuals, there may be a need to titrate some of the prescribed medications up or down as you proceed through cycles, seasonal or otherwise. But it needs to be done gradually and with full awareness of the consequences, and for that reason you should ALWAYS involve your mental health practitioners in the process. NEVER try to do it alone for the reasons stated above.

 

[Clancey]

Have you seen the movie "Mr. Jones" with Richard Gere and Lena Olin? It is one of the best I have seen at illustrating the extremes of Bipolar. It shows the dangers you caution about, David. It is very well done.

 

[David Baxter PhD]

Actually, I have that movie but haven't watched it yet. I'll add it to my to-do list.

 

[Banned]

This article resonates with me. As someone with bipolar disorder, I find the hardest part of managing my illness is staying on my medication as prescribed.

Thanks for the excellent article, David.

 

[Clancey]

Mr. Jones is a typical Hollywood production complete with a love affair, but whoever wrote the story had a good grasp of Bipolar Disorder.

For me, the danger isn't in the crash as much as in the escalation into full blown mania. It's there that my thinking is completely off and I have the fortitude (so to speak) to do the unthinkable.

Getting back to medication, your advice "to change at a gradual pace" is truly warranted, however not always observed. I can't standardize the necessary titration, as it changes depending on circumstance. It would be great to say, "Oh, I'm in a depression now I can take xyz mg, instead of my normal dose." Wish I could.

It's a very frustrating disorder, but fortunately for me lithium is very forgiving. The other meds I take are not, so I can't vary them. This is the first year that it has really been an issue.

I wonder how much people and the disorder change over time. I remember reading somewhere that the affects of Bipolar decrease as you get older. Not sure about that.

Anyway, I think it was great that you shared the article.

 

[David Baxter PhD]

Getting back to medication, your advice "to change at a gradual pace" is truly warranted, however not always observed. I can't standardize the necessary titration, as it changes depending on circumstance. It would be great to say, "Oh, I'm in a depression now I can take xyz mg, instead of my normal dose." Wish I could.

It's a very frustrating disorder, but fortunately for me lithium is very forgiving. The other meds I take are not, so I can't vary them. This is the first year that it has really been an issue.

What are those other medications, if I may ask?

I wonder how much people and the disorder change over time. I remember reading somewhere that the affects of Bipolar decrease as you get older. Not sure about that.

I don't think the pattern is that linear or that simple for many people and it seems to vary greatly from one person to another. For some, it seems to be more like waves and there may be long periods of relative stability between the waves. For others, the cycles can be quite short. But I don't think that for most the changes are age related.

 

[Clancey]

One is directly prescribed for Bipolar, Seroquel. Which for me induces sleep and cutting back translates to less sleep. The others affect indirectly. Losartin for blood pressure has to be taken at the same dose and Lipitor which is a statin drug for high cholesterol but has a side affect of sleep. I've eliminated just about everything else.

Seroquel was introduced along with an aggressive marketing plan. For me, it allowed me to let go of other sleep inducing preparations such as cold medicine that contained harmful amounts of Tylenol. Of course alcohol went by the wayside. There is a concern for long term use called diabetes but seems to apply to those who over eat while taking it.

David, may I ask what you medicate with?

I was so hoping I could out grow (with age) the disorder. lol Perhaps we simply slow down with age. The mind still racing but the body near retirement. That or we just get wiser and do as we are suppose to do, after many years of pushing the envelope, taking unnecessary risks, trying to find the mood that simply cannot be. Not in this lifetime.

 

[David Baxter PhD]

David, may I ask what you medicate with?

I don't have bipolar disorder personally.

 

[Clancey]

That's not what I asked, but I understand, it's a touchy subject. Ahhh, the stigma.

 

[David Baxter PhD]

That's not what I asked, but I understand, it's a touchy subject. Ahhh, the stigma.

No, no. I assumed you were asking about medications for bipolar disorder. It's neither a touchy subject nor a stigma issue, just a misinterpretation of your question.

I founded this forum. I am retired now but I used to be a psychologist.

Personally, I have had two major depressive episodes, one in the 90s and one in the past 2-3 years (which may still be active). Because of my medical conditions (two different cancers treated since 2014 plus some peripheral vascular issues), and chronic anemia over that time span, I still lack energy and stamina and find that I tire easily and need to sleep a lot. I recently discontinued Prozac primarily to see if (a) it might be contributing to ongoing low energy and fatigue, and (b) to see if I still needed it. I'm not yet certain about the answers to either of those questions.

I also take a low dose of clonazepam for anxiety, which I have done for many years.

And... I just accidentally wiped the contents of my iPod so I may need to start taking large amounts of medications on an emergency basis to cope with that unexpected event.

 

[Clancey]

You know David, ever since the world witnessed Hillary Clinton's private server saga I think that people may actually be a little more mindful of what they write online. It has certainly proven to be a danger in many ways. That being said, I certainly felt understanding when you didn't list your medications. I'm not sure why I feel comfortable on this forum, but I always figure that something that I may say, might help someone else. Someone who is afraid to share openly.

Sounds like you have certainly tasted life and the fun of growing older. With your depression it sounds like you could use some of my hypomania. If we could find a way to transfer that, we would both be famous.

The contents of your iPod are still there. Trust me, if it was in the hands of the FBI, they certainly would find it. Perhaps a good computer geek can unlock the mystery.

Thanks David, for being so open. Thank you for this forum and taking a concept and making it happen.

 

[David Baxter PhD]

Yes I retrieved the contents of the iPod, although it did take a bit of doing.

 

[Clancey]

Well, the panic should be over. That's the main reason I have a "Cell phone for dummies." I think it does text, however, I don't play with that.

You know with some medications, when you stop taking them, it is common for the individual to experience the original symptoms for which the medication was prescribed. I know it is that way with the benzodiazepines and some of the anti depressants. I'm not certain about Prozac.