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Feeling Like a Guinea Pig?

Posted on October 24, 2007 by Dr. Fink

When you begin seeing a psychiatrist (or any physician who manages your bipolar medication), you may begin to feel like a guinea pig. Your doctor tries one medication after another to see which one works and which one doesn’t, which one produces the least annoying side effects, and which medications seem to get along best with one another when you’re taking multiple medications. You may begin to wonder whether you are the first person on the planet who’s been diagnosed with bipolar disorder. Shouldn’t the medical community know by now what works and what doesn’t?!

Due to the nature of bipolar disorder, prescribing the right medication or combination of medications is not so easy. Your doctor may begin by prescribing lithium—the gold standard for buffering mood episodes, particularly mania, but if lithium doesn’t work, stops working, or triggers side effects you can’t tolerate, then you doctor may need to try other options.

Grasping the medication treatment goals

Once your doctor has diagnosed you as having bipolar disorder, he or she has three goals to achieve through medications:

Alleviate symptoms—mania, depression, or both
Maintain mood stability
Treat other symptoms, such as anxiety or insomnia

Understanding the challenges

Although the medication treatment goals seem straightforward enough, several factors make it difficult to prescribe the right medication or combination of medications. Researchers have not yet identified a single cause of bipolar disorder, and the fact that it affects both “poles” of a person’s mood continuum means that your doctor must try to treat the mania without worsening the depression and vice versa. Here are some of the major challenges in prescribing the right medications:

Symptoms differ among patients. One patient may feel hopeless and lethargic while another complains of racing thoughts and sleeplessness and a third experiences severe irritability.
Patients can have more than one disorder. A patient who has ADHD (attention-deficit hyperactivity disorder) in addition to bipolar disorder may require additional medications to treat the ADHD symptoms.
Each medication treats only specific symptoms. No single medication has been proven to effectively alleviate both mania and depression and in all patients. Some medications treat only the mania, while others are more effective in treating depression.
Patients respond differently to the same medications. A medication that works for one patient may not work for another or may even make the symptoms worse.
Side effects may be intolerable. Some medications can produce undesirable side effects that certain patients find intolerable, such as excessive weight gain, muscle aches, or grogginess. See “Managing Bipolar Medication Side Effects.”
Medications can aggravate symptoms. Some antidepressants, for example, can induce mania or increase anxiety.

Unfortunately, prescribing the right medication or combination of medications often requires some trial and error, which understandably can make you feel like a guinea pig. By remaining in close contact with your doctor and describing the effects (and side effects) that the medication has on you, the two of you can team up to potentially improve the outcome and expedite your treatment.

Tip: Keep a medication journal to track the effects of different medications. Jot down the medication name and dose, when you take it, how you feel, and any negative side effects you notice. This can be a valuable tool in helping your doctor make the right medication adjustments.

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