When you’re changing medications, it becomes very clear how much bipolar medication changes suck. Being on the first one(s) sucks and changing to the next one(s) sucks, too. And people not on medication may not get this. They may not get what it’s like to have to take medication for bipolar and they certainly may not get why bipolar medication changes suck.

I have always said bipolar medications cannot make you less intelligent. Now, I’m not saying they can’t impact how you think or your speed of thought and so on, what I’ve always said is that bipolar medications can’t actually harm your intelligence quotient (IQ). All that being said, a new medication I’m on, sure makes me feel stupid. The question is, what to do when bipolar medications make you seem less intelligent?

The idea that bipolar medication side effects suck is not a new idea. I am not the first person to mention this nugget. This is something every person with bipolar disorder who is on medication knows. In fact, when it comes to every medication, side effects suck. The reason why bipolar medications stand out for me is, of course, I take them, but not only that, they are medications that most of us have to take for the rest of our lives. When bipolar medication side effects suck, they suck for a very, very long time, so why take bipolar medications?

Let’s face it, side effects happen to almost everyone who takes medication for bipolar disorder. Bipolar medication side effects can range from annoying, to painful, to downright intolerable. But how does one deal with bipolar medication side effects?

As many of you have heard by now, the drug ketamine is being investigated as an antidepressant. Yes, the drug known on the street as “Special K” causing it’s users to fall into a “k-hole” is being researched for clinical, antidepressant use. Ketamine has shown promise both in unipolar and bipolar depression. There are many problems with ketamine, though, not the least of which being that it’s a scheduled substance in the United States and thus very hard to get your hands on. It can be done but it’s awfully pricey. There are also substantial side effects like hallucinations to worry about. (Ketamine is typically used as an anaesthetic in medicine.) Luckily, there is a chemical cousin of ketamine on the horizon that appears to work in a similar way to ketamine but without all the unfortunate side effects.

  People with bipolar disorder, regardless of medication, are, on average, heavier than the average person. This is likely due to sedentary lifestyles and poor dietary choices due, in part, to reduced income. I suspect it’s also because of untreated and undertreated people exhibiting major depression and never getting off the couch (something I know a lot about). But then, of course, there are the side effects from medication and one of the big ones that effects people drastically is weight gain. Antipsychotics, in particular, can make a person put on a lot of weight and fast. (Tip: the antipsychotic that was newly approved in bipolar disorder, lurasidone, has been shown to be weight-neutral.) And while many people work very hard to try to lose it, the fact of the matter is, most can’t. Losing weight is something that is tough in the average population let alone in a medicated one. So sometimes, acceptance is the only answer.

In bipolar disorder comorbid conditions (conditions that occur alongside the bipolar disorder) are more the rule than the exception. In the video I discuss the psychiatric and non-psychiatric conditions that commonly occur alongside bipolar disorder.

In psychiatric studies, generally response and remission are recorded for the effectiveness of medications. So, a certain percentage of people positively respond to medications (get somewhat better) and a smaller percentage of people go into remission (get mostly better) from medications. The definitions of “respond” and “remit” vary, but typically it’s a reduction in symptoms, as measured on a scale, to a specified degree. In practice, this means that a medication can still be deemed “effective” even if it only moves you from a 10 to a 5 on a scale of depression. Well, this isn’t good enough.

Today I tuned into a webcast on managing bipolar depression. I wasn’t sure what to expect although I was aware the webcast was designed for doctors so I knew the level of discourse would be high. And I must say it was a great hour. Granted, I knew the vast majority of what was being presented but the nuggets of new items here and there definitely made it worthwhile. What’s more is that this view on managing bipolar depression is evidence-based and they present the numbers behind what’s recommended. They make clear which studies are drug company-funded and which are not. It’s the kind of information that I wish every doctor knew. And, if you have bipolar, especially bipolar depression, it’s the kind of information you should know too.

Recently I went through a nasty bipolar medication change. I stopped one antipsychotic in favour of another. Of course, this was to improve my overall treatment. And as I’ve said before, if you change nothing then nothing changes, and in this case, I had to change medications in the hopes of changing my mental wellness. It did not go well. What ended up happening was a gradual slide into horrific suicidality. The new med was not effective for me. But I learned something from this experience. Before changing bipolar medications, it’s a good idea to put into place a medication change safety plan.