Onika L. Dainty

Bipolar I disorder is a mood disorder characterized by extreme highs (hypomanic, manic and psychotic episodes) and extreme lows (depressive episodes). When living with Bipolar I disorder it is necessary to take some form of medication to manage these drastic pendulums of moods otherwise you would be in constant flux between severe illness and short periods of stability. 

My medication journey started over 20 years ago and I have had both ups and downs when trying to find a medication cocktail that works best with my Bipolar disorder. Before I get into more details I would like to add that using medication to manage your Bipolar symptoms is a personal choice. Not everyone agrees with Western medicine and the methods it uses, however for me I have found that currently Bipolar disorder medications speak to my experience with this illness and I take medication daily for my mental health and sustained wellbeing.

There are four classes of medications used to address the various symptoms related to Bipolar disorder:

• Antidepressants: a class of medications used to treat depression and other mental health conditions. They work by increasing the activity of neurotransmitters in the brain. Side effects include-vomiting, diarrhea, weight gain, dry mouth, headaches, anxiety, sedation, tremors, constipation and in some cases thoughts of suicide.  

• Anticonvulsant: also known as anti-seizure medication is a class of medications that prevents or treats seizures and convulsions. They work by controlling abnormal electrical activity in the brain. Side effects include-drowsiness, fatigue, headaches, dizziness, nausea, blurred vision, stomach upset, weight gain or loss; rare but serious side effects include Stevens-Johnson's syndrome, liver failure, psychosis and lupus.

• Mood Stabilizers: a class of medications used to treat mood disturbances, such as Mania and Depression, and to help prevent manic and depressive episodes. They can also help reduce symptoms of Mania, such as rapid mood changes, sleep difficulties, racing thoughts, and risky behaviors. Lithium is the most widely used mood stabilizing drug.Side effects include-itchy skin or rashes, increased thirst, frequent urination, nausea, vomiting, slurred speech, blackouts, changes in vision, seizures, loss of coordination, weight gain, fatigue, headaches, drowsiness, dizziness, impaired memory, difficulty concentrating, hair loss, changes in menstrual cycle.

• Antipsychotics: a class of medication used to treat symptoms of psychosis, such as hallucinations, delusions and disorganized thinking. They work by altering brain chemistry to reduce psychotic symptoms and prevent them from returning. Side effects include-drowsiness, dizziness, dry mouth, blurred vision, tiredness, nausea, constipation, weight gain, trouble sleeping, tremors, stiffness, agitation, fluid retention, sexual problems, headaches, loss of menstrual periods in women, breast tenderness, muscle or nervous system problems. 

My Medication Journey

My medication journey had a rocky start in 2006, after my first manic-psychotic episode. I was given a cocktail of mood stabilizers, anticonvulsants and antipsychotics to stabilize me during what can only be called an extreme first episode. There are what I now call standard side effects like tiredness, drowsiness, tremors, increased appetite and dry mouth, that for me have come with the territory of taking this medication combination. 

However, three weeks after taking an anticonvulsant and mood stabilizer called Epival (Divalproex) I developed a rare and severe side effect called Stevens-Johnson syndrome, a flesh-eating skin disease that affects less than 1% of patients that take it. Once my medical team realized what was happening I was taken off this medication and put on Lithium which remains the main mood stabilizer I take daily. 

My Journey with Weight Gain and Medication

After extensive research and a lot of trial and error I have discovered that there are no Bipolar medications currently available where possible weight gain is not a side effect. For myself, it's the combination of mood stabilizers and antipsychotics that lead to increased appetite and weight gain. Both classes of medications have a weight gain component so when you put them together the likelihood of increased weight is inevitable for me. I have tried almost every combination of medication for my Bipolar and the one side effect that remains constant is gaining weight either an extreme amount (50lbs-80lbs) or a manageable amount (10lbs-15lbs). The only method I’ve found to combat this problematic side effect is being mindful about my diet and incorporating exercise into my daily routine. 

Though I still find it difficult to lose weight I am able to maintain the number I see on the scale. A large part of medication management is self-love, self-acceptance and self-awareness. It was important for me to learn to love the skin I’m  in and not focus on the weight. It's about realizing that in my experiences  the positive effects of taking medication outweigh the negative side effects like weight gain and I have to give myself grace regardless of where the numbers land. Yes, my body isn’t always the size I desire but where would my mind be without the medication? If you are not there yet it’s also important to advocate for yourself with your medical team to find a combination of medications that suit your needs both mentally and physically. I’ve been on this medication journey for a very long time and I’ve realized certain side effects for me come with the territory and I am still learning to accept that. 

My Journey with Medication Non-Compliance

There have been many times on my medication journey where the side effects became so overwhelming I stopped taking my meds all together. Other times I was actually doing well on my medication and I stopped for that very reason–I was doing well and convinced myself I was better and didn’t need them. In either scenario, I had some hard lessons to learn from medication non-compliance. My current reality is I have a severe mood disorder called Bipolar I which means my brain chemistry is imbalanced causing extreme mood swings that go from Hypomania or Mania (high-highs) to Manic-psychosis (losing touch with reality) to Depression (low-lows). 

Without a medication regimen that keeps me balanced my brain is in constant flux between these extreme emotional states. When I take my medication as prescribed and I don’t use other outside substances I can maintain a baseline (stable mood) that allows me to live a full and enriching life. When I am non-compliant with my medication I enter chaos where I can do irreparable damage to my life and the lives of those around me.

Another aspect of medication non-compliance that is rarely discussed is there is no guarantee the medication cocktail that originally stabilized you will work after you have another Bipolar episode due to stopping your meds. Every episode is like a fingerprint, unique in that the physiological and psychological damage that is done is different in every episode and must be treated differently. For example, For seven years my therapeutic Lithium levels created a mood baseline. When I stopped taking my medication I had several manic-psychotic episodes due to a dangerously low Lithium level.  After hospitalization when Lithium was reintroduced to my system doctors had to give me the highest level of the medication for a longer period of time to stabilize me. Essentially, this process changed my Bipolar I disorder mood baseline.

Final Thoughts

 I used to take a handful of prescribed pills a day to manage my illness, swallowing them all was excruciating. I would look at them and say to myself “Only for now, not forever.” What I wasn’t able to see or accept until now was that medication will probably always be a part of my mental health journey but through  self-advocacy and determination I have worked with my medical team to cut my daily medication intake down by more than half which is much easier to swallow. By practicing self-compassion, self-love and self-acceptance I’m learning that side effects like weight gain are simply a trade off for stability not a character deficit or personal failure.

Like almost all things in life, taking medication to manage your mental illness is a choice. I have chosen to incorporate medication management on my journey to wellness. There are people in my life that are grateful for me staying compliant with my medication regimen and others who are always ready to offer alternative treatments to my Bipolar I disorder. Only you can decide what's right for you. I have experienced life both on and off medication and I prefer to use medication as a tool to enhance my mental health and manage my illness. I am well researched on new and emerging medication options for Bipolar disorder and I speak with my pharmacist and psychiatrist regularly about how to continue to have positive experiences through medication and mitigate the negative side effects that cause problems on my journey to better health.

Everyone’s medication journey will look and feel different. The side effects that are a challenge for me may not be a part of your story. That’s why it’s important to have these honest conversations that take us beyond the stigma of taking mental health medications by sharing our trials about the adverse effects these medications have on our mind and body. If you want to share any part of your medication journey  I would love to hear from you, please comment below.  

If you or someone you know is on a mental health medication journey speak with your pharmacist to discover what’s new in the mental health medication world that can help you find a cocktail that suits your unique needs.Remember, you are not alone, so let’s continue the conversation in hopes of fostering hope, change and understanding on our path to wellness.