With your prescriber’s guidance, small changes to your medication plan can help address early bipolar symptoms, prevent mood shifts, and support stability.
What Should I Know to ‘Tweak’ My Bipolar Medications?
“Tweaking” has taken on a negative connotation in slang, but here it’s used in the sense of “small adjustments.” Tweaking your medications might involve switching to a higher or lower dose of a current medication in response to an immediate concern, or taking an additional medication on a one-time or short-term basis.
This approach can be useful for preempting a mood shift, dealing with heightened anxiety or insomnia, and easing symptoms you know are likely to arise when facing certain stressors.
Understanding Mood Shifts
Everyone has variations in mood and an occasional bad night’s sleep. That’s just life. Those living with bipolar disorder experience more frequent mood shifts and disruptions in sleep because that’s the nature of this brain-based condition.
Sometimes shifts in attitude, energy, and behavior will be temporary fluctuations, but sometimes they may be the first indicators of a disruptive and potentially life-threatening episode of mania or depression. For example, an increasing sense of anger or irritability may be the natural response to an annoying situation, or it may be an early symptom signaling an oncoming mood episode.
When to Call Your Prescriber
When you suspect it’s the latter, it can be a good idea to get in touch with your prescribing practitioner to discuss whether “tweaking” would be warranted. Someone who regularly takes a mood stabilizer in combination with an atypical antipsychotic might benefit from taking an extra amount of the atypical antipsychotic until stability is restored.
Developing a Rescue Medication Strategy
Another option would be to develop a rescue medication strategy (RMS). You and your healthcare provider would pinpoint situations that tend to put you off balance, then identify a rescue medication that can be taken on an as-needed basis. There are many options to consider, including formulations from the benzodiazepine and antipsychotic classes.
The better you know your own patterns and triggers, the more fruitful your planning discussions will be. That knowledge typically comes from experience and observation. Using a mood tracker may show that a bad night’s sleep, interpersonal conflict, or some other stressor habitually results in an unsettled state.
Not only do bouts of insomnia pose a big threat to stability, but they may also reflect that your system is already compromised. Your rescue medication strategy might call for a sleep aid to get you back on track. Rescue medications can also address powder-keg emotions such as spiking anxiety, irritability, or anger.
Several people have shared with me that just having the rescue medication available — just knowing that an effective intervention is at hand if needed — can be helpful in and of itself.
Are There Any Risks?
Frequent changes to your medication plan can have a downside. Higher dosages and extra medications can add up over the years, increasing the risk of side effects. Fiddling with your medication regimen should never be done without careful thought.
Along with considering the matter carefully with your prescribing practitioner, make sure your entire treatment team and others close to you are aware of any changes.
Setting Goals and Measuring Results
Modifications to any treatment strategy — medication included — should have a purpose or goal: What symptoms are you trying to address? It’s also important to have a way to measure the results. If the problem is poor sleep, the outcome measure may simply be the number of hours slept each night.
Keep in mind that there are many self-care strategies to use instead of, or in addition to, medication changes. Taking a hot bath before bed and keeping the bedroom cool aids the body in preparing for rest. Mindfulness exercises, deep breathing, and other calming techniques can be very effective in navigating stress. When those kinds of interventions aren’t enough, it’s time to think about a medication tweak.
UPDATED: Printed as “Ask the Doctor: Strategic Medication Variations,” Fall 2022