Chapter 18: Bipolar Medications

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Hey everyone, welcome back for another deep dive.

Today we're going to be tackling bipolar medications and treatments.

Sounds good.

And we're going to be looking specifically at this book, the Handbook of Clinical Psychopharmacology for Therapists.

Ninth edition.

Ninth edition.

Yeah.

Yeah.

I always love this book for a lot of reasons.

But I think it's really important for therapists to have a good grasp on what medications their clients might be taking.

Absolutely.

Because it really informs a lot of the work we do.

It does.

And you know, it's such an important area because the medications for bipolar disorder have gotten a lot more complex over the last 10, 15 years.

So there's a lot to keep up with.

Right.

And actually that's a good place to start.

So way back when, what were some of the initial treatments for bipolar?

Well, really the original one that was so groundbreaking was lithium.

And it revolutionized the treatment of mania.

Later on, anticonvulsants came into the picture and they became standard treatments for bipolar disorder too.

And those include medications like carbamazepine and valproic acid or dupacote, as it's often called.

And these medications, even though the term mood stabilizer isn't officially used anymore by the American Psychiatric Association, it's still a term that's widely used.

And we'll be referring to these medications in this way as mood stabilizers as we talk.

Makes sense.

So lithium for a while was really kind of the star of the show.

It really was.

And the book goes into this kind of interesting history behind it talking about how it was used in the 1800s.

Yeah.

For all kinds of things.

For things like anxiety and gout.

Totally.

And then, you know, they discovered kind of accidentally its anti -manic properties in the mid -1900s.

Yeah.

It's remarkable how some of these scientific discoveries happen almost by accident.

But you know, lithium also has its considerations like what we call a narrow therapeutic window.

What does that mean, a narrow therapeutic window?

So basically, the effective base of lithium is relatively close to the dose that can be toxic.

Oh, wow.

So it requires really close monitoring of blood levels to make sure that the person is getting enough of the medication to be helpful, but not so much that it causes harm.

Some doctors prefer Dybal Pro -X over lithium because of that, but both of them require this close monitoring.

So it's a balancing act in terms of dosage.

And the book also talks about lithium side effects.

Some are pretty common like increased thirst and urination, but then there are some that are a lot more serious, you know, neurological problems and kidney problems can arise.

Yeah, it really highlights the need for therapists to be aware of these potential side effects so we can help our clients make sense of what they're experiencing.

Yeah.

For example, you know, hoping a client differentiate between, you know, just feeling thirsty from the medication versus, you know, if they're actually dehydrated because dehydration can really impact lithium levels in the body.

Yeah, so it's having that knowledge and then being able to apply it to the therapeutic relationship.

Absolutely.

Okay, so moving on from lithium, we also have anticonvulsants.

And the book mentions a few carbamazepine, Tigretol, Dybal Pro -X, Dipakote,

and lamatrigine lamectal.

Yeah, those are some of the big ones.

The big ones.

And they're interesting because each one seems to have like a specific use or like a preference for certain bipolar symptoms.

Yeah, exactly.

So they each have their own little niche, you could say.

Right, like lamatrigine is really helpful for bipolar depression, not just the mania.

That's right.

Yeah, and you know, it's interesting how they weren't originally developed for bipolar disorder at all.

Right, they were for seizures.

Yeah, researchers kind of stumbled upon their mood -stabilizing effects, much like lithium.

But of course, with these medications come potential side effects.

Of course.

Lamatrigine, for example, carries a risk of a skin rash.

Yeah.

And carbamazepine can cause dizziness and, you know, stomach issues.

So therapists need to be aware of those things when they're talking with their clients.

Absolutely.

It's all about education and helping clients understand what to watch for and how to manage those effects.

And some of the anticonvulsants even seem to have neuroprotective properties.

Oh, wow.

Similar to lithium.

So it's not just about managing symptoms, but potentially protecting the brain in the long run.

So we have lithium, we have anticonvulsants.

What's next?

Well, we can't forget about the second generation antipsychotics.

They're becoming increasingly common in bipolar treatment, especially for acute mania and those mixed episodes.

They're not just for psychosis anymore.

Right, exactly.

Yeah.

And the book mentions a few of those, erypropryzol, lanzapine, cojapine, but those also come with side effects too.

Oh, yeah, definitely.

We're talking about powerful medications here.

So careful monitoring and management are really, really important.

And often, you know, a lot of people with bipolar end up taking a combination of these different types of medications.

Yeah.

It's not unusual to see combinations of mood stabilizers, antipsychotics, even anti -anxiety medications to manage, you know, all the different aspects of bipolar disorder.

Right.

And then there's this whole discussion around antidepressants and bipolar depression.

Yes, that's a tricky one.

Yeah.

The book talks about how they could potentially trigger mania or hypomania.

And it also discusses this study, this step BD study, that tried to shed some light on this issue.

Yes, that was a major research effort.

Yeah, seems like there's still a lot we're learning about how these medications work and interact.

Absolutely.

There's no one -size -fits -all approach.

Right.

Each person's treatment plan really needs to be carefully tailored to their specific symptoms,

you know, their medical history, and, you know, a whole bunch of other factors.

So it's like a puzzle almost.

It is.

It's like putting together a puzzle.

Figuring out what's going to work best for each person.

Yeah.

And that's where the therapist's role is so important because we help clients understand their medications, manage side effects, and advocate for themselves with their prescribing doctor.

Right.

And, you know, one thing that the book really highlights is this idea that bipolar disorder often requires long -term or even lifelong treatment.

Yeah, that's a reality for many people.

Yeah.

And so patient education becomes super important.

Absolutely.

You know, helping them understand the potential side effects, the consequences, of not taking medication as prescribed.

It's about empowering them to be active participants in their own treatment and helping them make informed decisions about their health, and, you know, sometimes that means helping them come to terms with the idea that medication might be a long -term part of their journey.

Yeah.

Which can be a really tough pill to swallow for some people.

Right.

It's not always easy to accept that.

It's not.

But we can help them understand that medication can be a powerful tool for them,

you know, for stabilizing their mood and reclaiming control over their lives.

And that's a good place to transition into the next part because now that we've kind of talked about the medications themselves,

I think it would be really helpful to explore that emotional impact of what it means to be taking these medications.

Yeah.

So stay tuned, and we'll be right back with part two.

Looking forward to it.

Okay, so we're back, and we were just talking about how important it is to really understand the emotional impact of taking these medications for bipolar disorder.

Yeah, because it can be a real shift in identity for some people.

You know, the book even talks about this sense of loss that some individuals experience when their symptoms are reduced by medication.

And it makes sense.

You know, it's not just about the physical side effects, but the emotional and psychological adjustments that come with it.

Exactly.

You know, think about it.

Someone who's used to that intense energy and creativity of mania, they might actually miss those aspects, even if they recognize that those episodes were also really destructive.

Yeah, it's almost like grieving a part of yourself, even if it was a part that caused pain.

That's a great way to put it.

And you know, some people also describe feeling emotionally numbed or flattened by the medication like their vitality has been kind of diminished.

So as therapists, you know, how do we help our clients work through these really complicated feelings?

Well, I think first and foremost, validation and empathy are key.

Of course.

You know, we need to normalize these feelings and help clients understand that it's okay to grieve.

It's a natural response to such significant changes.

So it's about helping them kind of reframe their understanding of what it means to live with bipolar disorder and how medication fits into that picture.

Exactly.

You know, instead of viewing medication as taking something away from them, they can start to see it as a tool to manage their symptoms and live a fuller, more balanced life.

And that's where I think the therapeutic relationship becomes even more crucial.

Absolutely.

You know, providing that safe space for clients to process these emotions and find new ways of coping.

It's about helping them find a new equilibrium, a new way of being in the world that incorporates both the challenges and the strengths that come with bipolar disorder.

And that brings us to this idea that, you know, bipolar disorder is often a lifelong condition requiring long term management.

And that can be a daunting thought for a lot of people.

You know, they might worry about being on medication forever or fear having a relapse.

So how do we as therapists support our clients in making that shift?

I think it starts with having those open and honest conversations.

You know, we can help them understand that while bipolar disorder is chronic,

it's also

manageable.

Right.

With the right treatment and support, individuals with bipolar disorder can lead incredibly fulfilling lives.

It's about highlighting those stories of hope and resilience.

Exactly.

And part of that management, you know, may involve accepting that medication is going to be a long term or even a lifelong part of their journey.

Which can be a tough concept for some people to grasp.

It can be, but we can help them understand that medication can be a powerful tool for for stabilizing their mood and reclaiming control over their lives.

It's not about becoming dependent on medication, but rather using it as a tool to gain freedom and well -being.

Exactly.

That freedom allows them to, you know, engage more fully in therapy, to make positive lifestyle changes and build those strong support systems.

So medication provides kind of like a foundation for stability upon which they can then build a fulfilling life.

I love that analogy.

And as we've been talking about, therapy plays a vital role in that building process.

Of course.

It's a space for processing experiences, developing coping skills, building resilience.

It's about empowering clients to be active participants in their own recovery.

And that extends to their medication management as well.

Right.

So we can help them learn to track their symptoms,

recognize early warning signs, and communicate effectively with their doctor.

It's about fostering a sense of agency and ownership over their treatment.

But you know, we also need to be realistic.

The journey of living with bipolar disorder, it's not always linear.

There will be ups and downs.

And that's where the therapeutic relationship becomes such a constant.

It's that steady source of support and guidance,

no matter what challenges arise.

I couldn't have said it better myself.

You know, a skilled therapist can help clients navigate those challenges with compassion and understanding and that unwavering belief in their ability to thrive.

It's a powerful reminder that, you know, hope and healing are always possible, even with a chronic condition like this.

Absolutely.

It's about empowering them to live their lives to the fullest, you know, embracing their unique strengths and finding joy and purpose, even in the face of adversity.

What a powerful message.

I think that's a good place to stop for now.

Yeah, I agree.

You know, we've covered a lot of ground today from the complexities of medication management to the really profound emotional and psychological aspects of living with bipolar disorder.

A lot to think about.

Yeah.

And in our final part, I'd love to delve deeper into the practical strategies and ethical considerations that come with supporting our clients through this journey.

Sounds good.

I think it'll be a really valuable discussion.

All right, we'll be right back with part three.

OK, so we're back for our final part of this deep dive on bipolar medications.

It's been quite a journey so far.

It has.

And, you know, we've talked about the different medications.

We've talked about the emotional impact.

But now I really want to focus in on the therapist's role.

Yeah.

What do we do with all this information?

Right.

What are the practical strategies and ethical considerations that we really need to keep in mind when we're working with clients who have bipolar disorder?

It's about going beyond just the medications themselves and really understanding how they impact our clients' lives on a deeper level.

Exactly.

So where do we even begin?

I think a good place to start is with psychoeducation.

Oh, of course.

You know, empowering our clients with knowledge about bipolar disorder.

It's symptoms and the different treatment options available.

It's like giving them a roadmap.

Exactly.

It's helping them understand that they're not alone in this and that there are tools and resources to help them navigate the challenges.

And it's not just about the general information.

It's also about helping them understand their individual triggers.

Right.

Those early warning signs of a mood episode and those coping skills that they can use.

It's about tailoring the information to their unique needs and experiences.

And you know, we talked earlier about medication compliance being a big issue for some people.

Oh, yeah.

That's a common struggle.

So how can we as therapists help with that?

Well, I think it often starts with having those open and honest conversations.

Of course.

You know, creating a space where clients feel safe to express any concerns or questions they have about their medications without judgment.

Because it's understandable that people might have mixed feelings about taking medication long term.

Absolutely.

You know, they might worry about side effects.

They might worry about changes in their personality or even question whether they need the medication at all.

Those are all very valid concerns.

So how do we approach those conversations in a way that honors their autonomy but also ensures their safety?

That's the balance we're always trying to strike.

I think first and foremost, we need to acknowledge their right to make decisions about their own treatment.

Our role isn't to persuade them to take medication, but to help them weigh the pros and cons and make an informed choice that feels right for them.

So helping them explore those choices thoughtfully and without pressure.

Exactly.

And sometimes that might involve helping them understand the potential risks of not taking medication like the increased likelihood of relapse and how that could impact their lives.

But it's also about exploring those alternative coping strategies.

Like lifestyle changes that can help support mood stability.

And we can also encourage them to have open communication with their prescribing doctor.

We can be their advocate and make sure that their voice is heard in those discussions.

So it's about fostering that collaborative partnership between the therapist, the client, and the doctor.

Exactly.

And that collaborative spirit can also extend to involving the client's family or support network.

Oh, that's so important.

Family therapy or psychoeducation can be incredibly helpful.

It equips loved ones with the tools to understand and support the person with bipolar disorder.

And it creates that network of support, which can make a world of difference.

And we can also connect clients with support groups or online communities.

Right.

So they know they're not alone.

Exactly.

Sharing experiences with others who really get it can be so validating.

And it helps combat that stigma that unfortunately still exists around mental illness.

Absolutely.

And, you know, another important aspect of our role is helping clients challenge those negative beliefs they might have internalized about themselves.

Oh, it's huge.

You know, it's about helping them cultivate self -compassion and develop a more positive self -image.

It's about shifting that narrative from I'm broken to I'm healing.

Exactly.

And I think that's really what it's all about at the end of the day.

Yeah.

Supporting clients with bipolar disorder goes beyond just symptom management.

It's about empowering them to live full and meaningful lives.

To embrace their strengths and find joy even amidst the challenges.

Couldn't I said it better myself.

It's been such a fascinating deep dive.

I feel like we've covered so much.

Me too.

We've really explored the complexities of bipolar medications and the many layers of the therapist's role in supporting clients.

A huge thank you to our expert for sharing their knowledge and insights with us.

It's been my pleasure.

And to all of our listeners out there, thank you for joining us on this deep dive.

We'll see you next time for another exploration into the world of mental health.