Bipolar medications adjust signals and chemical messengers in your brain to stabilize your mood, but what should you do if your bipolar meds aren’t working? Everyone can respond differently to treatment, and you may need to try a few medications before you find the one that works best for you.Your provider may recommend starting with a mood stabilizer or antipsychotic drug, with the goal of fewer mood episodes, better brain function, and improved quality of life. Sometimes a combination of medications works best to keep symptoms at bay.For acute manic, hypomanic, or depressive episodes, you may need to take additional temporary medications — like antipsychotics, anticonvulsants, antidepressants, or benzodiazepines — to get back to your baseline.At first it may feel like your medications aren’t working, but drugs taken for long-term maintenance can take weeks to months before you feel their full benefit. However, if you take your medications as prescribed and you don’t see enough improvement after the expected transition time, it’s important to tell your healthcare provider.
“Bipolar disorder is very treatable and manageable, provided patients are under a doctor's care,” says Cheryl Hurd, MD, a professor and the director of the psychiatry longitudinal integrated clerkship at Burnett School of Medicine at Texas Christian University in Fort Worth, Texas. And knowing the right questions to ask can help your doctor find a better treatment plan for you.
To understand when your bipolar medications work well and when you might need a change, it helps to keep track of your symptoms and side effects.
Your Symptoms Aren’t Getting Better
In a perfect world, your bipolar medications would work immediately, but in reality, your body can take time to respond fully to a new drug. If your mood symptoms keep going strong after several weeks, or you don’t see any improvement in your daily functioning, the medication at its current dose may not be effective for you and may need to be adjusted, says Christina Lee, MD, a psychiatrist and the medical director of mental health services at Kaiser Permanente in Baltimore.
“Or if you’re already on the maximum dose, that would be an indicator that it should be changed,” says Dr. Lee. “Many people with bipolar disorder need to take a mood stabilizer every day, and it can take trying several medicines to find the best combination.”
You may not always know if your symptoms have improved, but your provider and loved ones can help you figure it out, says Charles “Ken” Dunham, MD, a psychiatrist in private practice in Virginia Beach and the executive director of medical operations for behavioral health at Sentara Health. For example, “very often, a patient doesn’t see themselves getting better, but the spouse does notice,” says Dr. Dunham, who recommends getting a loved one’s opinion before considering a medication change.
Side Effects Become Unmanageable
Side effects offer another sign that you may need a medication switch. All bipolar medications come with side effects, but if their negative symptoms outweigh their benefit, let your provider know.“Common early side effects include sedation, gastrointestinal upset, tremor, and [weight gain],” says Dunham. Most bipolar medications also cause drowsiness, and many can prompt uncontrollable movements (extrapyramidal symptoms). Atypical antipsychotics increase your risk of high blood sugar and cholesterol, and lithium can cause a variety of side effects, including heart problems, kidney problems, changes in thyroid function, and confusion, among others.
Many side effects resolve within a few weeks, says Lee. “Mild issues like feeling dizzy or sleepy, or having an upset stomach, often improve as your body adjusts.” But if those symptoms don’t fade after several weeks, your medication may not be a good fit, says Lee.
Tracking side effects requires a good relationship with your psychiatrist, so you can voice your concerns and weigh the risks and benefits of your medication, says Suraj Modi, MD, a child and adolescent psychiatrist with Orlando Health Medical Group Behavioral Health in Florida.
You Have Significant Breakthrough Symptoms
If you have frequent breakthrough symptoms — like mania or depression — your medication or dose may need a change, says Dr. Hurd.
Mood episodes can happen when you have bipolar disorder, even if your medication typically works well. But frequent manic, hypomanic, or depressive episodes can increase your risk for suicide, decreased daily function, challenges with employment, and social withdrawal, which highlights the importance of treatment change when needed.
You may not have to change medications — just the dose, says Hurd. “Some patients may have control of some symptoms on medications, and that often means a dose adjustment is needed because of a partial but not full response,” she says.
Regularly talking to your provider about your symptoms and how well your medication is working can help you avoid mood episodes and boost your quality of life. Asking the right questions during a visit can help both you and your provider find the best treatment plan faster.
Our experts recommend asking these questions:
How long will it take before I start noticing improvement?
How will I know if the medication is working?
Is this drug being prescribed for a specific symptom?
What side effects are common, and which side effects mean I should contact my physician?
Do I need any routine medical tests to monitor my medicine?
How can I safely stop or change my medication?
What should I do if I miss a dose?
Some providers offer measurement-based care using standardized rating scales to track medication response and guide timing decisions, says Dunham. “Patients can ask their clinicians about these or keep a mood journal to help track how they are responding.”
If you have bipolar disorder, you should see your provider regularly — about every three months, says Hurd.
Your provider should tell you how long it may take for a new medication to start working, but if your mood swings stay strong or daily life still feels hard to manage, it’s a good time to ask about adjustments, says Lee. “You should also seek care soon if symptoms of depression or mania return or get worse, or if you have been treated for depression for more than three weeks without improvement. Getting help early can prevent symptoms from worsening.”
Lee recommends contacting your provider right away if you notice extreme mood changes, like feeling intensely happy or very irritable, talking much more than usual, not sleeping, acting impulsively, or having racing thoughts that make it hard to function. “These may be signs of mania that require quick treatment,” says Lee.
Some symptoms and experiences are an emergency, and you should call 911 or go to the nearest emergency room if you have any of the following:
Thoughts of suicide or death
Plans to hurt yourself or others
Hallucinations (seeing or hearing things that aren’t there)
Delusions (persistent false beliefs)
Severe nausea, vomiting, hand tremors, confusion, or vision changes (signs of lithium overdose)
Even if your concerns don’t seem worth contacting your provider, it’s always best to reach out. “I'd rather you call in between appointments if [you’re] uncertain about anything at all,” says Dr. Modi.
Bipolar medications don’t always offer the relief you hoped for, especially at first.
It can take weeks for the benefits of bipolar medications to build and the side effects to fade.
If you continue to experience symptoms and side effects, or you have any concerns about your medications, reach out to your healthcare provider, who can help you figure out what’s going on and adjust your medications if necessary.
