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‘In the central nervous system, where there is a multiplicity of receptors for each drug to act on, and where all of us have different proportions of each of these, the likelihood of a uniform response to any one drug is rather low. A diversity of responses, rather than uniformity, should be expected.’ Professor David Healy (Healy, 1997)

Stopping mood stabilisers suddenly can be dangerous and is associated with increased risk of recurrence of a mood episode (Keck et al., 1998; Scott & Pope, 2002). Therefore it is extremely important that prescribing is done in a collaborative way, that the person with bipolar disorder makes an informed choice about their medication use, and that this is reviewed on a regular basis so that any problems can be identified. Some people may want to involve their family and friends in this process. 11.2 Making decisions about medication Decisions about medication use can involve weighing up the advantages and disadvantages. These will be different for each individual, but some of the common pros and cons are summarised in Table 1. Table 1: Advantages and disadvantages of medication use. Advantages of medication use

Disadvantages of medication use

Reduces relapse

Side effects

Feel more in control of the disorder

Loss of positive aspects of bipolar experiences Questions of self identity Remembering to take tablets Regular health checks and blood tests

The main advantage to taking medication is that research shows it can be effective in increasing time to next episode (e.g. Geddes et al., 2004). However, this conclusion is drawn by looking at the average response across a large group of people. The effectiveness of each medication varies from person to person and over time. Effectiveness needs to be evaluated for each individual on an ongoing basis. A common disadvantage of taking medication is the unwanted effects they can cause (sometimes called ‘side effects’). Each drug has specific unwanted effects that should be discussed fully at the point of prescribing, and provided in written form. The most common include: Mood stabilisers: n Lithium can cause some unwanted effects as the body adjusts, including thirst, diarrhoea, mild tremor, and dry mouth. More serious long-term effects include weight gain, underactive thyroid (causing weight gain, tiredness, sensitivity to cold, depressed mood), and diabetes. If levels get too high, this can lead to lithium toxicity which causes seizures. Symptoms include vomiting, diarrhoea, slurred speech, blurred vision, confusion.

Part 3: Help and treatment

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Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...

Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...