I’ve spent years of my life on bipolar medication that doesn’t work — or, at least, bipolar medication doesn’t work as much as one would like. I know this isn’t the common refrain around medication – the common refrain is, take bipolar meds and get better – but it’s a reality many of us live with. So the question is, what do you do when the bipolar medication doesn’t work? What do you do when you have treatment-resistant bipolar disorder?
Why doesn’t bipolar medication work? Why are some people resistant to treatment?
I don’t know why bipolar medication sometimes doesn’t work. Actually, I don’t know why bipolar medication ever works — no one does. is one of the mysteries facing medicine right now. I do know, however, that most meds don’t work for me than, and I know it does for many of us. That’s why you have to cycle from drug to drug to find the right one for you. (If you’re lucky enough not to have gone through it, you’re in the minority.)
But if we know that bipolar disorder is a brain disease and we have drugs that treat it effectively, as confirmed in studies, why, so often, does bipolar medication not work for some people? I am very disappointed by this question. And I am deeply disappointed that 25% of people with bipolar disorder fall into the category of treatment-resistant bipolar depression. (People with treatment-resistant bipolar disorder tend to manifest it as persistent depression.)
What is treatment-resistant bipolar depression? What does “The drug is not working” mean?
Even treatment-resistant bipolar depression is difficult to define. This is because the definition of treatment resistance varies between studies. Not only do studies differ on how many treatments someone must fail to be considered treatment resistant, but they also differ on what they consider a successful treatment. One might say that a 50% reduction in symptoms is a successful treatment, while others might use a different measure. (And, as a patient, I can say that I don’t necessarily agree that a 50% reduction in symptoms is “success.” As we know, we should aim for zero symptoms.)
All that said, it is usually a failure of two treatments that indicates treatment resistance. But, when I say failure of two treatments, I mean failure of two treatments given at a sufficient dose for long enough to actually be blocked (many people give up before this happens).
(There is actually an even more serious concept that has been recognized called treatment-resistant bipolar depression. It is like treatment-resistant bipolar depression, with the addition of failure in psychotherapy treatment, at least one trial with an antidepressant, and electroconvulsive therapy (ECT) .I also fall into that category.)
To me, the definition of treatment-resistant bipolar depression is this: you can’t achieve anything close to remission after you’ve actually had two or more treatments. This is a loose definition, of course, but I think it best represents the patient’s point of view.
When you are resistant to treatment and your bipolar medication is working well enough, know it
There are many things to know about treatment-resistant bipolar disorder. The first, and perhaps most important, is this: Just because your bipolar medication isn’t working well enough, doesn’t mean it isn’t working at all. In other words, it can always get worse. You can’t assume that just because you’re still depressed, your medication isn’t doing anything. It’s very likely (and maybe possible) that without it, you’d be worse off. Consider the implications of this carefully when deciding to make medication changes. (I’m not saying that switching meds is the wrong move, just that you do it with this knowledge in mind.)
Second, while it sounds scary to have treatment-resistant bipolar depression, it doesn’t mean you can’t or won’t get better. I had a period of remission after trying everything I could think of (including electroconvulsive therapy). Remember that there is still hope.
Third, understand that bipolar disorder is extremely difficult and complicated to treat. This is evidenced by the fact that most people with bipolar disorder take two or more medications. This is known as polypharmacy. Polypharmacy is the norm in bipolar disorder rather than the exception. Obviously, if your wellness is going to come from multiple drugs, it’s going to take longer to dial it in than if it was just one.
Fourth, you may have to live with bipolar medication that doesn’t work well for some time. I know this is horrible and unfair, but it’s true. You can overcome this pain. It won’t last forever. You may be in a holding pattern for a number of reasons, including accessing the treatment you need.
Finally, don’t give up hope. Treatment-resistant bipolar disorder is not a diagnosis of death. People move from treatment-resistant to treatment-successful all the time. It’s hard and painful and long, but it happens. Trust me, I’ve been there. (Don’t lose hope even if your doctor gives up on you.)
I’m sorry your bipolar medicine isn’t working. You are not alone
As I said, a significant number of people are considered resistant to treatment, and even more people are on medications that are not nearly as successful. I’m sorry if that’s you. I’m sorry it’s me. But that doesn’t mean it’s over. That doesn’t mean you’ll always live like this. Suffering seems forever. And sometimes it’s very, very long. But change happens every day. New drugs become available every day. Wait. Better days are coming.
Sources
- Diaz, AP, Fernandes, BS, Quevedo, J., Sanches, M., & Soares, JC (2022). Treatment-resistant bipolar depression: Concepts and challenges for new interventions. Brazilian Journal of Psychiatry, 44(2), 178-186.
- Weinstock, LM, Gaudiano, BA, Epstein-Lubow, G., Tezanos, K., & Miller, IW (2014). Medication Burden in Bipolar Disorder: A Chart Review of Patients at Psychiatric Hospital Admission. Psychiatric Research, 216(1), 24.
