Recently I went through a nasty bipolar medication change. I stopped one antipsychotic in favour of another. Of course, this was to improve my overall treatment. And as I’ve said before, if you change nothing then nothing changes, and in this case, I had to change medications in the hopes of changing my mental wellness.
What ended up happening was a gradual slide into horrific suicidality. The new med was not effective for me.
But I learned something from this experience. Before changing bipolar medications, it’s a good idea to put into place a medication change safety plan.
What’s a Medication Change Safety Plan?
Well, it’s something I just came up with but seems like a good idea. Basically, it’s the rules by which you will make decisions once you undergo medication changes. It’s a setting out of possibilities at the outset so that if those possibilities emerge, you’ll know what to do. It’s a lot of “what if” scenarios.
And while you could simply make these decisions as you undergo medication changes, and not plan ahead, I’ve found that tack rather dangerous because if things go really wrong your ability to make those decisions is compromised. Thus, you will not make the best decisions and this can lead to even worse outcomes.
What to Put on a Medication Change Safety Plan
First off, list what medication you’re changing from, what you’re changing to and how you will do it. For example, “I’m going to decrease medication A 10 mg per week and on the third week I’m going to add 25 mg of medication B.”
You could use your calendar to remind you of what dosage should be administered when.
Questions you then might want to ask yourself are, “what if I get withdrawal symptoms from medication A,” and “what if I have too many side effects on medication B?”
So you might say that if you’re experiencing withdrawal effects from medication A that you’ll taper more slowly and if you’re experiencing too many side effects from medication B that you’ll increase its dose more slowly.
You’ll also want to note what to do in specific situations, like, “if I have any of the following side effects, I will call my doctor immediately.”
You also want to document what you’ll do if you see changes in your mood. So what happens if your mood destabilizes while tapering down on medication A? What happens if it destabilizers as you add B? What happens if you find yourself manic or depressed 3 weeks after starting medication B?
Why do these things matter? Well, because if your mood rapidly destabilizes you might not remember the right thing to do.
For example, “if I feel suicidal after starting medication B, I will switch back to medication A immediately and call my doctor.”
Does that sound simple? Maybe. But it’s not simple if your ability to think is compromised thanks to a bipolar disorder episode.
How to Build a Medication Change Safety Plan
It goes without saying that if you’re considering any medication change it should be with the help of a doctor, so get his or her involvement in your plan. Ask questions. Posit scenarios and note her responses. Communicate your plan with her. Communicate your plan with others so that they can help if they need to.
Changing medications can be a dangerous moment in bipolar treatment and it should be taken seriously. No, I don’t expect everyone to sit down and write all that out, but it really is a good idea to think about it beforehand. Because deciding what you’ll do with a clear head and the help of a doctor can help when your head becomes very dark and it’s a weekend.