Not all mood swings = bipolar disorder

Very commonly, patients will report a history of mood swings to their mental health providers who will very quickly diagnose bipolar disorder. While mood swings are a component of bipolar disorder, many individuals who do not have bipolar disorder can also present with mood swings. Because of this, many people end up on medications meant for bipolar disorder that do not fully benefit them and cause side effects.

Caveat: This is not to say medications do not work for those with properly diagnosed bipolar disorder, they can work very effectively!

Individuals with bipolar disorder have a higher rate of having other psychiatric conditions

Higher rates of generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), substance use disorders (SUD), and eating disorders have been observed in the research literature.

What this means is that individuals with a prior history of bipolar disorder will often need additional medication management of other psychiatric conditions.

It is a challenge for any psychiatrist to carefully weigh the benefits of adding additional medications to help an individual versus the additional side effect burden and potential drug-drug interactions.

Furthermore, the standard medication management treatment of these psychiatric conditions will often need to be altered significantly when there is a prior history of bipolar disorder, for which some psychiatrists and prescribers will not be as familiar with doing so.

Medication side effects

Many psychiatrists are familiar with using mood stabilizers and antipsychotics to treat acute mania in higher acuity settings. These medications work very well the short-term, but in the long-term may cause burdensome side effects such as sedation and weight gain.

There are some medications currently available that are not as frequently used in the inpatient settings that can be similarly effective when used in outpatient settings that do not cause as much weight gain or sedation. Some individuals may benefit from trialing different medications when their bipolar disorder condition is stable in an effort to minimize their side effect burden.

Medication management of bipolar disorder is difficult. Inherently, starting and monitoring the positive and negative effects of these medications will require more follow-up and laboratory monitoring.