Medication & Bipolar II Disorder – Planning ahead

When I was first diagnosed with Bipolar II Disorder I was overwhelmed and scared of what that label meant, yet at the same time, relieved that the erratic moods and feelings I was having finally had a name, and that there was treatment.

I remember early on as I started taking medication that I had so many questions. Some were easily answered, while others I had to develop my own answers.

I’ve separated them into categories to try to make it easier to make sense of.
I hope these questions and answers can be of use to you.

Planning ahead so you never run out a.k.a. Maintaining your supply

  1. Do I have enough of each of my medications to last me till the next time I plan to go to the pharmacy/chemist?
    I don’t count each and every pill I have, but I do make sure I have enough of each medication to last me at least until the weekend when I can go to a pharmacy. It’s always good to stock up a bit so you have an emergency supply. Generally, once any of my medications goes down to about a two week supply left, I make a point of going to the pharmacy.
  2. Am I low on repeat prescriptions for any of my medications?
    Your general practitioner or psychiatrist can give you more scripts for your medications as needed. Medication prescriptions have finite authorised repeats which means your GP or psychiatrist will have to routinely write you new ones in order for you to get your medication from the pharmacy. It helps to be aware in advance if you are close to maxing out your repeat script for any of your medications so you can ask for one at your next appointment. Many psychiatrists charge extra if you need a script outside of your appointment times while a doctor’s appointment generally involves a long, tedious wait beforehand.
  3. Do I know where the best pharmacies in my area are in terms of:
    • Location – Convenient and accessible, perhaps near your local shops, near home or on the way to work.
    • Type of stock – I found out through experience that some pharmacies only stock the generic brand of certain medications or only the brand name. It’s important to differentiate between generic and non-generic brands of medication. Although they would both have the active ingredient, the ratios will vary as well as the “filler” ingredients used in each pill. A good example is the drug quetiapine, which is also known by the brand name Seroquel. I was specifically directed by my psychiatrist to avoid the generic brand as it simply was not as effective. Always check with your doctor if it’s okay to get the generic brand to cut costs, otherwise you’ll have to make do with the more expensive, but also potentially more effective brand of medication.
    • Cheaper costs I’ve found that the cost of medication is highly dependent on location, with suburbs closer to inner Sydney or the city being more expensive than in the western suburbs.
    • Opening hours Late night chemists may help to cater for after work if you do long hours or if you need to buy any medication on short notice.
  4. Special considerations when travelling
    If you plan to travel, it’s important to make sure you have enough in stock to take enough of each medication with you in carry-on luggage only (not checked luggage). As a precaution, I always get a medical certificate along with any necessary vaccinations from my doctor to certify me for carrying medication, just in case I’m questioned by airport security.

Correct storage

5. Am I aware of the correct storage of each of my medications?
All medication has specific storage specifications. Always read and follow the medication instructions. I store my thyroxine sodium medication in the refridgerator at about 4-5 degrees, my lithium carbonate pills at room temperature, and my omega-3 capsules at room temperature away from light.
I generally store my medication in their original blister-packs or containers until I prepare my daily doses in pill boxes. I do this every two days so my medication isn’t exposed to air for more than 48 hours.

6. Storage when travelling
Many medications require storage at room temperature away from direct light and thus do not require any special care. Other medications, such as thyroxine sodium as mentioned above, need to be refridgerated which can make things a little tricky when you’re travelling overseas. A product like the Medication Travel Pack from The Australian Thyroid Foundation would have been handy on my previous trips as it is designed for the transportation and cool storage of medical supplies. It’s on my wishlist for future travelling adventures, though is a bit expensive at $69 (including membership).

Clear daily schedule

7. Do I have a clear daily schedule of when I take each medication?
By clear daily schedule, I mean a succinct and detailed timetable of what medication I take, each dosage, at what time, and any other specifics. I found this especially important after undergoing electro-convulsive therapy (ECT) treatment and suffered from some memory loss. It is also helpful for your emergency contact or loved ones to know your medication routine and to act as a reminder or in case of emergency.

8. Am I aware of how to take each of my medications?
Each medication has different and specific instructions on how to take it.
For example, I take my thyroxine sodium pill thirty minutes before food every morning (or whenever I wake up). I take my lithium carbonate tablets with food and I take my Seroquel tablet one hour before I get in bed.

9. Do I have my medication easily accessible and ready to take on a daily basis?
The main idea is to make taking medication on a daily basis simple and an automatic part of life i.e. minimum brain power required. The more I minimise the decision-making involved, the easier and seamless it becomes as part of my everyday life. It becomes less of a chore and just something I do everyday, like brushing my teeth.
Plus it will lessen the probability that I will miss or skip any doses.

10. Can I prepare my medications in labelled pill boxes in advance?
Consider trying different types of pill boxes to suit your needs. I’ve tried quite a few over the years depending on my medication as you can see in the photo below. I started by using seven-day pill boxes, then moved to split pill box containers with personalised labels for each day, and finally two handcrafted wooden pill boxes from an Etsy seller. My pill boxes evolved to suit my needs as I changed medications and dosages over the years.

pill boxes sa title

11. Do I need a split pill box to separate my morning medication and night medication?
This is helpful if you take pills that look similar at different times so you don’t mix up the doses, or if you’re like me and just like taking all the pills in the morning section in the morning, and all the pills in the night section at night.

12. Do I need a pill splitter to break any tablets and get the correct dosage?
Pill splitters are available at most pharmacies/chemists. You only really need it if you’re in-between doses under the instruction of your psychiatrist. I’ve found it to be quite a handy tool over the years as I’ve trialled different medications that required a gradual increase in dosage.

pill splitter sa title.jpg

13. Will it help if I set regular alarms/reminders on my phone so I can take my medication at set times?
I have my alarms set at 8 am, 12 pm, 8 pm, and 9 pm for the different prescription medications and vitamins I take.

14. Would it be helpful to trial the different mobile apps available for recording and taking my medication?
There are lots of apps available to help you take your medication on time. A key search term would be “Medication reminder“. I personally use an app called “Medisafe Pill Reminder” to monitor my changing medication. I have trialled others in the past but have stuck with this one for many years and find it helpful in monitoring my compliance i.e. if I take/miss/skip certain pills, as well as changes in dosage and changes in overall medication.

medisafe screenshot sa title.png

Coping with side effects

15. Do I know the potential and likely side effects of each of my medications?
This one is hugely important and means I prepare myself to cope with the side effects I experience as a result of all my medications. For example, lithium causes me to experience dehydration on a regular basis and constant thirst, so I will make an effort to drink a minimum of two litres of water a day and also always carry a reusable water bottle on me at all times. One of my medications, Seroquel, makes me very drowsy so I make sure to take it at night just before I sleep instead of in the morning, and I also make sure I don’t do anything that requires too much concentration like driving.
It’s a necessary evil to cater for the side effects of your medications, especially if that particular medication is working to help balance the chemicals in your brain. It’s a matter of striking a balance between what you are able or willing to tolerate in terms of negative side effects versus the gain in positive effects on your mental health, and to adjust accordingly.

In case of emergency

16. Do I have a complete and up-to-date list of all the medications I take in case of emergency (with dosages)?
I have a written reminder in my yearly planner to review my “Current medication list” every six months. I make sure to list all my current medications with today’s date, each medication dosage, when I take each in a day, and even a basic drawing of what each pill looks like. It is important to set aside time to regularly review and update this list so that you, your emergency contact, and any loved ones have this information on hand when needed. Pictured below is my actual current medication list. As you can see, it doesn’t have to be anything fancy, just as long as it conveys the necessary information.
On another note, this list is also handy to bring along to different doctor’s appointments as I’ve often been asked what medication I take and it’s easier to show this list than verbally list each one.

current meds list sa title

17. Have I made this list available/accessible to my chosen emergency contact?
I have my current medication list typed up as a digital note on Google Keep which I’ve shared with my emergency contact. I have also emailed this information to my emergency contact in the past and left a physical, written list attached to the front of our fridge with a magnet. You just need to find out what works best for you.

18. Do I know the important contact details of all my health professionals for emergencies? (Including full names, profession, contact number, address)

  • General practitioner
  • Psychiatrist
  • Psychologist
  • Other key therapists, support groups, etc

I find it helpful to keep this in one spot so it’s easy to refer to when needed. Include contact numbers as well as location.

19. Have I educated myself on the potential side effects of each of the medications I take in case of toxicity/overdose?
I learnt about lithium toxicity the hard way when I overdosed and had to admit myself to hospital. It’s important for you as well as your loved ones to know the signs so you can act fast. Find out what the signs and symptoms are for each and every medication you take, make a list, then share it with your emergency contact and loved ones. They may recognise emergency symptoms before you do and can act fast to get you help.

Regular review of medication

20. Am I aware of how regular my blood tests need to be?
In order for my doctor to monitor the correct level of medication in my body, I need to have regular blood tests. My test results help my psychiatrist to adjust my dosages accordingly and determine the number of tablets I need to take to achieve an optimum level in my blood. I think in general, it’s best to ask your doctor if you need a specific regular blood test each year to keep on top of things, or as often as every three months as in my case to track lithium levels. For myself personally, I ask questions specific to my medication such as:

  • Quilonum (slow release lithium carbonate) – How often should I be having blood tests to check my lithium levels? What is the optimum range? What happens if I’m below the optimum range? Will I experience symptoms? What happens if I’m above optimum range i.e. toxic level?
  • Thyroxine sodium – How often should I be getting thyroid function tests? Am I currently on the correct dosage of medication? Do I need to see an endocrinologist?

It’s important to become an active participant in your own healthcare because, ultimately, you are responsible for your own mental health. Your doctors, other health care providers, and loved ones are just your support team; they can’t take those steps forward for you.

I have found that this way of thinking strongly contributes to my mental resilience and the drive to get better and stay well even after every setback. I have to regularly remind myself that I am the catalyst; the game-changer; the one that makes the decision whether to try again. When, not if, I fall over, I can choose to get right back up; I can also choose to lie there for as long as I need to and recover. It’s a tough journey towards prolonged stability, especially if like me, you experience rapid cycling, so make sure you make the choices that are right for you to support your well-being. Yes, it will be a lot of trial and error, with a lot of setbacks, but you can do it. We can.

21. Are the medications I take regularly reviewed by my doctors? I’ve seen many different health professionals in relation to my bipolar II disorder and over the years, it’s easy to lose track of when you started or stopped different medication doses. I’ve often been asked when I started a particular medication and at what dose, so I found it helpful to make a concise record a.k.a. my treatment timeline, which includes both medication changes and treatment changes (see screenshot of my actual treatment timeline below). For example, I started Quilonum in November 2011 at 450 mg, or had 12 rounds of ECT treatment in August 2016.

tx timeline sa title.png

It also helps to make a note of what medications you used to take and why you stopped. E.g. Escitalopram, 20 mg, taken from February to May 2017, stopped due to side effects (add details).

Medication waste
Medication blister-packs are currently not recyclable in Sydney and can only go to landfill -_-” As someone who is trying to minimise their waste, this is a pretty big disappointment. Of course, I do recycle the cardboard boxes that the blister-packs come in, but I also regularly feel pangs of guilt as I drop yet another blister-pack in the bin.
This photo below is the amount of medication waste I generated in about two weeks T_T”

meds waste sa title.jpg

I am hopeful that TerraCycle in Australia will eventually offer a program in collaboration with the big pharmaceutical companies to recycle their pill packaging and force them to embrace a closed-loop environmental solution. This basically means that the companies that produce the pills and profit from the sales become accountable for their products from manufacture through to disposal (which is the way it should be!). Fingers crossed that future accountability and sustainability isn’t too far away.

I hope you have found at least one of these tips to be useful to you.

Keep embracing the adventure.

Thanks for reading ^_^”

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