Sometimes the Meds Work
Handy Tips


A week's supply of meds.
  • Purple tray: nighttime meds.
  • Green Tray: morning meds.
  • Blue Tray: vitamins, iron, and antioxidant.
  • Circled in Red: Lock button for blue tray.

    • Note that the trays fit nicely into a one quart Ziploc bag and the white button on the end, circled in red, is an "unlock" button -- these trays lock, which helps avoid them opening by accident, and spilling meds all over your purse or shaving kit.

    Medication is Key

    No one has figured out a way to deal with a serious case of bipolar illness without the patient having to take psych meds for life.


    Your Antipsychotic

    If you have ever had a bipolar I manic episode with psychosis, you have probably wound up in the hospital and been given an antipsychotic that worked. Arrange to have some of these meds in your possession.

    One thing about antipsychotics, is that they're helpful with a wide range of mental illnesses. If you show up at a mental hospital and you're seriously insane, they can give you an antipsychotic and you'll be making sense in a short time, without their even having to figure out what's wrong with you.

    In 1988, I was very seriously manic, and my shrink dialed in a prescription for an antipsychotic to my pharmacy. However, by the time I went to the pharmacy and brought it home, I was too far gone to take it. So you want to have antipsychotics in your home so you can take them right away if you feel that you're losing your mind.


    Buy Here

    It's also a good idea to keep some antipsychotic in a pill box in your pocket so you can have some wherever you are, if you start being unsure of your sanity. It's like a fighter pilot always wearing a parachute. This kind of pill box has multiple compartments, so you can also put in other kinds of meds that you might want handly like sudafed, pain killers, and sleeping pills.

    Pack the box with kleenex, so the meds don't rattle when you walk.

    Also, I keep a paper prescription for an antipsychotic in my wallet. They expire after a year, so I get a new one every year from my shrink around my birthday. This means that you can walk into any pharmacy and get some, no questions asked.

    Once I was travelling and felt that I needed an antipsychotic. I didn't have any with me, nor a prescription. My shrink wasn't responding to being paged, so the pharmacy wouldn't give me any. I had to go to an emergency room, and talk to a general practitioner who wasn't used to being around mentally ill people, and walk a fine line to convince him that I was crazy enough to need the med, but not crazy enough to need to be locked up.

    For all this effort that I've made to ensure that I always have easy access to antipsychotics if I need them, I haven't taken any since 2004.

    It's also good to have a second pill box in your pocket with your nighttime meds in it, in case you don't make it home one night.

    One thing that I don't understand is why my shrinks weren't more proactive in making sure that I had antipsychotic meds in my own possession. Even my very first manic episode was literally life-threatening. But it wasn't until after I had had two more life-threatening episodes that I got an antipsychotic in my possession, and even then it was my idea. What were my shrinks thinking????

    Learning to Gauge Your Mood

    One shrink did a practice that I thought was a really good idea. At the end of each therapy visit, he would gauge my mood from 0 (horribly depressed) to 10 (raving manic) and I would do the same. With time, we got to where we were always pretty much in agreement. It is very valuable to be able to tell if you are getting manic, so you can get things under control before they get out of hand.

    Most bipolars, especially people with bipolar II and not bipolar I, experience mania as pleasant, so they don't fear it. My early manic episodes were so horrific that I absolutely hate the sensation, and that's made me notice it plain as day, and vigorously act to keep it in check.

    Your Daily Meds

    It is important that you be well-organized with your medication to avoid forgetting it. If you start becoming manic, it is easy to start forgetting to take your meds, which will make everything worse. That happened to me in 1990. If your pills are in a weekly tray, it makes it easy to tell if you forgot to take them.

    The older you get, the more aches and pains unrelated to bipolar you will have, meaning the more meds you have to take.

    Especially if you have a lot of meds, it pays to get some of them refilled early so that eventually you get them all refilled on the same day. This saves on trips to the pharmacy.

    It is best to use a pharmacy that has a website where you can order refills, this is the most convenient way to do it. And if they're not close to your home or work, you can probably arrange for them to mail your meds to you. Also, the website will tell you the earliest date your meds are eligible for refill.

    Organize your meds into a weekly pill tray. This is much better than taking them out of the bottles each time you take them, because:

  • It saves time, over the course of the week, to split up your meds once at the beginning of the week. This is easier than getting out the bottles each time and counting a few pills out of each one.
  • If you have a weekly tray, especially if the plastic is at least partly transparent, you can look at the tray and tell if you remembered or forgot to take your medication.
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    Here are the pill trays I recommend:

  • Pill Trays: Buy Here
    •

    Vitamins

    I felt that since I was getting so organized to take meds, I might as well take vitamins while I'm at it, so I do. However, if you Google "vitamins", most of what you will find is a lot of quack information on the Internet that has no relationship to reality. There's some evidence that taking huge doses of vitamins is bad for you, you should be aiming more at the "Recommended Daily Allowance". Mention whatever vitamins you take to a medical doctor -- an M.D. or a psychiatrist, not a therapist. For example, when I told my kidney doctor that I was taking a gram per day of vitamin C, and he recommended against that, because it's apt to cause kidney stones, so I quit taking it.

    Your Wallet Insert

    It is a good idea to have a very small Word document in your wallet, on the back side of your driver's license. If you're running around bat shit crazy in the street, the cops, once they've overpowered you, will take out your wallet to try to figure out what's going on -- I know this from personal experience.


    You want, in that document, where they'll find it in your wallet,

  • Mention of the fact that you're bipolar and what antipsychotic you're responsive to, in case you're too far gone to explain it to the cops and doctors at the time.
  • Phone numbers of family members or close friends.
  • Names, specialties, and phone numbers of all your doctors.
  • A list of all your daily meds and their doses in case you're hospitalized or incarcerated.
  • If you're on lithium and consume ridiculous amounts of water, it's important to mention that. If you're in a hospital and can't talk, they need to know that.
  • Where your will is if you have one, in case you die in an accident.
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    The Friend Whose Name and Number Are in Your Wallet

    If you go to the hospital, they might not be willing to discharge you unless someone comes and picks you up. That happened to me once. So if you don't have any family in town, it is good to have one friend who knows about your condition. Then, they will visit you in the hospital and drive you home when you're discharged. Bipolar support groups are a great place to find someone to fill that role.

    Your Meds Document

    It is unlikely that the first medication you take is going to be just hunky-dory and everything's fine. Particularly with antidepressants, you'll probably have to try several before you find one that works. And, typically, it takes a month to try each one.

    It's important that you write down the names of all the meds you try, and how they worked out. If you invest a month of your life into finding out that an antidepressant doesn't work for you, you don't want to forget about that so you waste another month trying it again 5 years in the future. And the antidepressants tend to have long, hard to remember names. Very few people can remember the four-syllable, bizarre name of an antidepressant that they tried for a month, 5 years ago, that didn't work.

    So I keep a Microsoft Word document on my computer, listing all of the psych meds I've ever tried, and how well they worked (or if they didn't). I make sure it's backed up with a printout in my file folder in case my computer disk crashes.

    This document is extremely valuable. As valuable as your birth certificate. When I change shrinks, the new shrink can come up to speed on my situation in very little time. Shrinks can tell, from what meds have and haven't worked on you, what other meds are most likely to work.

    The list of meds in my Word document, from my 34 years since my first breakdown:

  • Lithium
  • Haldol
  • Klonopin
  • Xanax
  • Temazepam
  • Atenolol
  • Vivactil
  • Sinequan
  • Trazedone
  • Nortriptyline
  • Neurontin
  • Zyprexa
  • Seroquel
  • Depakote
  • Paxil
  • Risperdal
  • Topamax
  • Geodon
  • Wellbutrin
  • Lamictal
  • Fish Oil
  • Melatonin
  • Remeron

    • Note that my document also has a paragraph or two about each med, telling how well it worked.

    Travel

    When you travel, always keep your meds in your carry-on, never in your checked baggage.

    There is always a risk that your checked baggage will be delayed to the next flight, or lost altogether. If this happens, you'll have to go, with your traveling companions, to a pharmacy and get a replacement for all your meds. This could easily take a couple of hours, especially if your shrink doesn't pick up the phone when they call them for a prescription phone-in. It's very inconvenient and frustrating for everyone on their vacation, and very humiliating for you.

    And unless your traveling companions know your history very, very well, they probably won't understand why you can't just "do without" for a few days, and that going off your meds is life-threatening.

    Some countries won't let mentally ill people visit. I know a woman who is ethnically Chinese, and she tried to go to China with her American-born brother, who was bipolar, and the Chinese government refused to give him a visa.

    I went to China. On the visa application they asked if I had any disabilities. I consider the fact that I'm bipolar to be an intimate secret, and not something that I wanted to confide to any communist party. I figured "No, I'm working full-time with no accomodations." and said "No."

    I made some effort to conceal it. I didn't take my meds in the bottles that had the prescription name on them, replacing the bottles with bottles from over the counter meds that I bought and threw out the contents. It turns out that most of the bottles of meds in the drug store had pictures of the pills on them. It took some effort to find matching bottles. The bottles I used were for pain killers, so I figured I'd tell anyone who looked through my meds that I had "back pain". But at customs, they just waived me through without looking in my suitcase or carry-on.

    Favorite Hospital

    Have a mental hospital in mind that you can go to and check yourself in at if you need to. There are several ways to choose one:

  • The hospital where your shrink has visitation rights (but in practice they're unlikely to show up).
  • Covered by your insurance.
  • Recommended by people in your bipolar support group (there'll be no shortage of opinions from that source).
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    Suicide Hotline

    It is a good idea to have a suicide hotline as a speed dial in your cell phone. You never know when you might need it.

    The Stockpile

    Normally, the whole system with pharmacies is set up so that you refill your meds just when you're about to run out. In my case, going off my meds is literally life-threatening. This means they kept me constantly on the brink of running out and dying.

    Normally, this isn't a big deal, but if you move, it can be. When I moved from coast-to-coast, the HR department at the company I was going to work for refused to give me a URL or a PDF describing the health plan. So I had no way of knowing which shrinks were covered, so I couldn't even contact a shrink until my first day at work. It had already been a couple of weeks since my last refill in California by that point. Then I had to work for a week or so and get the lay of the land and see how hard it would be to sneak out and see a shrink.

    When I finally saw a shrink, W.H., he refused to prescribe one of my meds for stupid reasons. I had to find another shrink. I asked if he'd prescribe some Depakote to tide me over, but be wouldn't.

    My shrink back in California couldn't refer me to anyone who would be more helpful.

    At this point I was really running low. I contacted about a dozen shrinks who were on the health plan. Almost none of them would consider this one problematic med. There was one, S.P., who would. The reason he did was that he was so personally obnoxious that the only way he could get patients was by prescribing meds that no one else would. I put up with his B.S. and got a prescription in the nick of time.

    So in case you ever want to move, it's pretty important to have a stockpile of meds. This isn't hard to arrange. Most insurance will pay for a 30 day refill about 26 days after the last one you got. So if you're careful to refill as early as you can over a long period of time, you will have a substantial stockpile. Meds expire after awhile, but expired meds are a lot better than no meds.

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