From Kimberly Read & Marcia Purse,
Your Guide to Bipolar Disorder.
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About.com Health's Disease and Condition content is reviewed by Steven Gans, MD

A. When you begin taking one or more medications for bipolar disorder, changes will start to occur on both a physical and emotional level. Usually the first thing that you notice, if a med is working properly, is a change in your emotional response.

It's generally a very subtle, gradual change ... not like a bolt of lightning out of the blue. It happens over a period of time that varies for each individual. Sometimes you aren't aware that changes are happening until they've been occurring for a little while. It's pretty common for other people to recognize the subtle changes before you do, so it's often helpful to ask people around you if they are noticing any changes.

Here are some examples of how you might feel when a medication is on the mark:

• You might notice that something that has always upset you no longer elicits the same physical and mental response.

• You may notice that you are not thinking or obsessing about subjects with the same intensity and frequency, your thoughts are not as fragmented and disjointed, and your mind is not wandering from one thing to the next. In spite of the physical fatigue that sometimes comes at the beginning of treatment, overall focus and clarity seem improved. You might find that you can concentrate on one thing for a longer length of time.

• A person that you don't get along with suddenly doesn't seem to be as irritating or triggering. You might suddenly be able to make headway with communication.

• A situation that has always made you anxious is now something you hold at arms' length, and sail through with a core feeling of calm. NOTE: If you take benzodiazepines, be alert to this change and start cutting back on the amount that you take (with your doctor's assistance) to avoid problems with addiction. (See Related Resources, above right.)

• You begin to separate sadness from depression. Something that has always made you depressed may now make you feel sad, but the sadness has a stopping point that you don't advance beyond, and the usual physical feelings that accompany the sadness - teariness, sick stomach, inability to think, numbness, etc. - are not present. The sadness goes away within a 24-hour period.

I crossed over from depression/mania into full remission eleven years ago, and these are all changes that I experienced when my medications finally clicked.

Bipolar is a very treatable disease with a fairly high treatment success rate. Keep in mind that the treatment goal that you are aiming for is FULL remission of symptoms, not just relief. Don't settle for less and work hard at it until you achieve that goal. Explore all available treatment options, even the ones that you don't particularly like (because sometimes the treatment you resist the most is the one that will work the best). If you feel that positive changes are occurring but you could be doing better, talk to the doctor about fine tuning your medication.

To achieve the goal of remission you need patience and perseverance, and it's something you have to make up your mind to commit to from the very beginning. Make up your mind that you will give each medication a full trial with numerous tweaks over a period of 3-6 months, and (barring any severe responses or allergic reactions) be determined to continue even if temporary unpleasant side effects appear in the first eight weeks of treatment. This initial period of therapy, when any temporary side effects will occur, is when you have to be tough and resilient and have good communication with your doctor.

A sad fact is that too many people become frustrated, lose patience with a medication and drop it before they give the side effects time to wear off and see if the treatment is workable. People who are impatient with side effects and drop their meds willy-nilly after only a few weeks rarely achieve treatment success.

Finally, it's impossible to underestimate the value of a good support system. If you can, find someone in your personal life that you can be mutually honest with - someone with body presence and a face you can actually read - and make that person an accountability partner. Call him/her whenever you feel like skipping a dose or doing something counterproductive. Of course, our forum is always available as well for support.

by PaulaHOST