Daria Lewis, FNP, DNP, shares insights on medication switching for patients with bipolar disorder, and advice on working with patients in managing their psychiatric medications. In order to start working with patients on a medication plan, Lewis says she wants to connect with patients to help them understand that even if they are functioning, their medication will help them get through their day as best as possible. Ensuring providers are on the same page as the patient in terms of treatment goals and plans is an essential part of the collaborative care aspect that Lewis focuses on. If a patient has been living with the symptoms of their disorder for an extended period, this can become a normal functioning pattern for them, Lewis says, but clinicians should help the patient understand that medication can help improve daily function.
After starting a medication, if a change is needed, Lewis prefers to see patients after about 2 weeks to catch any potential side effects that could signal the new medication is a poor fit. With the growth of digital tools like video call and Google Voice, clinicians are able to quickly meet with patients to check in more often and more easily.1 Especially with bipolar disorder and the lack of insight patients deal with, having virtual meetings can allow individuals close to the patient to have input on medication efficacy and connect with the clinician. Patients may be adamant that they are functioning well, but need to have the outside perspective from others showing them that they could be doing better.
Letting patients know what adverse effects they may experience and titrating medications when switching are good ways to help prepare the patient for new medications, Lewis says. If patients struggle to take medications orally every day, Lewis recommends discussing long acting injectables (LAIs).2 “A lot of times there can be the misconception that an injection is a punishment, and that is not the case,” Lewis notes. If the patient can be relieved of the daily responsibility of taking a pill, Lewis will discuss the option of LAIs and emphasize the benefit of the patient not having to think about taking a pill every day. Lewis adds “for a vast majority of my patients, it is not a one time conversation” about LAIs, and that this type of medication requires trust and connection between patient and provider.
References
1. Molfenter T, Heitkamp T, Murphy AA, Tapscott S, Behlman S, Cody OJ. Use of telehealth in mental health (MH) services during and after COVID-19. Community Ment Health J. 2021;57(7):1244-1251.
2. Bartoli F, Cavaleri D, Nasti C, et al. Long-acting injectable antipsychotics for the treatment of bipolar disorder: evidence from mirror-image studies. Ther Adv Psychopharmacol. 2023;13:20451253231163682.