Is emotional instability common in early bipolar treatment?

Question

Hello doctor,

I was diagnosed with bipolar II last year. I have long depressive phases when I cannot get out of bed, then suddenly I will have these bursts of energy when I overdo everything, spending, cleaning, and barely sleeping. I am on lithium and Lamictal but still feel emotionally unstable. Kindly answer my following questions:

Is that normal early in treatment?
Sometimes I get foggy or shaky. I am worried about my kidneys and thyroid with lithium. How often should I check laboratory reports?
Also, how do I know if therapy is helping or if I need medicine adjustments?

I just want to find balance again.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

The symptoms you are describing are actually a very common phase early in the management of bipolar II disorder. You are doing the right thing by staying on medication and staying observant about your symptoms. It is quite normal in the first six to 12 weeks of treatment for mood to fluctuate, especially in bipolar II.

Lithium is a mood stabilizer that helps control both hypomanic and depressive phases and reduces recurrence, and Lamotrigine (Lamictal) mainly targets the depressive side of bipolar disorder. If your mood is still fluctuating, the lithium level needs to be monitored. Psychosocial stressors also need to be addressed.

The cognitive fog or shakiness can be a mild side effect of lithium, often related to slightly high lithium levels, dehydration, caffeine, or missed meals. Kidney function and thyroid monitoring with lithium are also crucial for long-term safety.

Psychotherapy is a key part of long-term bipolar management. It helps regulate lifestyle, stress, and provides insight into early mood changes. You will know therapy is helping if:

You can recognize triggers or early signs of mood shifts better.
You are learning tools to manage impulses (like spending or sleeplessness).
Your relationships and daily routine start feeling more stable.

I suggest you follow these instructions:

Maintain consistent sleep and wake times.
Avoid alcohol and excessive caffeine.
Track your mood and triggers in an app or journal.
Maintain steady hydration, especially when taking lithium.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.