What to do when bipolar medications stop working?

Question

Hi doctor,

I was diagnosed with bipolar II about three years ago. I have been taking Lamotrigine and Sertraline, but lately, I have been feeling low again. It is that deep, foggy kind of sadness that would not lift. I am sleeping too much, I cannot focus, and I just feel flat.

I am scared to switch medications because the last time I did, it triggered a hypomanic episode. I just want to find balance.

How do you even know when a medication stops working?
I have read about light therapy and TMS. Do they actually help?

I see a therapist weekly, which is helpful, but it is still hard to keep up with work and social obligations. I just want to feel normal again, even for a little while.

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

I completely understand how exhausting it can feel to go through these low phases again, especially after you have been working hard to maintain your stability and take care of yourself.

Living with bipolar II is incredibly challenging, and even when you’re doing everything right, depressive waves can still return. The foggy sadness, oversleeping, and difficulty focusing that you describe are classic signs that your current combination of mood stabilizers and antidepressants may no longer be fully effective.

Sometimes, medications lose their effectiveness over time, a phenomenon known as tachyphylaxis, or your brain chemistry may shift slightly, altering how your body responds. This does not always mean you need a complete medication switch, but your psychiatrist might consider adjusting dosages or adding another mood stabilizer or adjunct therapy while closely monitoring for signs of hypomania.

Light therapy and transcranial magnetic stimulation (TMS) are promising options, especially for bipolar depression that doesn’t respond well to medication alone. Light therapy can be beneficial if your symptoms worsen during darker months or in the mornings, although it should be used cautiously under medical supervision to prevent triggering hypomania.

On the other hand, TMS is a noninvasive treatment that uses magnetic pulses to stimulate brain areas involved in mood regulation and can effectively alleviate depressive symptoms with minimal side effects.

It is good to know that you are continuing therapy, as consistent support plays a significant role in managing the emotional ups and downs and helping you build coping strategies for daily life.

Your self-awareness and determination, despite the weight of these feelings, demonstrate real strength. Please reach out to your psychiatrist soon to discuss the changes in your mood so you can adjust your treatment plan before things worsen.

With the right combination of care, it is possible to regain that sense of balance and lightness.

I hope this answers your query. Feel free to reach out anytime.

Thank you.