Managing Medication Dosage for Bipolar Disorder: Key Considerations

I would like to inquire about medication dosage?

Hello, Doctor.
The medications I am using are EPINE F.C.
Tablets 25mg and Wan You Ting Capsules 30mg.
I should be considered as having bipolar disorder, but I have been improving recently.
When I visited the doctor, he mentioned that I could appropriately reduce the dosage.
I was advised to cut the first tablet into a quarter or half.
The doctor also indicated that Wan You Ting can be split in half, but at that moment, I refused because I thought it would be a hassle.
However, I found that taking Wan You Ting leads to shorter sleep duration and side effects such as nausea and headaches.
Previously, I was taking one whole tablet of each of these two medications along with another one that I forgot.
When I took the first tablet alone, I would wake up in the middle of the night.
So, I would like to ask if these side effects could be alleviated by taking a higher dose? Additionally, if I want to reduce the capsule dosage by half, what precautions should I take?

mister, 20~29 year old female. Ask Date: 2021/12/06

Dr. Zhang Gengjia reply Psychiatry

Dear Sir/Madam,
From your letter, it is evident that you are experiencing discomfort and distress due to suspected bipolar disorder and physical ailments.

1.
Facing an uncertain future, psychosomatic disorders, such as bipolar disorder, are common in modern society.
This is a chronic condition that requires long-term treatment for recovery.
2.
Bipolar disorder is a chronic illness characterized by episodes of mania and depression, as well as periods of remission and relapse.
More than half of patients may experience a recurrence of symptoms even after they have improved.
Due to individual differences in physiology, it may take time to determine the most suitable medication, so please be patient and cooperate with your physician.
3.
In terms of pharmacological treatment, each primary medication typically requires 4 to 6 weeks to assess its efficacy.
If you experience any adverse symptoms, it is advisable to note the duration and frequency of these symptoms and discuss them with your physician.
4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment that does not require anesthesia, has a high safety profile, and does not necessitate hospitalization.
It can improve anxiety and depressive moods.
For patients with treatment-resistant depression or poor medication response, rTMS has shown significant improvement in depressive symptoms after treatment.

Please discuss any psychosomatic issues thoroughly with your physician during your follow-up appointment, as some symptoms may be related to the original condition, while others may be side effects of the medication (such as Wen Yao Ting).
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
I recommend considering a visit to have your symptoms personally evaluated by a physician, so that we can collaboratively determine the best course of action for you.
Wishing you mental and physical well-being.
Sincerely,
Dr.
Chang Geng-Jia
Department of Psychiatry

Reply Date: 2021/12/06

More Info

Managing medication for bipolar disorder, particularly when considering dosage adjustments, is a critical aspect of treatment that requires careful attention to both efficacy and side effects. In your case, you are currently taking EPINE F.C. Tablets (25 mg) and Wan You Ting (30 mg), which is known to be an antidepressant. It’s important to understand how to manage these medications effectively, especially when you are experiencing side effects such as nausea, headaches, and changes in sleep patterns.

Key Considerations for Managing Medication Dosage
1. Consultation with Your Healthcare Provider: Before making any changes to your medication regimen, it is essential to have a thorough discussion with your healthcare provider. They can provide guidance on how to taper your medications safely and monitor your response to any changes. Since your doctor has suggested reducing the dosage, it’s crucial to follow their advice and not make changes independently.

2. Understanding Dosage Adjustments: When your doctor recommends reducing the dosage, it is typically to minimize side effects while maintaining therapeutic efficacy. For instance, if you are cutting the EPINE tablet into quarters or halves, ensure that you are doing so accurately to avoid underdosing or overdosing. Many medications can be split, but it’s important to confirm this with your pharmacist or doctor, as some formulations are not designed to be divided.

3. Monitoring Side Effects: As you reduce your dosage, keep a close eye on any side effects you experience. The nausea and headaches you mentioned could be related to the medication itself or the adjustment in dosage. If these symptoms persist or worsen, it’s important to report them to your healthcare provider. They may need to adjust your treatment plan further.

4. Sleep Patterns: Changes in sleep can be a common side effect of medications used to treat bipolar disorder. If you find that your sleep is disrupted, it may be worth discussing with your doctor. They might consider adjusting the timing of your medication or exploring other options to help manage your sleep disturbances.

5. Gradual Tapering: If you decide to reduce the dosage of Wan You Ting, it’s generally recommended to do so gradually. Abrupt changes can lead to withdrawal symptoms or a resurgence of mood symptoms. Your healthcare provider can help you devise a tapering schedule that minimizes risks.

6. Lifestyle Considerations: Alongside medication management, consider incorporating lifestyle changes that can support your mental health. Regular exercise, a balanced diet, and good sleep hygiene can all contribute positively to your overall well-being and may help mitigate some side effects.

7. Support Systems: Engaging with support groups or therapy can provide additional coping strategies and emotional support as you navigate your treatment. Having a support system in place can be invaluable during times of medication adjustment.

Conclusion
In summary, managing medication for bipolar disorder requires a collaborative approach with your healthcare provider. It’s essential to communicate openly about your experiences with side effects and any concerns you have regarding dosage adjustments. By working together, you can find a treatment plan that effectively manages your symptoms while minimizing adverse effects. Remember, it’s not advisable to increase your dosage in hopes of alleviating side effects without professional guidance. Always prioritize safety and open communication with your healthcare team.

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