Managing Medication Side Effects in Bipolar Disorder Treatment

With any medication, side effects can be difficult to navigate, bringing into question whether the benefits and efficacy of the drug outweigh the pitfalls. In the treatment of bipolar disorder, managing medication side effects, according to Julie Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, clinical professor of psychiatry and nursing at the University of Illinois at Chicago, can be a "game-changer." Following her session at Psych Congress 2022, Steering Committee member Dr Carbray talked with Psych Congress Network about how clinicians can work with their patients to manage medication side effects and better reach patient goals for treatment. 

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Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, is a clinical professor of psychiatry and nursing at the University of Illinois at Chicago. Dr Carbray holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago, and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana. Dr Carbray was recognized by the UIC community in 2008 by receiving the Karen Gousman Excellence in Nursing Award and the American Psychiatric Nurses Association’s (APNA) Best Practices in Outpatient Mental Health Nursing Award. In 2012, Dr Carbray was awarded the University of Illinois at Chicago’s Inspire award for her long-standing commitment to UIC values and her inspiration of others in her work, and in 2016, Dr Carbray was awarded the Distinguished Service Award by APNA for her service to the profession of psychiatric nursing.

Psych Congress Network: How can clinicians work with patients experiencing side effects that impact their daily life? How can these treatment plans better serve patient goals?

Dr Carbray: We all know that managing side effects of medications in the treatment of bipolar disorder can really be a game-changer. If a medication side effect really shuts down the ability of that drug to help a patient, we're boxed in. Meeting with our patients on a frequent basis, really deciphering with them what might be a side effect of the medication versus just an environmental effect or something that's coming outside of the potential psycho-pharmacologic side effects, is important. Sifting that through, and then weighing how important it might be for us to manage those side effects and keep the drug versus throwing this drug out because of the side effects.

There are many options for managing side effects, anything from increasing exercise to help with things like weight gain to increasing hydration just to help with concerns around dry mouth, for instance. But when it comes down to things like a fine tremor or sedation, sometimes they could be game-changers. We really do need to work with our patients together in discussing "how do we determine whether this is a drug we want to continue to manage? It has enough efficacy where managing side effects might be an option, or do we need to switch to a different agent?"