Have you ever wondered if your over-the-counter pain aid or the dietary supplements you take for your health could interact with the medication you are taking to help manage bipolar disorder? Surprisingly, there are some items in your local pharmacy aisles and in the grocery store that could cause a problem with your prescribed bipolar meds — or any of your regular prescriptions for that matter.
How Common are Drug Interactions with Bipolar Medication?
Interactions with bipolar medications are fairly common, though not all are debilitating or life threatening. In some instances you might feel overly tired or like your heart is racing. Other times it could be more severe, especially for those that are taking more than one prescription.
A 2019 study conducted using a South Korean national database found that the predominant prescribing pattern in patients with bipolar disorder was multiple medications (known as “polypharmacy”).
Over 51% of patients were found to have “simple polypharmacy” regimens and “complex polypharmacy” was found to be prescribed in over 34% of patients.
Adding to the problem of possible drug interactions is the fact that many people with bipolar disorder also have one or more prescriptions for other health conditions.
When supplements and OTC medicines are added, the already high risk for an interaction is significantly increased because OTC medicines often contain ACTIVE substances.
What OTC Medications Could Result in a Drug Interaction?
The first thing to remember is that everyone is different. What might cause a drug interaction in you may not affect someone else.
This is why you must stay in contact with your mental health care provider and be completely open and honest about any medications you are taking. This includes any over the counter drugs and supplements.
Bipolar medications can include everything from mood stabilizers and anticonvulsants to atypical antipsychotics. Obviously, the type of bipolar disorder you are managing will determine the medication(s) you are prescribed.
This will play a role in what could cause a drug interaction.
There are prescribed medications that can interact with your bipolar meds and it is your responsibility to ensure that every health care provider you see is aware of all your prescriptions. This even includes medications that you have taken in the recent past, some can linger in your system for several days or even weeks.
What many people don’t think about are the supplements and over-the-counter remedies that are often a part of a daily routine.
3 (review of different herbal and supplemental drug interactions)
Herbal supplements are not currently regulated by the FDA and there are only a few studies on how they can affect bipolar medications. What is known are some of the common symptoms that indicate there could be a problem.
- Low or increased blood pressure
- Racing/rapid heart beat
- Excessive or abnormal bleeding
- Bipolar medications aren’t as effective
- Damage to the liver or kidneys indicated by pain or change in urine quantity/color
These are only a few of the symptoms that could signal an interaction with your bipolar medications. If you ever feel like something is “off” contact your primary mental health care provider. It is always better to be safe than risk your physical and mental health simply because you think that you might be overreacting.
Some of the OTC remedies and supplements that you might want to stay away from are:
- John’s Wort and Rhodiola rosea can cause mania. Nausea, vomiting and rising or falling blood pressure have been reported in patients that are also taking a SSRI.
4(serotonin syndrome in St. John’s Wort and SSRI use) It can also increase depression depending on the medications you are currently taking.
- Evening primrose oil can interact with Lamictal and some other anticonvulsants.
5(evening primrose oil lowers seizure threshold in patients taking anticonvulsants)
- Ginkgo biloba can reduce the effectiveness of Depakote.
If your type of bipolar disorder calls for an anticonvulsant or anti-anxiety medication you will want to stay away from the following since they have been linked to drowsiness,
6(drowsiness and muscle relaxation at high doses)
- Gotu kola
These supplements might not be as widely known as others but they are 3 that you should discuss with your physician or psychiatrist before adding them to your routine.
Over-the-counter remedies for everyday aches and pains can also interact with some bipolar medications. Ibuprofen, naproxen sodium, and other NSAIDs can counteract some medications or cause complications that could affect your mental and physical health.
This can be especially true if you are already taking Lithium.
Even aspirin can cause complications, along with some OTC remedies for stomach problems.
Other common non-prescription drugs that should not be taken with bipolar medications include,
- Medications for cough or the flu, they can interact with some antidepressants.
- Dextromethorphan often results in major interactions with most antidepressants.
You also want to watch out for OTC medications that contain guaifenesin, diphenhydramine
7 (CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors), and pseudoephedrine.
While not everyone will experience a drug interaction, it is something to be aware of. The best step is to ask a licensed pharmacist or your mental health care provider before you take an over-the-counter medication or add a supplement to your diet.
Getting informed first could prevent a potential drug interaction.
See here for more information on Bipolar medications.
What About Alcohol?
A cold beer, refreshing drink or glass of wine often sounds great, especially when you’re out with friends. However, alcohol can and often does interact with bipolar medications.
7 (CNS Depressants may enhance the CNS depressant effect of Alcohol)
The other thing you should be aware of is that alcohol is a depressant. Not only can you lose your normal inhibitions, it can cause or worsen depression.
Suicidal thoughts also aren’t uncommon and if this happens it needs to be addressed immediately.
Some other symptoms of bipolar disorder medications and alcohol interactions include sleepiness which will affect your ability to drive and even perform your job. Alcohol when mixed with some medications for anxiety can also dangerously slow your breathing down.
Since most medications prescribed for bipolar disorder affect the central nervous system and chemicals in the brain adding alcohol to the mix can cause or worsen certain side effects such as,
- Memory loss
7(lurasidone may enhance the CNS depressant effect of Alcohol)
- Poor judgement
- Loss of balance and increased risk of injuries
If you’re used to indulging in a few pints or glasses and have just been diagnosed with a type of bipolar disorder, it is important that you talk to your prescribing physician or therapist about your habits and how they could impact your treatment.
When it comes to illicit drug use, don’t. Not only is it dangerous, it is also illegal. Interactions are common, and for some they could be life threatening.
7 (Amphetamines may enhance the serotonergic effect of Serotonergic Agents (such as liithium). This could result in serotonin syndrome)
Can Certain Foods Interact with Bipolar Medications?
Did you know that some foods could trigger a mood swing?
Hopefully, your mental health care provider has already given you information on “diet and wellness” but not all pay attention to the possibility that what you eat could interact with the medications you are taking.
It is important to note that there is not a “bipolar diet” currently recommended and agreed upon by all physicians and psychiatrists, and what could interact or trigger an episode in one person may not apply to you.
Unfortunately, when it comes to food and diet it does depend on the individual. This could mean that you are stuck in a temporary period of trial and error.
Some foods that seem to cause problems more often than others include,
- Caffeine: For most people coffee, tea and other foods or beverages that contain caffeine are perfectly safe. However, the stimulant has been known to cause mania in some bipolar patients. It can interrupt normal sleep patterns and this can also lead to mood changes.This can negate the effects of some medications resulting in dosages being “upped” or the prescription being changed.
7(Caffeine and Caffeine Containing Products may decrease the serum concentration of Lithium) This often means new side effects and something else you need to “get used” too.
- Foods high in salt or just using the shaker liberally can be a problem if you are also taking Lithium. The medication can already cause high or low sodium levels, both of which are unhealthy. A condition known as “Lithium toxicity” can also develop, so be sure to talk with your prescribing physician if you are currently taking this medication.
1In general, adults typically require 1,500 to 2,300mg of salt per day but check with your physician before you make any dietary changes.
- If you have a “sweet tooth” it might be time to make a change. Sugar can not only exacerbate mood swings, regardless of your medication, there is the possibility that it can cause a metabolic condition that could be a precursor to diabetes.Unfortunately, if you are managing bipolar disorder you are already at risk and foods rich in sugar only increase your chances of developing this disease.
Rachel Bergmans, PhD, MPH, at the University of Michigan Medical School in Ann Arbor states, “So maintaining a healthy diet has the potential to benefit not only the symptoms of bipolar disorder but to reduce the burden of these co-occurring illnesses.”
Even if these, and other foods, do not necessarily interact with your medications the fact that they could cause a manic or depressive episode should open up a discussion about your current diet with your treatment team.
More information on foods to avoid can be found at: http://ibpf.org/article/foods-supplements-and-drugs-avoid-when-you-have-bipolar-disorder
You can also learn more about eating healthy and how it can help you manage your mood disorder at: https://www.bipolar-lives.com/bipolar-diet-ebook
Staying Safe and Healthy
It might seem like there is a list of foods, supplements, and OTC remedies that you have to watch out for, and for some people this is true. Interactions with bipolar medications do happen, more often than you might think.
Your best course of action is to discuss all medications, prescribed and over-the-counter, with your primary care giver.
It is also a good idea to keep a list of all the medicines and supplements you are currently taking with you. It’s easy to forget a supplement or something else not related to your bipolar treatment and that could be the one that causes an interaction.
Be completely honest about everything you are taking, and don’t be afraid to ask questions. After all, this is your mental and physical health.