During an acute and severe manic episode, a doctor is likely to treat mania more aggressively, perhaps by taking the following steps:

  • Prescribing substantial doses of medications such as Abilify or Seroquel.
  • Using loading doses of Depakote to reduce acute mania more rapidly. A loading dose is a higher initial dose than normally prescribed. Loading doses are used to ramp up a medication to a therapeutic level more rapidly.

These more aggressive interventions for mania are often performed in hospital. When providing outpatient treatment, doctors usually ramp up these medications more slowly to reduce side effects. Lamictal, which is used to prevent mood cycles, requires many weeks to reach a therapeutic level because of the risk of a skin condition that is much lower if the doses are increased very slowly.

Antidepressants are another story. Routinely, patients are told that they won’t be likely to experience any benefits from their antidepressants for at least a few weeks. Sometimes it can take much longer, and doctors rarely, if ever, suggest what to do in the meantime. Patients are often expected to tough it out. And if the person complains, the doctor often advises them to “BE PATIENT.” Easier said than done in the midst of debilitating depression.

So, what can you do in the meantime to start feeling better right away? Consider the following strategies:

  • Use your non-medication interventions aggressively during this time. Engage fully with your therapist to identify ways to reduce environmental mood triggers, increase the availability and effectiveness of your support network, and improve your coping skills.
  • Sometimes the doctor can prescribe shorter acting medications to address associated symptoms, such as anxiety/panic or insomnia. Benzodiazepines, such as Xanax, can be used judiciously to more rapidly reduce acute anxiety symptoms, and then be tapered off as the antidepressants or anti-manic agents kick in. Similarly, medicines to help you sleep can be quite beneficial early on in the process while waiting for antidepressants or anti-manic agents to take effect.
  • Communication with your prescriber is the key to developing the most effective strategy. Keep asking for help and utilize your therapist as well as your doc – ask whether they can speak to each other to more effectively coordinate your care and come up with ideas to help you manage during the medication trials.

Important: If risks of self harm or hurting someone else are present, then hospitalization or day treatment may be necessary while the medications are being adjusted. You and your doctor must continue to monitor the level of your safety and risk throughout these medication trials.