When Should I Call My Doctor Between Appointments?

Managing Bipolar Disorder

Phone now

I know, taking your regular medication and attending your routine appointments with your psychiatrist just to keep your bipolar disorder in check can feel burden enough. Still, if you're managing bipolar disorder, or love someone who is, it won't be long before a circumstance may arise between appointments that warrants a call to the psychiatrist. I tell my patients never to hesitate to contact me, but I find that many still do.

Oftentimes, they spend a good deal of time wondering if this is one of those situations that warrants contacting the doctor between appointments. If you're even wondering, it's probably worth the call to your doctor's office (or however you & your doc have arranged for contact between appointments). Patients who are managing bipolar and are encouraged to contact their providers between visits have better outcomes! Worst case scenario if you do call, is that the call was unnecessary, but you'll be able to stop weighing out whether or not you ought to call. So there's some pretty big upside. Worst case scenario if you don't call can be a mood exacerbation, a serious medical consequence, or worse.

When to Call

But, it's still tough to figure out when to make that call sometimes. So, to make it easier, here's a short-list of circumstances that should prompt a call to your psychiatrist's office:

1. You're having thoughts of hurting yourself or someone else. 

This one is the biggest deal there is when managing a psychiatric illness, especially one like bipolar disorder that, unfortunately, has a high rate of suicide attempts and deaths by suicide. It can't hurt to mention it again (and again).

Technically, and this is very important, if you're having thoughts of self-harm or thoughts of harming others, you should call 911 and/or go to your nearest emergency room first, then phone your doctor's office, so they can assist with your care. You can never, ever, be too careful with your safety.

2. You've run out of medication or realize you're going to run out of medication before your next appointment. 

Maybe you left a few tablets in a handbag somewhere. Or maybe your doc wrote the prescription for too short a time period. The most important point is that finding the right medication balance for the best treatment of your bipolar illness, you probably know all too well, takes work, patience, and perseverance. Missing medication is highly likely to dismantle the work you've put in, and precipitate a mood episode.

3. You're not sleeping or sleeping less at night. 

Most people know decreased need for sleep is a common feature of manic episodes (though not present in manic episodes experienced by every single patient, of course).

Many people are also aware that manic episodes can actually be triggered by decreased sleep (so the causality can be reversed, as well). It's extremely important to remember that a reduction in the number of hours slept, whether it's due to jet lag, or a new baby at home waking throughout the night, can quickly produce manic symptoms. Again, even if the initial cause for decreased sleep was not mania or hypo-mania, decreased sleep can quickly generate a manic episode. Once mania gets underway,  it has a tendency to ramp up quickly. So, it may be useful to get in the habit of calling your doc any time you notice a change in your sleep pattern, particularly if you have gotten less sleep than your baseline. NAMI offers a discussion board on sleep and bipolar disorder that can serve as a further resource.

4. You've experienced a loss or major stressor.

Of course, for each person, a major life event will be defined differently. For one person, it could be a break-up or divorce. For another, it could be the death of a much loved pet. And for someone else, a devastating event could be career setback. Management of bipolar illness isn't just about medication. Mood episodes can, for most people, be prompted by life events, too. Particularly those life events that just about anyone might benefit from some psychotherapy to help them process and cope better with. Around these times, a medication adjustment may be of help as well. The most important thing to remember is that if something emotionally taxing occurs between appointments, it's worth it to ring your doctor and make sure you're doing all you can to feel your best and that it doesn't contribute to destabilization of your illness.

5. You've experienced a positive major life event.

So this one may not be that obvious. Oftentimes it's not the first thing we think of, but major life events, even positive ones, like a promotion at work, a proposal from a loved romantic partner, may be just as positive as they seem, but they may also come with a dose of anxiety or simply change. There are few major life events, in fact, even those we very much want, that come without change. A promotion at work, while longed for and well deserved, may also mean more responsibility. A proposal may mean a wedding to plan (depending on who you are, that may be great, awful, or a bit of both) and in-laws to deal with. These are important times to give some serious thought to calling your psychiatrist to strategize, discuss managing increased stress, different hours, or anxiety that may accompany your good news, as well as to review and identify any pitfalls you could see arising in your new circumstance, and how you would plan to manage them if they arose. The key is that you'll be a significant step ahead if you discuss this before you have any mood exacerbations.

6. You're pregnant or planning to become pregnant.

Because a number of medications that are used to treat bipolar illness should be avoided in pregnancy, or alternative medications should be considered, and bipolar disorder confers a risk of peripartum (during pregnancy) as well as postpartum anxiety, depression,and psychosis, it's vital to consult with your doctor around a pregnancy. Ideally, this would be reviewed before you became pregnant. Before conceiving is the optimal time to make changes to medications if necessary, and review the right monitoring schedule and signs to look out for during pregnancy, in particular. 

If you've become pregnant or suspect you have (for instance if you've missed a period and/or had a positive home pregnancy test), it's essential that you contact your psychiatrist's office so that the right steps for keeping you and your baby as healthy as possible can be undertaken as quickly as possible. A Lancet article summarizes this nicely. 

7. You're wondering if you ought to phone your doctor.

In most cases, when a person is struggling with whether or not to phone their psychiatrist, as mentioned at the beginning of the post, they've got a pretty good reason to be thinking calling might be the right way to go. So instead of agonizing, or missing an important opportunity to preserve your health, I would go ahead and make the call!

Final Thoughts

Of course, the above isn't a comprehensive list of all the circumstances in which any person managing bipolar illness should call their psychiatrist, but it might serve as a good cheat sheet for you, or a conversation starter between you and your physician surrounding which circumstances, in your particular case, should prompt a phone call.

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