BY BETH CARSON, SHARECARE

Managing bipolar disorder is a balancing act—and often a difficult one. The trick is to smooth out the highs and lows and treat the flare-ups of depression or mania without tipping too far the other way. And because the way people will react to medications is unpredictable, diagnosis and treatment is a trial-and-error process.

The unfortunate result, research shows, is that people can end up taking many prescriptions at the same time.

Related: Learn about the different types of bipolar and out how doctors make the diagnosis.

How Many Meds is Too Many?
One study, conducted at Brown University and published in the journal Psychiatry Research, looked at 230 people who were admitted to a Rhode Island hospital for bipolar disorder in 2010. More than half of those patients were taking three or more bipolar medications, and 36 percent were taking four or more. Women were especially likely to be prescribed 4 or more psychiatric drugs—​including stimulants and anti-anxiety medications, considered controversial as treatments for bipolar disorder.

If you factor in the prescriptions patients were taking for other health problems, the average person was downing six different medications a day. 

While it’s not unusual for doctors to prescribe more than one drug to manage bipolar symptoms—one to manage mood shifts, for example, and another to relieve depression—the experts are concerned about the damage taking a large number of medications (called “complex polypharmacy”) could be doing to people’s overall health. For starters, the drugs could interact in unknown ways. The authors noted that no trial of bipolar medications has ever tested more than two drugs at a time in combination. And it can be hard for people to keep up with (and afford) all those medications, making their treatment more complicated and less effective.

Perhaps worst of all, the fact that the people in the study were hospitalized shows that their treatment wasn’t working.

Related: Try AskMD and find out what may be causing you to feel depressed or anxious.

Medication Not the Only Option
Medications are the cornerstone of bipolar treatment, but there are other ways to keep symptoms at bay and help lessen your dependence on multiple medications.

• Therapy or counseling. Speaking to a licensed professional is a great way to help manage your bipolar disorder. Psychotherapy offers support, education and guidance to patients with bipolar and their families. People with bipolar can also learn to manage day-to-day stressors that can trigger episodes, and learn to change negative or harmful thoughts and behaviors.
• Physical activity. Exercising helps to fight depression by releasing chemicals that promote psychological well-being. It also helps combat the weight gain that’s a potential side effect of many bipolar medications, improves quality of sleep—one of the most important aspects of managing your bipolar disorder—and it can help take the edge off of manic episodes.
• Writing. Someone in the throes of mental illness is often focused on the negative aspects of their diagnosis and their perceived lack of control over that illness. Journaling allows you to channel depressive or manic energy into a more positive outlet. It can give you perspective and help to lessen the pain of traumatic experiences.