Why is Medication Not Enough?


Question: Why do some kids still have trouble even after they find medication that works? My daughter is 14 and has been stable for many months and now she is suddenly spiraling now for what seems like no reason.


Answer: Even when those who live with mood disorders or bipolar who are stable, ups and downs happen for a variety of reasons. There is a normal ebb and flow to these disorders and learning to recognize early signs that indicate a mood shift can reduce the likelihood that a full blown mood episode is imminent. It’s important to consider a reliable and secure system that assists in recording and tracking moods, medications, seasons, weather, temperature, and other factors which can contribute to mood variability*. 


An effective tracking system will help reduce the intensity, frequency, and longevity of bipolar symptoms over time. Using accurate and reliable data will provide the information doctors, therapists, parents, and patients need to make those evidenced based adjustments to treatment. 


Over the years people living with mood and bipolar disorders learn how their body responds to seasonal and weather changes. It has been noted how the changes in the season greatly impacts the specific type of mood episodes. For example, many adults living with bipolar will say they experience depressive episodes in the winter and in spring and summer they are more likely to experience hypomania or manic episodes. This isn’t true for all persons living with bipolar and there are some people where the reverse is true, summer ushers in a depressive episode and fall or winter provides an increase in energy. For others, temperature, humidity, and/or time of day play key roles in how their body responds to their environment. When a younger child or teenager is newly diagnosed with bipolar it takes time to learn and recognize these patterns. Being able to identify the patterns quickly is key to providing interventions that will lessen the impact of those changes. 


It’s common for parents of teenagers who live with a mood disorder and also have a menstrual cycle to observe fluctuations in moods based on where their child is in that monthly cycle. Discussing hormone therapy options (such as the “birth control pill”) with a prescribing healthcare provider, and having PRN medications during specific times in their cycle, can alleviate some of those symptoms. 


Puberty, regardless of gender, can be a time of rapid and intermittent growth spurts. These sudden changes in the brain and the body can contribute to significant shifts in stability to more pronounced disrupted mood episodes. Parents who are aware their child has entered into a growth spurt, or have observed traits consistent with the onset of puberty, can discuss with their child’s physical and psychiatric doctors what adjustments can be made to the treatment plan. 


In school the second semester, or second half of the school year, is a time of increased mood instability or dysphoric mood disturbances. The second half of the school year starts in the middle of winter, immediately following a break for the holidays, and in a season highly correlated with depressive mood episodes. This second semester in middle and high school is also typically a time of increased academic demands, which can be an overwhelming stressor. Parents and educators can work together to make appropriate accommodations in the 504 plan or IEP such as decreased or eliminated homework in order to help the student with a mood disorder be more supported and therefore more able to succeed. 


More often than not, multiple factors contribute to a spiral into a disrupted mood episode. Increased academic stressors, an argument with a best friend, changing brain and body chemistry, and fluctuating weather patterns could create “the perfect storm” and trigger a disrupted mood episode.


But without being able to track the mood changes and symptom presentation parents and patients may not realize that an episode of depression or overwhelming anxiety is about to descend, leaving the child and family unprepared.


Sometimes adjustments in medication are necessary, and sometimes non-pharmacological interventions, otherwise known as “lifestyle changes”, can be made that can make a big difference. 


During these times of increased anxiety, irritability, and mood instability, parents can decrease demands and lower expectations. 


One parent of a 16 year old daughter living with both bipolar and Fear of Harm shared that when she notices her child spiraling she treats her the same way she would a person who had come down with a purely physical illness like the flu. 


She allows her daughter to stay home from school, doesn’t expect her to do her chores, and tries to minimize stressors as much as possible. Many parents of kids with mood disorders, bipolar disorder, and FOH agree that minimizing stress and taking a break from school helps their child to reset and resume their typical schedule sooner, rather than attempting to push through a difficult episode.


Children learn to recognize when their brain and body need to rest, how to advocate for their needs, and what forms of self care work best for them. Modeling for children how to responsibly track their moods and then make adjustments using that data and evidenced based approaches gives them the opportunity to develop healthy skills that set them up to thrive throughout their lives.



*CMHRC offers members access to a daily tracking system that records customized symptom presentation and severity, medication compliance, overall behavior and mood, and weather. It’s called the Member Toolkit and can be accessed by anyone with an active CMHRC membership.

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