Your most pressing questions about Bipolar 1 Disorder, answered by people who know

Upon being diagnosed with bipolar 1 disorder at the age of 24, Charlotte, a budding singer-songwriter, wasn't particularly angry, upset, or surprised. Her first thought after hearing the news? That makes sense. After three years of intense mood swings, severe insomnia, impulsivity, reckless behavior, fights with her family, and bouts of depression, Charlotte now had an explanation for the way she had been feeling and acting.

Bipolar disorder is a brain disorder that causes changes in a person's mood, energy, and ability to function. An estimated 1 percent of adults in the United States are living with bipolar 1—the specific type of bipolar that Charlotte was diagnosed with. The symptoms of this condition can include, but are not limited to, extreme swings between emotional states of manic/hypomanic highs (abnormally happy or irritable mood) and depressive lows (sad mood). These swings are commonly referred to as mood episodes, and often begin in the early to mid 20s. When it comes to seeking treatment, the stigma that exists around this condition can make it difficult for those experiencing symptoms, and for those caring for a loved one with symptoms, to know how to proceed.

The three years before Charlotte's diagnosis were challenging, frightening times for her and her family. Now that she and her mother, Kim, are on the other side of the uncertainty, they want to share their experiences confronting bipolar 1 to help others. Cosmopolitan sat down with the mother-daughter duo, as well as Charlotte's mental health care provider, Richard Louis Price, M.D., to discuss what living with this condition is really like.

What does it feel like to have bipolar 1 but not know it?

Charlotte: It feels like alternating between the highest highs and the lowest lows with no control. For me, the lows came first. I was sleeping for 20 hours a day and feeling extremely numb. I stopped playing my guitar, stopped singing—I had no creativity whatsoever. I quit my job and isolated myself from my friends. My social anxiety was through the roof. If I did go out with people, I'd have to drink so much to feel normal, even around my best friends.

But then my mood would flip all the way around. When I first started experiencing symptoms of mania, I didn't realize what was going on. I thought, Oh, I'm finally being normal. I'm not depressed anymore. It was thrilling at first. Writing songs was easier than ever; they just flowed out of me whenever I picked up the guitar. I'd play for hours every day. But it was an extreme, destructive euphoria that also included stealing from stores, driving recklessly and getting into car crashes, smoking and drinking a lot—I couldn't stop myself from doing these things. A lot of furniture was broken in our house. I'd have terrible fights with my parents, punch walls, and scream until I lost my voice.

How can I help someone struggling with their mental health—especially if I don’t know what the issue is?

Kim: The three years before Charlotte's diagnosis were confusing for all of us. She was being extremely reckless, continuously engaging in risky behaviors, and doing things that were out of character for her. Bipolar 1 doesn't run in my family or my husband's and we were not familiar with the illness. How could our daughter have this condition? Initially we were in denial, but understood that the first step in being able to help someone is overcoming that innate refusal to admit that something is wrong.

We had to do something. Without notice, I drove to pick her up. When we got in the car, I told her, 'I'm going to take you to the hospital.' Charlotte looked at me and said, 'I think that's a good idea.' It was very calm. We drove to the hospital and went to the emergency room. Charlotte was admitted to the hospital. We both knew that we couldn't do this anymore.

What are the first steps after diagnosis?

Charlotte: For anyone facing bipolar 1, it's important to surround yourself with a strong support system. We all need people to be there for us. Another thing that helped me was establishing a schedule for myself. If you're doing nothing during the day, it's easy to spiral in either direction—up or down. And you need a good night's sleep. Making a commitment to sleeping a normal amount each night has helped a lot.

Kim: When your loved one is taking these first steps, it's important to remain patient and supportive, and try not to trigger them. Love them. Listen to them. But at the same time, seek professional help. Once we got the help we needed, things improved.

Charlotte: To get the help I needed, I had to figure out a treatment regimen that worked for me. I found a healthcare provider I trusted, and together we discussed treatment options to figure out what could help me manage my symptoms.

What is the process of finding the right medication for yourself?

Kim: Charlotte and I both knew that finding the right medication for her condition was a journey best taken with the guidance of Dr. Price, Charlotte's psychiatrist. She began treatment with medication, but it was hard to find one that worked for her. One medicine helped to reduce her bipolar 1 symptoms; but, unfortunately, it came with side effects she couldn’t tolerate. We discussed our concerns with Dr. Price and together, we engaged in open and informed discussions about other potential treatment options. One of the treatment options he told us about was LYBALVI® (olanzapine and samidorphan).

A note about LYBALVI: LYBALVI is an oral prescription medication used in adults to treat manic or mixed episodes that happen with bipolar 1 disorder, either alone for short-term (acute) or maintenance treatment or in combination with valproate or lithium. LYBALVI is also used in adults to treat schizophrenia. It is not known if LYBALVI is safe or effective in children. It's important to note that LYBALVI may cause serious side effects, including increased risk of death in elderly people with dementia-related psychosis. LYBALVI increases the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). LYBALVI is not approved for the treatment of people with dementia-related psychosis. Please read additional Important Safety Information below.

Charlotte: Since starting LYBALVI, I've noticed improvement in my bipolar 1 symptoms and I have been able to manage the side effects. Working collaboratively with Dr. Price helped me get to this point of finding a plan that works for me. However, this is just my experience, so it's important to talk with your healthcare provider about what may work for you.

It's important for me to stay consistent in managing my condition. I take my medication as prescribed, meet regularly with my doctor, and stay on top of the other things that keep me healthy, such as exercise, healthy eating, staying active with my music, and striving to stay hopeful and positive. I make an effort to remember why focusing on my health is important.

After hearing Charlotte and Kim's story, we had an opportunity to speak to Charlotte's mental health care provider, Richard Louis Price, MD, about the things he wants everyone to know about bipolar 1 after his years of diagnosing and treating the condition.

What are the signs that people should look for when questioning if their symptoms may be related to bipolar 1?

Dr. Price: There are certain signs of mania that are observed primarily in bipolar 1 and not in other mood disorders, such as remaining highly energized on little sleep without the influence of stimulants, or intense hypersexuality that seems out of character. In my experience, bipolar 1 is best observed over a longer period of time where you can document the up-and-down mood swings; these fluctuations are the primary characteristic of the condition.

Do these mood swings present themselves the same way in everyone with the disorder?

Dr. Price: No two people present with bipolar 1 in the same way—it's a spectrum. For example, the mania component of bipolar 1 could lead to delusions and hallucinations, which could require hospitalization. Or, someone with bipolar 1 might remain highly functional while still existing in this unhealthy state. The mood episodes ("ups" or "downs") that people with bipolar 1 experience can be chronic (persistent or constantly reoccurring) or episodic (occurring occasionally and at irregular intervals).

Getting the right diagnosis and helping patients find treatment that works for them is important because the results of getting it wrong can be damaging.

What is the role of the caregiver in the treatment process?

Dr. Price: I believe that many people in our society lead already stressful lives. Having a loved one who is living with bipolar 1 can add to that stress, unintentionally placing a burden on the person living with the condition, which could make things more difficult. To me, the role of caregivers in the treatment process is to create an environment where everyone understands that having bipolar 1 is not a personal failing. My hope is for families to understand that being more accepting, tolerant, loving, and understanding will help everyone involved.

If I'm diagnosed with bipolar 1, won't medication change my personality?

Dr. Price: With medication, people may feel as though they've lost their 'high' (manic state), but what we need to remind everyone is that mania isn't a healthy state, and that what they're feeling now is a much more manageable state. One of the most exciting parts of my job is helping people figure out their treatment routine and helping them work towards their treatment goals, whatever those may be.

If you or a loved one is living with bipolar 1, talk to a healthcare professional. To learn more about LYBALVI, visit lybalvi.com.

Please read the Important Safety Information about LYBALVI below. See Prescribing Information and Medication Guide.

This is perspective from Charlotte, Kim, and Dr. Price and does not represent the opinions of all patients, caregivers, or healthcare professionals. The information included is not a substitute for professional medical advice. Always talk to your healthcare provider. Intended for US audiences only.

INDICATIONS AND IMPORTANT SAFETY INFORMATION

LYBALVI is a prescription medicine which contains 2 medicines (olanzapine and samidorphan) used in adults:

• alone for short-term (acute) or maintenance treatment of manic or mixed episodes that happen with bipolar I disorder
• in combination with valproate or lithium to treat manic or mixed episodes that happen with bipolar I disorder
• to treat schizophrenia

It is not known if LYBALVI is safe or effective in children.

LYBALVI may cause serious side effects, including increased risk of death in elderly people with dementia-related psychosis. LYBALVI increases the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). LYBALVI is not approved for the treatment of people with dementia-related psychosis.

Do not take LYBALVI if you are taking opioids or are experiencing acute opioid withdrawal.

LYBALVI may cause serious side effects, including:

• Stroke (cerebrovascular problems) in elderly people with dementia-related psychosis that can lead to death.
   
• Opioid withdrawal. Do not take LYBALVI for at least 7 days after you stopped taking short-acting opioids and for at least 14 days after you stopped taking long-acting opioids. One of the medicines in LYBALVI (samidorphan) can cause opioid withdrawal that may be severe and cause hospitalization in people who are physically dependent on opioids. Talk to your healthcare provider if you have questions about the type of opioid you take.
   
• Risk of life-threatening opioid overdose. You should not start taking opioids for at least 5 days after you stop treatment with LYBALVI. One of the medicines in LYBALVI (samidorphan) can increase your chance of having an opioid overdose that can cause death if you take opioids during treatment or within 5 days after stopping treatment with LYBALVI.
  
  You can accidentally overdose in 2 ways:
  • LYBALVI blocks the effects of opioids, such as heroin, methadone, or opioid pain medicines. Do not take large amounts of opioids to try to overcome the opioid-blocking effects of LYBALVI. This can lead to serious injury, coma, or death.
  • After you take LYBALVI, its blocking effect slowly decreases and completely goes away over time. You may be more sensitive to the effects of opioids. If you have used opioid street drugs or opioid-containing medicines in the past, using opioids in amounts that you used before treatment with LYBALVI can lead to overdose or death.

It is important that you tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose.

• You or someone close to you should get emergency medical help right away if you:
  • have trouble breathing
  • become very drowsy with slowed breathing
  • have slow, shallow breathing (little chest movement with breathing)
  • feel faint, very dizzy, confused, or have unusual symptoms

Tell your healthcare provider if you are taking LYBALVI before a medical procedure or surgery.

• Neuroleptic malignant syndrome (NMS), a serious condition that can lead to death.
  Call your healthcare provider or go to the nearest hospital emergency room right away if you have some or all of the following signs and symptoms of NMS:
  • high fever
  • stiff muscles
  • confusion
  • sweating
  • changes in your breathing, heart rate, and blood pressure

• Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): One of the medicines in LYBALVI (olanzapine) can cause DRESS, which can cause death. Tell your healthcare provider right away if you develop any of the following symptoms of DRESS, including:
  • rash
  • swollen glands
  • liver problems
  • heart problems
  • fever
  • kidney problems
  • lung problems
     
• Problems with your metabolism such as:
  • high blood sugar (hyperglycemia) and diabetes. Increases in blood sugar can happen in some people who take LYBALVI. Extremely high blood sugar can lead to coma or death. Your healthcare provider should check your blood sugar before you start and regularly during treatment with LYBALVI.
    
    Call your healthcare provider if you have any of these symptoms of high blood sugar during treatment with LYBALVI:
    • feel very thirsty
    • feel very hungry
    • feel sick to your stomach
    • need to urinate more than usual
    • feel weak or tired
    • feel confused, or your breath smells fruity
       
  • increased fat levels (cholesterol and triglycerides) in your blood. Your healthcare provider should check the fat levels in your blood before you start and regularly during treatment with LYBALVI.
  • weight gain. You and your healthcare provider should check your weight before you start and often during treatment with LYBALVI.
     
• Uncontrolled body movements (tardive dyskinesia). LYBALVI may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop taking LYBALVI. Tardive dyskinesia may also start after you stop taking LYBALVI.
   
• Decreased blood pressure (orthostatic hypotension) and fainting. You may feel lightheaded or faint when you rise too quickly from a sitting or lying position.
   
• Falls: LYBALVI may make you sleepy or dizzy, may cause a decrease in your blood pressure when changing position (orthostatic hypotension), and can slow your thinking and motor skills, which may lead to falls that can cause fractures or other injuries.
   
• Low white blood cell count. Your healthcare provider may do blood tests during the first few months of treatment with LYBALVI.
   
• Difficulty swallowing that can cause food or liquid to get into your lungs.
   
• Seizures (convulsions).
   
• Problems controlling your body temperature so that you feel too warm.
   
• Increased prolactin levels in your blood. Your healthcare provider may do blood tests to check your prolactin levels during treatment with LYBALVI.

The most common side effects of LYBALVI when used to treat people with schizophrenia include:

• weight gain
• dry mouth
• sleepiness
• headache

The most common side effects of LYBALVI when used to treat people with mixed or manic episodes that happen with bipolar I disorder include:

• weakness
• constipation
• sleepiness
• shaking
• dry mouth
• increased appetite
• dizziness

The most common side effects of LYBALVI when used in combination with lithium or valproate to treat people with mixed or manic episodes that happen with bipolar I disorder include:

• dry mouth
• increased appetite
• back pain
• problems speaking
• memory problems
• weight gain
• dizziness
• constipation
• mouth watering
• numbness and tingling in your arm and legs

Do not drive a car, operate machinery, or do other dangerous activities until you know how LYBALVI affects you. LYBALVI may make you feel drowsy.

Avoid drinking alcohol during treatment with LYBALVI.

Avoid getting over-heated or dehydrated.

• Do not exercise too much.
• In hot weather, stay inside in a cool place if possible.
• Stay out of the sun. Do not wear too much clothing or heavy clothing.
• Drink plenty of water.

Before taking LYBALVI, tell your healthcare provider about all of your medical conditions, including if you:

• have or had heart problems or a stroke
• use or abuse street (illegal) drugs
• have or had low or high blood pressure
• have kidney problems
• have diabetes or high blood sugar or a family history of diabetes or high blood sugar
• have or have had high levels of total cholesterol, LDL cholesterol, or triglycerides or low levels of HDL cholesterol
• have or had a low white blood cell count
• have problems swallowing
• have or had seizures (convulsions)
• have or had problems with urination or prostate problems
• have or had breast cancer
• have or had constipation or a bowel obstruction
• have or had high prolactin levels
• are pregnant or plan to become pregnant. Talk to your healthcare provider about the risks to you and your unborn or newborn baby if you take LYBALVI during pregnancy. 
• are breastfeeding or plan to breastfeed. LYBALVI passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with LYBALVI.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

LYBALVI and other medicines may affect each other causing possible serious side effects.

LYBALVI may affect the way other medicines work, and other medicines may affect how LYBALVI works.

Especially tell your healthcare provider if you:

• take opioids or have stopped taking opioids in the past 14 days
• take or plan to take other olanzapine containing medicines

Your healthcare provider can tell you if it is safe to take LYBALVI with your other medicines. Do not start or stop any medicines while taking LYBALVI without first talking to your healthcare provider.

Tell your healthcare provider if you take a urine drug screening test because LYBALVI may affect your test results. Tell those giving the drug screening test that you are taking LYBALVI.

These are not all the possible side effects of LYBALVI.

Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Please see full Prescribing Information, including Boxed Warning, and Medication Guide.

LYBALVI® (olanzapine and samidorphan) is available as 5 mg/10mg, 10 mg/10 mg, 15 mg/10 mg, and 20 mg/10 mg tablets.

ALKERMES® is a registered trademark of Alkermes, Inc. LYBALVI® and logo are registered trademarks of Alkermes Pharma Ireland Limited, used by Alkermes, Inc., under license. ©2024 Alkermes, Inc. All rights reserved. LYB-002688