Britney Spears, 37, claimed to have bipolar disorder in her 2013 documentary I Am Britney Jean, however, it has never been publicly announced that she was officially diagnosed with the mental disorder. But the pop star’s longtime manager, Larry Rudolph, recently claimed he felt that Britney may never perform again because her “meds stopped working.” While it’s unknown exactly what “meds” he’s referring to, and why she was taking them, HollywoodLife spoke EXCLUSIVELY with Dr. Neeraj Gandotra, psychiatrist and Chief Medical Officer at Delphi Behavioral Health Group to explain what could happen if medications for a patient with bipolar disorder stopped working.
HL: Why does medication all of sudden stop working for some bipolar patients?
Dr. Gandotra: “This is a common challenge faced by psychiatrists and mental health professionals. There are a lot of things that can determine whether or not medications are going to be less effective. One reason might be if the patient doesn’t take the medication regularly. If they take the medication sporadically, then it can lose efficacy. Then they may not be able to perceive if it’s working well or not. More importantly, if they’re perceiving that it’s not working well, and the provider thinks they’re taking it as prescribed, they might get switched off of a medication and it may not have reached its therapeutic potential.
“Another reason might be that if a patient is taking a medication as prescribed, but there is a change in their metabolism in either their liver or their kidney. That change could be the result of a medical issue or something self-inflicted like they’ve taken some over-the-counter medication, or taken some drugs or alcohol. It could even be something as simple as drinking grapefruit juice which has been implicated with a number of medications because it affects the metabolism of a specific liver enzyme that is metabolizing that medication.”
HL: Is it possible a patient may never find a balance in medications working ever again?
Dr. Gandotra: “There are such a variety of medications. These medications can range from mood stabilizers, to the atypical anti-psychotics, anti-depressants, anti-anxiety medications, etc. We can find something that will work.”
HL: What are the affects to a bipolar patient when their medications stop working?
Dr. Gandotra: “I would never speculate to her prognosis without treating her, but bipolar disorder is a life-long illness. Bipolar disorder is considered to be a type of mood disorder. It’s a brain disorder that’s usually causing shifts in mood, energy, and activity levels, as well as difficulty in maintaining concentration. There are two poles in bipolar disorder. There is the depressive pole and a manic pole. It’s actually the manic pole that is the diagnostic criteria for bipolar disorder.
“A manic episode may include someone feeling ‘up,’ with lots of energy, decreased need for sleep, pressured speech, racing thoughts, they may be irritable or impulsive. They may be engaged in activities that others would perceive as reckless at the time, and the person would perceive as reckless after the fact that they may regret.”
HL: What can be done for a patient whose medications stop working?
Dr. Gandotra: “If they can recognize that their medications stopped working early enough, then they can work with their psychiatrist or prescriber on an outpatient level who can help modify the medications. However, if the patient has progressed to where the depression is so severe that they’re contemplating suicide, then medication modifications should occur in the hospital, as well as if they’ve already reached manic symptoms. If they’re at a danger of harming themselves or someone else than obviously they need to be in a more structured or controlled environment.”