If you are still not feeling well despite taking prescribed medications for 6 months, it is important not to seek a review with your doctor or psychiatrist. Sometimes medicines need dose adjustment or combination changes because each person responds differently to treatment. Your doctor may check blood levels of lithium and valproate to ensure they are within the correct range, as too low may not control symptoms and too high may cause side effects. It is also important to assess whether ongoing symptoms are due to depression, anxiety, mood instability, or side effects of medicines such as sedation or emotional dullness. Benzodiazepines, if used for a long time, can sometimes cause dependence or reduced effectiveness. Along with medicines, psychological therapies such as cognitive behavioural therapy, regular sleep routine, stress management, and avoiding alcohol or recreational drugs can help improve recovery. Do not stop or change your medicines on your own. A proper follow-up with your doctor will help adjust your treatment and safely improve your symptoms.

Lithium is an effective medicine for bipolar disorder, but during pregnancy, it must be used with careful medical supervision. Studies show a small increased risk of heart defects in the baby, particularly a rare condition called Ebstein anomaly (affects the tricuspid valve, which controls blood flow on the right side of the heart), mainly when lithium is taken during the first trimester. Some newborns may also have temporary problems such as feeding difficulty, low muscle tone, or thyroid and kidney issues after birth. Because of these risks, doctors monitor lithium blood levels closely during pregnancy, as they can change with fluid balance and kidney function. In some women, lithium may still be continued if the benefits outweigh the risks, but this decision must be guided by a specialist. Alternative options may include certain antipsychotic medications, such as quetiapine or olanzapine, or lamotrigine for mood stability in selected cases. Medicines like valproate are usually avoided in pregnancy due to the higher risk of birth defects. Careful planning before conception and regular prenatal check-ups, including heart scans of the baby, are very important.

A slightly low serum lithium level means that the amount of lithium in your blood is below the usual therapeutic range needed to effectively control mood symptoms. This may happen if a dose is missed, the dose is too low, or due to factors such as changes in kidney function, fluid intake, or interactions with other medicines. It is important not to adjust or stop your medication on your own. You should discuss this result with your doctor or psychiatrist. Your doctor may ask how regularly you take your medication and check for any recent changes in your routine, diet, or other medicines. Based on this, they might adjust your lithium dose or repeat the blood test to confirm the result. It is also important to continue regular monitoring of kidney function and thyroid function while on lithium. Taking the medicine at the same time each day and staying well hydrated can help maintain stable levels.