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Side effects can usually be reduced or gotten rid of, if the doctor knows about them and works with the patient to make sure they are properly treated.  For example, meds that induce sleepiness can be taken in the evening, and those that cause insomnia are probably better at breakfast.  A drug that causes nausea can be taken with food.   Doctors can also prescribe medications to block nasty side effects, or adjust doses of lithium or of anti-depressants to reduce the side effects to a level the patient can handle.   Sometimes the medication itself is the problem and your provider needs to prescribe something else. 

Medications for bipolar disorder may also appear not to work because they are not having an immediate effect on the patient's mood.  There are many reasons for this, of which the most common are described below.

1. There are often few clear improvements early in the treatment because many mood disorders medications can spend up to eight weeks moving through patients' bodies before the results become noticeable.  
2. The initial dosage may be too low.  Each person processes mood disorder medications differently; the same pill could manage to deliver its entire payload of medicine to one person's brain but only a small fraction to another.    Since the medication can only be effective if it has reached the brain, people who are not seeing an effect may need to increase their dosage so that more of the drug makes the whole trip.  
3. A particular combination of medications may not be appropriate for a particular patient.   In this case,  the doctor can prescribe different meds, or add new meds to your prescription, in order to treat mood swings effectively. 
4. Patients might not be following doctor's instructions and taking the medicine as prescribed.   Perhaps a patient has started to feel better, and stopped taking the medication as a result.  Perhaps they are forgetting to take the drugs on certain days, or the correct number of times each day.   Some useful memory-jogging techniques include the use of an alarm or pager, a pillbox to keep track of the drugs the patient has taken, or a daily schedule that includes the names and doses of medicines.  Habit-forming is also helpful -- patients can take medications at the same time each day, or during a specific daily event such as dinnertime,  a television show, or a morning getting-ready-for-work routine.  
5. The side effects of some medicines are so uncomfortable that people skip doses or stop taking their medication completely.   The medicines themselves may work, but their side effects may make the cure worse than the disease.   Sometimes the side effects are hard to tell apart from the symptoms of depression or mania, making it hard to know whether one is feeling the effects of illness or of the medication.
6. There can be interactions between different medications.  Patients who are getting treated for other diseases may find that the medications for those diseases  are diminishing the effectiveness of bipolar disorder drugs. For example, some medications may prevent others from reaching critical mass in the bloodstream, or cause your body to break them down and eliminate them before they've begun to  have an effect. 
7. Sometimes a medication fails because the patient has other diseases such as a brain injury, chronic fatigue syndrome, or thyroid problems,  which render the medication more difficult for the body to process.  A person who is getting older or going through menopause or menopause begins  to have different brain chemistry,  which may create the need for a new drug, or for a different dose of the drug a patient has been prescribed.
8. Alcohol and illegal drug abuse have dangerous side effects, and make it hard to treat depression or bipolar disorder.  Alcohol, in particular, weakens the effect of antidepressants.  People who are constantly drunk will also find it difficult to learn any coping skills in  talk therapy because they are not likely to be paying much attention to the treatment.
9. Finally, the truism that each individual responds differently to medications is especially true for depression and bipolar disorder.  Some standard medications have no effect at all on some patients.   If no medication can help,  the provider may suggest some of the many other available treatments.   A small sample follows. 

Electroconvulsive therapy (ECT)

In the 1930s, researchers began to send electrical currents through the brains of people with depression.  These caused minor seizures in some patients which changed the chemical interactions inside their brains, often shocking them out of their "down" moods.   Since those early days, ECT has become milder and easier to tolerate, and it appears to be quite effective in treating severe depression.   It may be appropriate, for example, when a person with bipolar disorder becomes suicidal, psychotic, or dangerous to others.   ECT is effective 75% of the time and it acts more quickly than any drug to ease severe mania or depression.

However, ECT is not without problems.  It requires patients to be hospitalized and sedated with anesthesia,  and causes them to become temporarily confused and forgetful.  Therefore, providers use it as a last resort with patients who do not respond either to medication or to psychotherapy.
 
Transcranial Magnetic Stimulation (TMS) involves a small electromagnetic device, which doctors hold in their hands, set against the patient's scalp and then use to send short bursts of magnetic energy through the brain.   TMS is still in clinical trials and the FDA has not yet approved it for treatment of depression.  However, early findings suggest that TMS can normalize the warped chemistry of depression.  Moreover, TMS travels lightly on the body and the brain.  It involves no surgery, anesthesics or hospital stays, and its side effects, which include mild headaches or lightheadedness, are both temporary and infrequent.

* This article is based on the information at http://www.dbsalliance.org/, http://en.wikipedia.org, http://www.nih.gov/ and  http://www.webmd.com/