Medications to Treat Bipolar Disorder
Medically reviewed by Femi Aremu, PharmD
Bipolar disorder is a mental health condition that can severely affect your day-to-day life if not treated properly.
Symptoms can range from acute (short-term) mania to depression and depressive episodes. Luckily, multiple treatments exist that can help you manage the condition. Medications such as mood stabilizers, antipsychotics, and benzodiazepines can be used alone or in combination with other pharmacologic therapies to create an individualized treatment regimen.
Other options, such as certain nondrug therapies and interventions, can be used alongside medication for added relief.
This article will discuss the types of medications often prescribed to help treat bipolar disorder, including drug classes, examples of specific medications, and how to determine which treatment is right for you.
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Mood Stabilizers
Mood stabilizers are medications that work in the brain by reducing the ability of certain nerves in the brain to become too excited. They can be used alone or in combination with other medications to treat symptoms associated with bipolar disorder.
Some examples include:
Equetro (carbamazepine)
Lamictal (lamotrigine)
Depakote (divalproex)
Lithium
Lithium (brand-name Lithobid) is a mood stabilizer. It is one of the oldest medications still used to treat bipolar disorder. It can treat acute manic (feeling emotional highs) and mixed episodes (feeling both emotional highs and lows) or as a maintenance treatment in people 7 and older.
Lithium can have serious side effects if concentrations in the blood are too high. This can happen if you become dehydrated, especially if you have kidney damage. Follow up with your healthcare provider when blood lab tests are requested. Additionally, make sure to let your provider know about other medications you are taking during your treatment with lithium, as interactions are possible.
Carbamazepine
Carbamazepine (brand-name Equetro) works in the body by reducing nerve excitement in the brain. It can be used for the treatment of bipolar disorder, as an anti-seizure medication, or for trigeminal neuralgia.
Carbamazepine can cause severe skin reactions and anemia. Therefore, you should ask your healthcare provider if you need any tests done before and during treatment. Carbamazepine can also reduce the concentrations of other drugs, so it is important to tell your provider about any other medications you're on.
Lamotrigine
Lamotrigine (brand-name Lamictal) is another mood stabilizer used to manage bipolar disorder. It is also commonly prescribed as an anti-seizure agent.
Lamotrigine is a maintenance therapy that helps delay the time to occurrence of mood episodes in people with bipolar 1 disorder. It is not an acute treatment.
Like carbamazepine, lamotrigine has been associated with severe skin reactions, such as rashes, including Stevens-Johnson syndrome, which can be potentially life-threatening. These typically occur within two to eight weeks of starting treatment. Although some rashes may be harmless, it is important to tell your healthcare provider immediately if you notice any skin changes such as a rash while taking lamotrigine.
Divalproex
Depakote, which can also be called divalproex, valproate, or simply valproic acid, is a medication that can be used to treat manic episodes that are caused by bipolar disorder.
Divalproex has many serious side effects, which can include pancreatitis, liver toxicity, and serious fetal harm if used during pregnancy. It is important to follow up with tests if asked by your healthcare provider, as levels of the drug may need to be monitored.
Antipsychotics
Antipsychotics are generally used to treat schizophrenia, but some are also approved to help manage and treat symptoms associated with bipolar disorder, such as mania or manic episodes.
All antipsychotics should be used cautiously if you are over 65 and have a history of dementia-related psychosis, as there can be an increased risk of death.
Antipsychotics commonly used for bipolar disorder include:
Zyprexa (olanzapine)
Latuda (lurasidone)
Abilify (aripiprazole)
Olanzapine
Olanzapine (brand-name Zyprexa) is a second-generation antipsychotic used for manic episodes associated with bipolar disorder.
Olanzapine may be taken alone (monotherapy) or with other medications (adjuvant therapy), such as lithium or valproate. It is also used in a combination treatment called Symbyax, which combines olanzapine and fluoxetine (an antidepressant) in one medication to treat depressive episodes associated with bipolar 1 disorder.
Lurasidone
Lurasidone is another second-generation antipsychotic that is used to treat depressive episodes associated with bipolar disorder in adults or adolescents 13 to 17 years. It can be used alone or in combination with other medications to help better manage symptoms.
Aripiprazole
Aripiprazole is a second-generation antipsychotic that is used to treat manic and mixed episodes associated with bipolar disorder. Like lurasidone, it can be used alone or with other medications. You can take it by mouth (orally) or through an injection into the muscle.
Your starting dose may vary depending on the treatment regimen your healthcare provider places you on. A common side effect when starting aripiprazole is restlessness. Let your healthcare provider know if you start to have trouble staying still.
Antianxiety Drugs
Although primarily used for anxiety disorders, benzodiazepines such as Klonopin (clonazepam) or Ativan (lorazepam) can help treat the acute symptoms of bipolar disorder until long-term treatment with mood stabilizers takes effect.
However, benzodiazepines are not considered for treating bipolar symptoms outside of the acute setting. This is due to their risk of abuse and dependency and the overall lack of evidence regarding long-term safety and efficacy.
Additional caution must be used if you are also prescribed an opioid at the same time. Both types of medications taken together can increase your risk for respiratory depression (slow and shallow breathing) and death.
What's the Right Medication for You?
Certain factors will help your healthcare provider determine which medication is right for you. This might include:
Age: If you are over 65, you may be at higher risk of negative health effects from taking medications like benzodiazepines and antipsychotics.
Cognitive motor conditions, such as Parkinson's disease: Medications such as antipsychotics may worsen your condition.
Pregnancy status: Some common bipolar medications, such as lithium, are not recommended to take while pregnant.
When looking for the right treatment plan, it is important to ask your healthcare provider about the side effects of each medication and possible interactions with medications you may already be taking.
Pregnancy Considerations
With pregnancy, certain medications are contraindicated, meaning they absolutely cannot be taken while pregnant due to the risk of harm to the fetus.
Medications such as valproate, lithium, and carbamazepine are not recommended while you are pregnant or trying to become pregnant.
If you take any of these medications before becoming pregnant, talk to your healthcare provider about slowly reducing your dosing. Do not abruptly stop taking your medication, as it can lead to unwanted side effects and may worsen your symptoms of bipolar disorder.
Lamotrigine has been found not to seriously harm the fetus during pregnancy and may be an option to discuss with your healthcare provider for treatment of your bipolar disorder.
Summary
When it comes to managing your bipolar disorder, several medications are available. These include mood stabilizers, antipsychotics, and antianxiety drugs.
Always remember to discuss other medications you may be taking or if you have other medical conditions, as your treatment may vary depending on these factors. Bipolar disorder is a difficult but manageable medical condition, and with the right treatment plan, you can live a healthier and more enjoyable life.
Frequently Asked Questions
What is the most commonly prescribed drug for bipolar disorder?
No single drug is guaranteed to work for every person with bipolar disorder. Common medications, such as lithium or valproate, may not be suitable for everyone. It is important to speak to your healthcare provider to create a personalized plan to best help manage your bipolar disorder.
What treatments other than medication help manage bipolar disorder?
Several treatment-based options are available for better managing bipolar disorder. However, it is recommended to speak to your healthcare provider, as they can help personalize your treatment with bipolar disorder.
Some examples, such as cognitive behavioral therapy, family-focused interventions, and interpersonal and social rhythm therapy (IPSRT) are all add-on therapies that can help with symptoms when used in combination with medication.
It is important to never stop taking your medication unless instructed by your healthcare provider, as medication adherence will play a large role in your symptom management.
How long do bipolar medications take to work?
Depending on the type of medication, the time for you to feel the effects will differ. There is no fast treatment for bipolar disorder, so it is important you follow up with your healthcare provider after starting on medication. Certain medications, like antipsychotics, may be administered intramuscularly (IM) for acute (short-term) episodes. These may offer faster relief; however, this is usually given in a hospital setting when under the monitoring and care of a healthcare team.
Read the original article on Verywell Health.
