What Medications Are Used to Treat Bipolar Disorder?
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Medically reviewed by Steven Gans, MD
In most cases of bipolar disorder, medication is used to help keep someone stable. Medications that are prescribed may be used to treat psychosis, depression, hypomania, or mania present in someone who has bipolar disorder.
While lithium was once the only medication used for bipolar disorder, many medications are now used to manage the illness. These medications fall under the following categories: anticonvulsants, antidepressants, antipsychotics, and benzodiazepines.
This article covers some of the most common medications used to treat bipolar disorder as well as some other non-pharmacological treatments.
Bipolar Disorder Treatments
Typically, treatment for bipolar disorder includes medication in addition to psychotherapy. Sometimes more than one medication may be recommended to manage symptoms.
One study showed that about half of patients with bipolar disorder take at least three psychotropic medications.
For example, a benzodiazepine may be added to a mood stabilizer to treat symptoms of anxiety or sleep disturbances that may occur in bipolar disorder.
Psychotherapy to Treat Bipolar Disorder
Psychotherapy is often used in conjunction with medication to help people with bipolar disorder manage their condition long-term and prevent new episodes. Some modalities that are commonly used in people with bipolar disorder include:
Psychoeducation (individual or group)
Family-focused therapy
Interpersonal and social rhythm therapy
Group mindfulness-based cognitive therapy
Integrated group therapy
Other treatments may include dark therapy, electroconvulsive therapy, transcranial magnetic stimulation, and ketamine.
Related: What Is Therapy for Bipolar Disorder?
Medications to Treat Bipolar Disorder
Lithium continues to be one of the mainstays of bipolar disorder treatment. However, other options include anticonvulsants, antidepressants, antipsychotics, or benzodiazepines.
Here's what you need to know about these types of medications.
Lithium
Lithium is a naturally occurring mineral. It was not until 1949 that an Australian psychiatrist named John Cade discovered that it was found to help treat manic episodes. However, it was not until 1970 that the U.S. Food and Drug Administration (FDA) approved lithium as a medication to treat bipolar disorder.
Lithium is thought to act as a mood stabilizer,which reduces mood swings.
It may also help with decreasing suicide risk.
It has been studied to be particularly helpful in elderly people dealing with mania.
It may even help treat unipolar depression (depression without mania).
Lithium has some side effects, including diarrhea, frequent urination, hair loss, nausea, swelling, tremor, and weight gain. It can also lead to toxicity, which can be dangerous. It is essential to have regular tests to monitor calcium levels and kidney and thyroid functioning while taking lithium.
Related: Lithium Toxicity: Types, Symptoms, Diagnosis, and Treatment
Anticonvulsant Bipolar Medications
Anticonvulsant medications, also known as antiepileptics, are usually designed to treat seizures associated with epilepsy. However, these medications can also be used to treat bipolar disorder.
The reason that these medications are effective in bipolar disorder is not completely clear:
One theory suggests that anticonvulsant medications make nerve cells in the brain less excitable, thus leading to a lower likelihood of mania or depression.
Another theory proposes that they raise the levels of the neurotransmitter GABA,which calms the brain.
They may also modulate glutamate. Glutamate is an excitatory neurotransmitter, meaning it causes other neurons to fire. Elevated levels of glutamate are often found when someone is experiencing mania.
However, not all anticonvulsants help the same symptoms. For example, Depakote (divalproex sodium) and Tegretol (carbamazepine) tend to work particularly well on mania; Lamictal (lamotrigine) is particularly successful in targeting depression.
Other common anticonvulsants sometimes used for bipolar disorder include:
Neurontin (gabapentin)
Topamax (topiramate)
Gabitril (tiagabine)
Trileptil (oxcarbazepine)
Anticonvulsants that are FDA-approved to treat bipolar disorder include Depakote, Tegretol, and Lamictal. Other anticonvulsants, such as Topamax and Trileptal, are sometimes prescribed off-label.
Related: Anticonvulsants for Mania in Bipolar Disorder
Antidepressant Bipolar Medications
Prescribing antidepressants for bipolar disorder can be controversial. Some believe they are helpful, while others think they may worsen it, triggering mania and increasing mood cycling.
However, many in the field agree that antidepressants should not be used as monotherapy, or the only treatment someone is on for bipolar disorder.
And some antidepressant classes, such as tricyclics or serotonin-norepinephrine reuptake inhibitors (SNRIs), may cause a higher “switch” rate (from depression to mania) than selective serotonin reuptake inhibitors (SSRIs) and bupropion.
SSRIs include:
Celexa (citalopram)
Lexapro (escitalopram)
Prozac (fluoxetine)
Luvox (fluvoxamine)
Paxil (paroxetine)
Zoloft (sertraline)
Viibryd (vilazodone)
Trintellix (vortioxetine)
Some people may be more prone to experiencing mood switching or mania on antidepressants, including those with bipolar I or bipolar with mixed features. The type of antidepressant can also play a role. Your doctor may recommend mood stabilizers alongside antidepressants.
Antipsychotic Bipolar Medications
Antipsychotic medications are often prescribed for those with bipolar disorder, especially Bipolar I, where delusions and hallucinations are present. Antipsychotic medications can help manage psychotic symptoms associated with bipolar illness, and the newer "atypical" antipsychotics have mood-stabilizing properties.
These medicines come in two classes: newer ones called “atypical” antipsychotics, and older ones called “typical” antipsychotics. Generally, the atypical antipsychotics have a different side effect profile than the older antipsychotics.
Frequently, an antipsychotic will be prescribed with a mood stabilizer, and research shows that the combination of the two can be more effective than just one alone.
However, older antipsychotics are often associated with extrapyramidal symptoms, otherwise known as movement-related side effects, such as acute dystonic reactions, parkinsonism, akinesia, and akathisia. They also have a greater risk of tardive dyskinesia and neuroleptic malignant syndrome.
However, the atypical antipsychotics aren’t perfect either. These agents may carry a higher risk of metabolic side effects such as weight gain and type 2 diabetes.
Seroquel (quetiapine), Latuda (lurasidone), Vraylar (cariprazine), and Zyprexa (olanzapine) are the atypical antipsychotics that have an indication for depression in bipolar disorder.
Clozaril (clozapine) also shows high levels of efficacy in treating different aspects of bipolar disorder and is sometimes prescribed off-label.
Benzodiazepines for Bipolar Disorder
Benzodiazepines, anti-anxiety medications, are sometimes prescribed for people with bipolar disorder to treat agitation, anxiety, and sleep disturbances associated with acute mania or bipolar depression.
There is some risk of dependence and abuse with these medications, so they tend to be used for the short-term management of the disorder.
Benzodiazepines can have potentially dangerous side effects if you stop taking them abruptly. It is not safe to stop taking benzodiazepines without talking to your doctor first.
Your doctor can help you safely make any changes to your medication routine, including gradually tapering your dose or switching to a different medication.
