In people with bipolar disorder, antipsychotics are also used "off label" as sedatives, for insomnia, for anxiety, and/or for agitation. Often, they are taken with a mood-stabilizing drug and can decrease symptoms of mania until mood stabilizers take full effect. Some antipsychotic drugs may also help lessen bipolar depression.
Cyclothymia -- or cyclothymic disorder -- is a relatively mild mood disorder. In cyclothymic disorder, moods swing between short periods of mild depression and hypomania, an elevated mood. The low and high mood swings never reach the severity of major depression or full mania. People with cyclothymic disorder have milder symptoms than occur in full-blown bipolar disorder.
Some antipsychotics seem to help stabilize moods on their own. As a result, they may be used alone as long-term treatment for people who don't tolerate or respond to lithium and anticonvulsants.
Antipsychotic drugs help regulate the functioning of brain circuits that control thinking, mood, and perception. It is not clear exactly how these drugs work, but they usually improve manic episodes quickly.
The newer antipsychotics usually act quickly and can help you avoid the reckless and impulsive behaviors associated with mania. More normal thinking often is restored within a few weeks.
Certain antipsychotic drugs cause significant weight gain and high cholesterol levels, and they may increase the risk of diabetes. People considering an antipsychotic for bipolar disorder should be screened for their risk of heart disease, stroke, and diabetes, according to a study published in Diabetes Care.
Common side effects of antipsychotic medications include:
Note: Clozaril is not used often, despite its effectiveness for bipolar disorder. The drug can cause a rare, potentially fatal side effect affecting the blood that requires weekly or biweekly blood test monitoring. Also, Geodon is linked to a rare but potentially fatal skin reaction.
Older antipsychotic drugs are also generally not used to treat bipolar disorder, although they are less well-established for treating depressive symptoms or preventing episodes during long-term use. However, they may be helpful if a person has troublesome side effects or doesn't respond to the newer drugs. Older antipsychotics include Thorazine (chlorpromazine), Haldol (haloperidol), and Trilafon (perphenazine). These drugs may cause a serious long-term side effect called tardive dyskinesia, a movement disorder characterized by repetitive, involuntary movement like lip smacking, protruding the tongue, or grimacing. Newer atypical antipsychotics also have the potential to cause this side effect, but are thought to have a relatively lower risk than the older conventional antipsychotics.
WebMD Medical Reference: "Bipolar Disorder (Manic Depressive Disorder)."
WebMD Assess Plus: Bipolar Disorder Assessment. National Institute for Mental Health: "Step-BD Womens Studies."
Massachusetts General Hospital Bipolar Clinic & Research Program. MedicineNet.com: "Bipolar Disorder (Mania)." WebMD Medical Reference: "Effects of Untreated Depression."
American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."
Sunovion Pharmaceuticals, Inc.
Joseph Goldberg, MD on September 17, 2014