Antipsychotic medications are used as a short-term treatment for bipolar disorder to control psychotic symptoms such as hallucinations, delusions, or mania symptoms. These symptoms may occur during acute mania or severe depression. Some also treat bipolar depression, and several have demonstrated long-term value in preventing future episodes of mania or depression.
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.
Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and, while their safety and effectiveness for the condition is controversial, antidepressants.
Typically, treatment entails a combination of at least one mood-stabilizing drug and/or atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote). Lithium carbonate can be remarkably...
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.
Antipsychotics used to treat bipolar disorder include:
Common side effects of antipsychotic medications include:
Muscle spasms or tremors
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.
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