Antipsychotic medications are used in those with bipolar disorder as a short-term treatment to control psychotic symptoms such as hallucinations or delusions or mania symptoms. Some also treat bipolar depression, and several have been demonstrated long-term value to prevent future episodes of mania or depression. These symptoms may occur during acute mania or severe 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.
People with bipolar disorder often have cycles of elevated and depressed mood that fit the description of "manic depression." When a person's illness follows this classic pattern, diagnosing bipolar disorder is relatively easy.
But bipolar disorder can be sneaky. Symptoms can defy the expected manic-depressive sequence. Infrequent episodes of mild mania or hypomania can go undetected. Depression can overshadow other aspects of the illness. And substance abuse can cloud the picture.
Some of the newer 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 balance certain brain chemicals called neurotransmitters. 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.