Bipolar Disorder: Antipsychotic Medication for Bipolar Disorder

Antipsychotic medications are used as a short-term treatment to control psychotic symptoms such as hallucinations or delusions. These symptoms may occur during acute mania or severe depression.

In people with bipolar disorder, antipsychotics are also used 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 medications may also help lessen bipolar depression.

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 week.

Antipsychotics used to treat bipolar disorder include:

• Abilify (aripiprazole)
• Clorazil (clozapine)
• Geodon (ziprasidone)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)

Antipsychotics Side Effects

Certain antipsychotics cause rapid weight gain and high cholesterol levels, and they may increase the risk of diabetes. People considering an antipsychotic for bipolar disorder should first be screened for their risk for heart disease, stroke, and diabetes, according to a study published in the February 2004 issue of Diabetes Care. The study specifically recommended that doctors screen people taking Risperdal, Seroquel, or Zyprexa for diabetes, prediabetes, and high cholesterol.

Abilify does not cause weight gain but may increase the risk of diabetes.

Common side effects of antipsychotic medications include:

• Blurred vision
• Dry mouth
• Drowsiness
• Muscle spasms or tremor
• Involuntary facial tics
• Weight gain

Note: Clorazil 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 generally not used to treat bipolar disorder. 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 serious long-term side effects called tardive dyskinesia, a movement disorder characterized by repetitive, involuntary movement like lip smacking, protruding the tongue, or grimacing.

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.