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Treatments for Mania in Bipolar Disorder

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Antipsychotic Drugs for Bipolar Disorder

Antipsychotic drugs originally were 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. Today, they are increasingly being used for acute symptoms other than psychosis (such as agitation or insomnia), as companions to mood stabilizers to bring about faster improvements, and as relapse prevention drugs.  Some (but not all) antipsychotic drugs also are used as antidepressants for 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.

What It Is: Antipsychotic drugs help modulate certain chemicals in the brain called neurotransmitters. It is not clear exactly how these drugs work, but they usually improve manic episodes quickly.

What to Expect: 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, but the full effects of an antipsychotic medication make take several weeks to determine.

Antipsychotics used to treat bipolar disorder include:

  • Abilify (aripiprazole)
  • Geodon (ziprasidone)
  • Latuda (lurasidone) (for bipolar depression)
  • Risperdal (risperidone)
  • Saphris (asenapine)
  • Seroquel (quetiapine) (for mania or bipolar depression)
  • Zyprexa (olanzapine)

Risks and 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 journal Diabetes Care

Common side effects of antipsychotic drugs include:

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

Older, conventional antipsychotics 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), Loxitane (loxapine), and Trilafon (perphenazine). These drugs may cause serious long-term side effects called tardive dyskinesia, a movement disorder.

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