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Bipolar Disorder Health Center

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Medications for Bipolar Disorder

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What other medications help stabilize moods with bipolar disorder? continued...

Sometimes benzodiazepines are prescribed to help patients with acute mania and also to relieve insomnia. These drugs belong to a group of medications called central nervous system (CNS) depressants, which act on neurotransmitters to slow down normal brain function. CNS depressants are commonly used to treat anxiety and sleep disorders and are sometimes prescribed as adjunctive therapy with bipolar disorder.

Commonly used benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin),diazepam (Valium), and lorazepam (Ativan). These drugs all carry the risk of being habit-forming/addictive medications.

Some of the newer sleep medications such as eszopiclone (Lunesta) and zaleplon (Sonata) may cause fewer problems with memory and thinking as compared to benzodiazepines and may be prone to become habit-forming.


Which antidepressants are prescribed for bipolar disorder?

Antidepressants are commonly prescribed to treat depressive disorders. However, in bipolar disorder, a primary mood stabilizer is recommended. According to the 2002 APA guidelines, the first-line treatment for acute depression in bipolar patients is lithium or Lamictal (lamotrigine). Since the guideline was issued, however, Lamictal by itself has been shown to be more effective in preventing future episodes of depression (and to a lesser extent mania) than treating acute episodes of bipolar depression.

The only FDA-approved medications for acute bipolar depression are Seroquel, Latuda, and olanzapine-fluoxetine combination (Symbyax). Lithium or Lamictal are sometimes added to other medicines to try to enhance an overall antidepressant effect. Preliminary studies also have shown value for the atypical antipsychotic caripirazine (Vraylar) to treat bipolar depression "off label."

If an antidepressant is used with bipolar disorder, it’s usually added after an anti-manic drug has first been started. Fewer antidepressants have been studied in bipolar depression than unipolar depression. Examples of well-studied antidepressants in bipolar depression include bupropion (Wellbutrin), fluoxetine (Prozac),  and sertraline (Zoloft).

In about 10% to 20% of people with bipolar disorder, antidepressants may cause shifts from depression into a manic or hypomanic episode. Because of this risk, your health care provider should monitor you closely if you take an antidepressant.


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