Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and, while their safety and effectiveness for the condition are sometimes 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 effective in reducing mania, although doctors still do not know precisely how it works. Lithium may also prevent recurrence of depression,but its value seems greater against mania than depression, and therefore it is often given in conjunction with other medicines known to have greater value for depression symptoms, sometimes including antidepressants.
Valproic acid is a mood stabilizer that is helpful in treating the manic or mixed phases of bipolar disorder, along with carbamazapine, another antiepileptic drug. These drugs may be used alone or in combination with lithium to control symptoms. In addition, newer drugs are coming into the picture when traditional medications are insufficient. Lamotrigine, another antiepileptic drug, has been shown to have value for preventing depression and, to a somewhat lesser degree, manias or hypomanias.
Haloperidol or, more recently, other newer antipsychotic medications, such as olanzapine or risperidone, are often given to patients who fail to respond to lithium or divalproex. They also may be given to treat acute symptoms of mania -- particularly psychosis -- before lithium or divalproex can take full effect, which may be from one to several weeks. Another antipsychotic, Latuda, is approved for use in bipolar I depression as is the combination of olanzapine plus flupxetine (called Symbyax). The antipsychotic quetiapine is approved to treat bipolar I or II depression.
Some of these drugs can potentially become toxic if doses get too high. Therefore, they need to be monitored periodically with blood tests and clinical assessments by the prescriber. Because it is often difficult to predict which patient will react to what drug or what the dosage should ultimately be, the psychiatrist will often need to experiment with several different medications when beginning treatment.