Medications for Bipolar Disorder

If you have bipolar disorder, the right medications can be like a pair of eyeglasses. Bipolar distorts your view of yourself and the world, but the medicine can help you to see things clearly again.

Medications are an essential part of a treatment plan. They won’t cure you, but they will help you keep your moods in balance so you can do the things you need and want to do.

Which Bipolar Medicine Is Best?

Doctors use many types of drugs to treat bipolar disorder. Some fight the extreme highs of mania and others treat the depression. You might take one drug at a time or a few at the same time.

The best bipolar medicine is the one that works best for you. Work with your doctor to decide on the medication plan that helps you the most.

You may keep taking these medications for years or decades, even if it’s been a long time since your last manic or depressive episode. This is called maintenance therapy.

What Is Mood-Stabilizing Medication?

Mood stabilizers are medicines that treat and prevent highs (mania) and lows (depression). They also help to keep your moods from interfering with work, school, or your social life.

Examples include:

  • Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
  • Divalproex sodium (Depakote)
  • Lamotrigine (Lamictal)
  • Lithium
  • Valproic acid (Depakene)

Some of these drugs are known as anticonvulsants, including carbamazepine, lamotrigine, and valproic acid.

Not all of these drugs have the same effects, though. Some (such as lithium) are better at treating mania. Others (such as lamotrigine) may be more useful for depression.

Keep in mind that the term "mood stabilizer" can be misleading. If you take one, your mood can still change during the day. These medicines treat full episodes of mania or depression that last for several days or weeks at a time.

Other Mood-Stabilizing Medicines

Drugs called antipsychotic medications are also common in bipolar treatment plans. You can take them alone or with mood stabilizers to help with symptoms of mania. These drugs include:

  • Haloperidol (Haldol)
  • Loxapine (Loxitane) or loxapine inhaled (Adasuve)
  • Risperidone (Risperdal)

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Today, doctors may prescribe newer antipsychotic drugs, including:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Cariprazine (Vraylar) 
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Quetiapine fumarate (Seroquel)
  • Ziprasidone (Geodon) 

If you have sleep problems along with bipolar symptoms, you may get a type of drug called a benzodiazepine. Doctors usually prescribe these drugs to treat anxiety and sleep disorders, but they can be part of bipolar treatment, too.

Common benzodiazepines include:

  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Lorazepam (Ativan)

Newer sleep medications such as eszopiclone (Lunesta) and zaleplon (Sonata) may cause fewer problems with memory and thinking than benzodiazepines.

Medicines for Bipolar Depression

Most of the time, doctors will start bipolar treatment by prescribing a mood-stabilizing drug like lithium. But the FDA has approved some medicines for bipolar depression, too:

  • Fluoxetine combined with olanzapine (Symbyax)
  • Quetiapine fumarate (Seroquel)
  • Lurasidone (Latuda). You might take it alone or with lithium or valproic acid.

For some people, traditional antidepressants may trigger a manic episode. Because of this risk, your doctor should keep track of you closely if you take one.

Will the Medicine Work for Me?

Your doctor can’t predict how well a particular bipolar medication will work for you. You may need to try several different kinds and different doses to figure out the right approach. And that can take time.

It can be frustrating, but don't give up. Eventually, you and your doctor should be able to find a prescription that works for you.

Medication Tips

If you have bipolar disorder, taking your medication should be part of your routine. Take it at the same time every day. It's easier to remember if you do it along with another daily activity, like brushing your teeth, eating breakfast, or getting into bed. A weekly pillbox can help you see if you've missed a dose.

Be sure to talk to your pharmacist or doctor about the best time of day to take your bipolar medications. Some are best if you take them in the morning or at bedtime and others with meals or after meals.

Make sure you know what to do if you accidentally miss a dose. Ask your doctor. Don't assume that doubling up is a good idea.

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Side Effects of Bipolar Drugs

Like any drug, bipolar medicines can cause some side effects. They vary depending on which medications you use. These side effects can include:

  • Nausea
  • Tremors
  • Hair loss
  • Sexual problems
  • Weight gain
  • Liver damage
  • Kidney damage
  • Diarrhea
  • Belly pain
  • Skin reaction

Some medications can affect how well your liver works or the amount of white blood cells or platelets you have. You may need regular tests to make sure that you're staying healthy. The antipsychotic drug ziprasidone (Geodon) is linked to a rare but serious skin reaction called DRESS syndrome (drug reaction with eosinophilia and systemic symptoms).

Many side effects will go away after a few weeks of treatment. If you still feel bad after that, see your doctor. Don't assume you have to just live with the side effects. Your doctor may be able to change your dose, give you another medicine to control the side effects, or try a different medication altogether.

Stick to Your Treatment

Medications for bipolar disorder are powerful drugs, and you must take them exactly as your doctor recommends. Don't stop taking a medicine without your doctor's approval. It can be dangerous.

When you're feeling good, you might decide that you want to stop taking your medication. But that's a bad idea unless your doctor agrees. Treatment only during mood episodes may not be enough to prevent symptoms from coming back. In most people, maintenance treatment between mood episodes makes mania and depression happen less often and makes them less severe. If you're feeling good now, that's likely because your medication is working. So stick with it.

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on November 08, 2017

Sources

National Institute of Mental Health: “How is Bipolar Disorder Treated?”

Fieve, R. Bipolar II.

American Journal of Psychiatry: "Practice Guideline for the treatment of patients with bipolar disorder. Part A: Treatment recommendations for patients with bipolar disorder."

Mayo Clinic: “Bipolar disorder.”

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