Antipsychotic Medications for Treating Bipolar Disorder

Doctor explaining prescription medication to patient in clinic
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Psychosis is a term describing a mental disorder in which people see or hear things that are not there (hallucinations) or believe things to be true that are not true (delusions). Psychosis is, of course, a dangerous disorder. Acting on the basis of hallucinations and delusions can result in injury to oneself or others — and psychosis makes it impossible to engage in the ordinary activities of life, such as self-care and work.

As many as two-thirds of those with bipolar disorder who experience acute episodes of mania also experience psychosis. During manic episodes, psychotic delusions may include beliefs in special powers or abilities; during depressive episodes, people prone to psychosis may have delusions of persecution.

Antipsychotic Medications 

Because psychosis is fairly common among people with bipolar disorder, doctors often prescribe antipsychotic medications to decrease symptoms of mania. They are also often used to decrease symptoms of mania until mood stabilizers such as those listed above can take full effect.

Sometimes, antipsychotic medications can be short-term solutions for extreme manic episodes. But that's not always the best course to follow. A person who has experienced a psychotic episode is more likely to experience such episodes in the future. It can be difficult to predict such episodes — and, when they happen, it can be hard to take action. Hospitalization is usually a good choice for someone in the midst of a psychotic episode. For these reasons, antipsychotics are sometimes used for long-term maintenance of stability.

About Antipsychotics

Unfortunately, most antipsychotics (particularly older drugs such as Thorazine) do come with a long list of possible side effects. Weight gain and a rise in cholesterol are common; other side effects can include dry mouth, muscle spasms, and (in rare cases) involuntary movement.

The following are antipsychotics most often used to treat bipolar disorder:

  1. Olanzapine (Zyprexa)
    1. This medication was the first antipsychotic to be approved by the FDA for mania. Research shows it to be as effective as Lithium and it seems to help with mixed episodes. Weight gain is, however, a problem. 
  2. Risperidone (Risperdal)
    1. Risperdal also shows similar efficacy to Lithium. Research further indicates that as an adjunctive it works well for long-term stability. Again weight gain is often a concern. 
  3. Clozapine (Clozaril)
    1. This drug is known for how quickly it works to reduce symptoms. It is also quite successful in helping difficult to treat cases. There is some concern that it may reduce white blood cell count. 
  4. Quetiapine (Seroquel)
    1. The use of Seroquel for bipolar disorder is fairly new, but initial studies seem to indicate its utility for acute mania and rapid cycling. 
  5. Ziprasidone (Geodon)
    1. This medication is also only recently being used for bipolar disorder with similar results for acute mania. It demonstrates a tendency for rapid stabilization. 
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