What Medications Are Used to Treat Bipolar Disorder?

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In most cases of bipolar disorder, medication is used to help keep someone stable. Medications that are prescribed may be used to treat psychosis, depression, hypomania, or mania present in someone who has bipolar disorder. 

While once lithium was the only medication used for bipolar disorder, there are now many medications used in the management of the illness that fall under the following categories: anticonvulsants, antidepressants, antipsychotics, and benzodiazepines.

This article covers some of the most common medications used to treat bipolar disorder as well as some other non-pharmacological treatments.

Bipolar Disorder Treatment

Typically, treatment for bipolar disorder includes medication in addition to psychotherapy. Sometimes more than one medication may be recommended in order to manage symptoms.

In fact, one study showed that about half of patients with bipolar disorder take at least three psychotropic medications.

For example, a benzodiazepine may be added to a mood stabilizer to treat symptoms of anxiety or sleep disturbances that may occur in bipolar disorder.

Psychotherapy to Treat Bipolar Disorder

Psychotherapy is often used in conjunction with medication to help people with bipolar disorder manage their condition long-term and prevent new episodes. Some modalities that are commonly used in people with bipolar disorder include:

Other treatments may include dark therapy, electroconvulsive therapy, transcranial magnetic stimulation and ketamine.

Medications Used to Treat Bipolar Disorder

Bipolar disorder treatment may include lithium, one of the mainstays of bipolar disorder treatment, anticonvulsants, antidepressants, antipsychotics, or benzodiazepines.

Here's what you need to know about each of these types of medications.

Lithium

Although lithium is a mineral that is found naturally, it was not until 1949 that lithium was discovered, by John Cade, to be helpful in treating manic episodes. However, lithium was not approved by the US FDA until 1970 as a medication to treat bipolar disorder.

Lithium is thought to act as a mood stabilizer,which reduces mood swings. It may also help with decreasing suicide risk. It has been studied to be particularly helpful in elderly people dealing with mania. It may even be helpful in treating unipolar depression (depression without mania).

Anticonvulsant Medications for Bipolar Disorder

Though the reason that these medications are effective in bipolar disorder is not completely clear, one theory is that anticonvulsant medications make nerve cells in the brain less excitable, thus leading to a lower likelihood of mania or depression. One theory is that they raise the levels of the neurotransmitter GABA,which calms the brain.

They may also modulate glutamate. This neurotransmitter is an excitatory one, meaning it causes other neurons to fire; elevated levels of glutamate are often found when someone is experiencing mania.

However, not all anticonvulsants help the same symptoms. For example, Depakote (Divalproex sodium) and Tegretol (carbamazepine) tend to work particularly well on mania; Lamictal (lamotrigine) is particularly successful in targeting depression.

Other common anticonvulsants sometimes used for bipolar disorder include:

  • Gabapentin
  • Topiramate
  • Tiagabine
  • Oxcarbazepine

Antidepressant Medications for Bipolar Disorder

Prescribing antidepressants for bipolar disorder can be controversial; some believe they are helpful while others believe that they may actually make it worse, triggering mania and increasing mood cycling. However, something many in the field do agree on is that antidepressants should not be used as mono therapy (the only treatment someone is on) for bipolar disorder.

And some antidepressant classes such as tricylics or serotonin-norepinephrine reuptake inhibitors (SNRIs) may cause a higher “switch” rate (from depression to mania), than selective serotonin reuptake inhibitors (SSRIs) and bupropion. SSRIs include:

  • Celexa (citalopram)
  • Lexapro (excitalopram)
  • Prozac (fluoxetine)
  • Luvox (fluvoxamine)
  • Paxil (paroxetine)
  • Zoloft (sertraline)
  • Viibryd (vilazodone)
  • Trintellix (vortioxetine)

Antipsychotic Medications for Bipolar Disorder

Antipsychotic medications are often prescribed for those with bipolar disorder—especially with Bipolar 1, where delusions and hallucinations are present. Antipsychotic medications can help manage psychotic symptoms associated with bipolar illness and the newer "atypical" antipsychotics have mood-stabilizing properties.

These types of medicines come in two classes: newer ones called “atypical” antipsychotics, and older ones referred to as “typical” antipsychotics. Generally, the atypical antipsychotics have a different side effect profile than the older antipsychotics.

Combining Antipsychotics With Mood Stabilizers

Frequently, an antipsychotic will be prescribed with a mood stabilizer, and research shows that the combination of the two can be more effective than just one alone.

However, the older antipsychotics are often associated with extrapyramidal symptoms, otherwise known as movement-related side effects, such as acute dystonic reactions, parkinsonism, akinesia, and akathisia. They also carry a somewhat greater risk of tardive dyskinesia and neuroleptic malignant syndrome.

However, the atypical antipsychotics aren’t perfect either; these agents may carry a higher risk of metabolic side effects such as weight gain and type 2 diabetes.

Seroquel (quetiapine), Latuda (lurasidone), and Vraylar (cariprazine) are the atypical antipsychotics that have an indication for depression in bipolar disorder. Zyprexa (olanzapine) and Clozaril (clozapine) also show high levels of efficacy in treating different aspects of bipolar disorder.

Benzodiazepines for Bipolar Disorder

Benzodiazepines, anti-anxiety medications, are sometimes prescribed for people with bipolar disorder to treat agitation, anxiety, and sleep disturbances associated with acute mania or bipolar depression.

There is some risk of dependence and abuse with these medications, so they tend to be used for the short-term management of the disorder.

A Word From Verywell

Many of these medications have side effects if you stop taking them abruptly, so talk to your doctor before making any changes to your medication routine.

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