Medications Prescribed to Treat Bipolar Disorder

Common Medications to Manage Depressive Episodes, Mania, and Hypomania

Bipolar treatments Geodon, Paxil, Seroquel, Risperdal, Abilify, and Zoloft. Bloomberg/Contributor/Getty Images

Bipolar disorder is typically a lifelong illness with episodes (especially if untreated) that are highly variable and unique to each individual. Treatment is complex and often involves more than one medication—a maintenance medication (mood stabilizer) and a medication to treat acute episodes. 

Importance of Medication in the Treatment of Bipolar Disorder

Bipolar medications can help a person feel good and function well in everyday life.

A person who has bipolar disorder tends to experience extreme highs (mania) and extreme lows (depression). Certain medications help stabilize your mood so you don't experience severe highs and lows.

Since drug therapy is an important component of treatment for bipolar disorder, it's important to educate yourself about the various medication options. A psychiatrist will choose which medications are likely to work best for your symptoms. At times, your medications may need to be adjusted or changed. 

Anti-Convulsants

Anticonvulsants, also known as anti-seizure medications, are sometimes used as mood stabilizers in bipolar disorder. 

Antipsychotics

First generation antipsychotics, also known as typical antipsychotics, include:

Atypical antipsychotics have fewer extrapyramidal side effects when compared to typical antipsychotics. But some, especially clozapine and olanzapine, carry a high risk of metabolic syndrome.

Atypical antipsychotics include:

Antidepressants

Selective serotonin reuptake inhibitors, or SSRIs, are antidepressants that are commonly prescribed for major depressive disorder but can also be prescribed for a bipolar depression. The SSRIs include:

The serotonin-norepinephrine reuptake inhibitors (SNRIs) include:

Tricyclic antidepressants are an older class of antidepressants that while effective for some people do carry a large side effect profile including heart arrhythmias and anticholinergic side effects like dry mouth, sedation, and constipation. 

Monoamine oxidase inhibitors are an older class of antidepressant. They work by preventing the breakdown of monoamines in the brain, like dopamine, norepinephrine, and serotonin.

Examples include:

There are also antidepressants that do not necessarily fit into a single class, like Nefazodone (Serzone), Trazodone (Olepro, Desyrel), and Bupropion (Wellbutrin).

Benzodiazepines

Benzodiazepines depress a person's central nervous system and are used to treat anxiety, insomnia, and seizures. Benzodiazepines have different half-lives, meaning some are short-acting, intermediate-acting, or long-acting. They include:

Calcium Channel Blockers

This class of drugs is only used to a very minor degree in managing the symptoms of mania associated with bipolar disorder. Their efficacy is limited. They include:

  • Verapamil
  • Diltiazem
  • Nifedipine
  • Nimodipine

Other Medications

There are a number of other medications used in people with bipolar disorder. Some are used quite commonly but do not necessarily fit into a psychiatric medication category. One example is Lithium (Lithane, Lithobid, Lithonate, Eskalith, Cibalith-S, Duralith)—a common and effective mood stabilizer that requires careful monitoring. On the other hand, Verapamil (Calan, Isoptin), is a blood pressure medication rarely used in the treatment of mania. 

Combination Medications

Sometimes your doctor will prescribe a single medication that combines two drugs. This can provide convenient dosing and make keeping track of your medications a lot easier. Three examples include:

  • Triavil (Amitriptyline/perphenazine)
  • Limbitrol (Amitriptyline/chlordiazepoxide)
  • Symbyax (Fluoxetine/olanzapine)

Take Medication as Directed

If you have bipolar disorder and you're unhappy with the medication that you're currently on—perhaps you feel like it's not working well enough or maybe you're experiencing a side effect that you simply can't stand—remember that it's never a good idea to stop taking a medication cold turkey or change the dose of a medication without first talking to your doctor. If you need to switch medications, your physician or psychiatrist will advise you about how to do so safely. 

Talk Therapy

Talk therapy can be a vital component in the treatment of bipolar disorder. A trained mental health professional can help you identify when your moods are changing, triggers that lead to depressive or manic episodes, and skills to cope with bipolar disorder. 

Sometimes, family treatment is helpful. Family therapy can help other members of your family gain a better understanding of bipolar disorder and it can assist them in supporting your treatment. 

Complementary and Alternative Treatments

It's important to talk to your doctor before trying any alternative treatments. Herbal supplements, like St John's Wort, could interfere with your medication or it may even trigger a manic episode but studies have shown it may alleviate mild to moderate depression.

Another alternative treatment to bipolar is phototherapy, also known as light box therapy. It is often used to treat seasonal and non-seasonal depression but some individuals report it helps with bipolar disorder. 

Evidence regarding the benefits of omega-3 fatty acids or acupuncture is inconsistent. There is not much data available regarding the effectiveness of other alternative interventions (e.g., aromatherapy massage, massage therapy, yoga). 

Before starting any type of alternative treatment, talk to your physician or psychiatrist before starting. It's important that all of your treatment providers are aware of any complementary treatments. 

Lifestyle

Your doctor and therapist will likely talk to you about strategies to manage your lifestyle. Adequate sleep, exercise, and good nutrition can be key components to managing your symptoms.

It's also important to manage your stress level. Developing healthy coping skills and helpful outlets for your stress can be key to regulating your mood.

It may also be important to avoid drugs and alcohol. Mood altering substances tend to intensify the problems associated with bipolar disorder. 

Support can also be helpful in managing your symptoms. If you lack natural resources, like supportive friends and a family, joining a support group for individuals with bipolar disorder may be especially important. 

Where to Find Treatment

If you suspect you may have bipolar disorder, talk to your physician. Your physician will likely refer you to a psychiatrist or other mental health professional. 

Bipolar disorder is best managed by a team of professionals. When those professionals work together to manage your symptoms, you'll likely be able to experience remission. With the right treatment plan, many people go for years and even decades being symptom-free.

Remission is about gaining stability and keeping your bipolar disorder under control, and that's what most people who have bipolar disorder are hoping for—a productive and harmonious life. Achieving stability usually requires medication as part of the treatment plan.

Sources

American Psychiatric Association (2010). Practice Guideline for the Treatment of Patients with Bipolar Disorder Second Edition

Hamer AM & Muench J. Adverse effects of antipsychotic medications. Am Fam Physician. 2010 Mar 1;81(5):617-22.

Ravindran AV, Silva TLD. The role of complementary and alternative therapies for the management of bipolar disorderOxford Medicine Online. March 2017.