Medications for Mania in Bipolar Disorder

Man looking at bottles from medicine cabinet
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People with bipolar disorder cycle between extremes of depression and mania. The symptoms of depression include sadness, fatigue, anxiety, and lack of interest in one's usual pursuit. The symptoms mania are almost the opposite of depression: very high energy, extreme creativity, impulsivity, feelings of great happiness (or, sometimes, irritability).

While mania may sound like a desirable state, it can create serious problems: in some cases, people experiencing mania may impulsively overspend, have indiscriminate sex, or take other physical risks.

The primary method of treatment for bipolar disorder is pharmacological intervention: medications. The prescriptions for treatment are usually specific to mania or depression. Outlined below, are the general classes and some specific examples of drugs used in the management of symptoms of mania.


Approved by the FDA in 1970, Lithium has traditionally been the first line of treatment for mania. More recent studies have also confirmed lithium's effectiveness for treating depression. Kay Redfield Jamison, the author of An Unquiet Mind and a leading authority on bipolar disorder, believes lithium is underprescribed because it is inexpensive. 


The use of anticonvulsants in the treatment of mania was introduced when their therapeutic value was noted through improved mood stability of those with epilepsy.

Initially, they were used for those who were resistant to Lithium treatment. They are now an important alternative both as a monotherapy and as an adjunctive to other medications.

Calcium Channel Blockers

This class of drugs (of which Verapamil, Diltiazem, Nifedipine, and Nimodipine are examples) is only used to a very minor degree in managing the symptoms of mania associated with bipolar disorder.

Their efficacy is limited.


Acute episodes of mania present psychosis (hallucinations and delusions) in as many as two-thirds of those with this disorder. Thus, this class of meds is used to a great extent. They are also often used to decrease symptoms of mania until mood stabilizers such as those listed above can take full effect. In some cases, these may be used for long-term maintenance of stability.


The Benzodiazepines are central nervous system (CNS) depressants. They are used to produce sedation, induce sleep, relieve anxiety and muscle spasms, and to prevent seizures. For bipolar disorder, they are used to gain rapid control of manic symptoms so that mood stabilizers have time to take effect. They may also be used to help restore a normal sleep schedule. The most common medications in this class include alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), and Clonazepam (Klonopin). 

It's important to note that different individuals have different reactions to medications -- and all of the medications listed above may have side effects. You will need to work with your doctor to determine the best medication (or combination of medications) to treat your particular symptoms.