Several types of medications are used to treat bipolar disorder. These include mood stabilizers, antidepressants, and drugs that relieve anxiety. Your doctor may prescribe one or a combination of medications for maximum effect. Finding the right medication or combination of medications—as well as the ones with the fewest side effects—will take some trial and error. This process can take up to eight weeks to see the effects of each medication. Usually, only one medication is changed at a time so your doctor can better monitor and identify which medications are not working and which are. Medications for bipolar disorder include:
Lithium (such as Lithobid) is a mood-stabilizing drug that has been used since the 1970s. It helps control symptoms of acute mania and is effective at preventing the recurrence of periods of mania and depression. Common side effects include weight gain, digestive issues, and thyroid and kidney problems. Periodic blood tests are required to monitor thyroid and kidney health. Lithium is a category D drug that should be avoided in pregnancy if at all possible, though in some instances the benefit of use may outweigh the potential risks to the fetus.
Anticonvulsants are mood stabilizers and have been approved for use in treating bipolar disorder since the mid-1990s. In 2009, the drug asenapine was approved in the treatment of bipolar disorder I and for alleviating symptoms in people who experience mixed episodes. Anticonvulsants include:
- asenapine (Saphris)
- divalproex sodium (Depakote)
- lamotrigine (Lamictal)
- valproic acid (Depakene)
Side effects vary depending on the specific medication, but common side effects of anticonvulsants include weight gain, drowsiness, and the inability to sit still or remain motionless. Anticonvulsants are also associated with increased risk of suicidal thoughts and behavior. Valproic acid is known to cause damage to fetuses and should be avoided in pregnancy. Lamictal is known to cause a rash that can be dangerous. Alert your doctor to any new rash that develops while on Lamictal.
Antipsychotic medications appear to help people with bipolar disorder who don’t do not improve on anticonvulsant medications. Some commonly prescribed antipsychotics are:
- olanzapine (Zyprexa)
- risperidone (Risperdal)
- quetiapine (Seroquel)
Side effects vary depending on the specific medication, but common side effects of antipsychotics include weight gain, drowsiness, dry mouth, decreased libido, and blurred vision. The use of antipsychotics may also affect memory and attention and cause involuntary facial or body movements.
These include serotonin-reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclics. Antipressants are usually prescribed with caution because they can trigger manic episodes in some people with bipolar disorder. If they are prescribed, it is often in combination with a mood stabilizer to avoid onset of manic symptoms. While not an exhaustive list, here are some of the more commonly prescribed antidepressants:
reuptake inhibitors (SNRIs)
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta, Yentreve)
- venlafaxine (Effexor)
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac, Prozac Weekly)
- paroxetine (Paxil, Paxil CR, Pexeva)
- sertraline (Zoloft)
- desipramine (Norpramin)
- imipramine (Tofranil, Tofranil-PM)
- nortriptyline (Pamelor)
- monoamine oxidase
- phenelzine (Nardil)
- tranylcypromine (Parnate)
In general, MAOIs are rarely prescribed unless a patient has a poor response or no response to safer medications like SNRIs or SSRIs. When taking a MAOI, it is important to avoid other medications or foods like wine and cheese that can cause a rare, dangerous condition known as serotonin syndrome.
These are a group of medications with anxiety-relieving properties. Benzodiazepines include:
- alprazolam (Xanax)
- chlordiazepoxide (Librium)
- clonazepam (Klonopin)
- diazepam (Valium)
- lorazepam (Ativan)
Side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory. These medications should be used with caution due to the risk of dependence.
This medication combines fluoxetine and the antipsychotic olanzapine, giving it the properties of an antidepressant and mood stabilizer. Side effects can include increased appetite, sexual problems, drowsiness, fatigue and dry mouth. If you are prescribed this medicine, be sure to ask your doctor if it is less expensive to simply receive each medication as its own pill. There is nothing magic in using the combination pill; it is simply a new formulation of two existing drugs.
Medications and Pregnancy
Many of the medications for bipolar disorder can cause birth defects. Certain medications used to treat bipolar disorder can also cause birth control drugs to become less effective. If you are using birth control to prevent pregnancy, make sure to discuss this with your doctor before taking any other medication. If you have a newborn and are already breast feeding, talk to your doctor about the best treatment options; some medications may not be safe for you and your baby.