The first-line treatment for bipolar disorder usually involves medications, which help control symptoms quickly. Drugs like mood stabilizers, antidepressants, or benzodiazepines can be prescribed either on their own or in combination.
Finding the right medication or combination of medications will take some trial and error. You may need to change medications due to side effects.
It can take up to eight weeks to see the full effects of each medication. Usually, only one medication is changed at a time. This helps your doctor to better monitor and identify which one isn’t working.
Once medications stabilize your initial symptoms, you’ll receive maintenance treatment to reduce the risk of relapse. Maintenance treatment also reduces the chance of minor shifts in mood developing into mania or depression.
If you have bipolar disorder, you’ll need to be treated on an ongoing basis. In fact, you should be seeing a mental health professional regularly, even if you feel fine. Long-term treatment usually includes a combination of medication and talk therapy.
The following types of medications are used to treat bipolar disorder.
Lithium (such as Lithobid) is a mood-stabilizing drug that’s been used since the 1970s. It helps control symptoms of acute mania. It’s also effective at preventing the recurrence of periods of mania and depression.
Common side effects include weight gain and digestive issues. The drug can also affect your thyroid and kidneys. Periodic blood tests are needed to monitor thyroid and kidney health.
Lithium is a category D drug that should be avoided in pregnancy if possible. However, in some instances the benefits may outweigh the potential risks.
Anticonvulsants are mood stabilizers used to treat bipolar disorder. They have been used since the mid-1990s. Anticonvulsant drugs include:
- divalproex sodium (Depakote)
- lamotrigine (Lamictal)
- valproic acid (Depakene)
Common side effects of anticonvulsants include weight gain, drowsiness, and an inability to sit still. Anticonvulsants are also associated with increased risk of suicidal thoughts and behavior.
Valproic acid is known to cause birth defects. Lamictal is known to cause a rash that can be dangerous. Alert your doctor to any new rash that develops while on Lamictal.
Antipsychotic drugs are another treatment option. Some commonly prescribed antipsychotics include:
- olanzapine (Zyprexa)
- risperidone (Risperdal)
- quetiapine (Seroquel)
- lurasidone (Latuda)
- aripiprazole (Abilify)
- asenapine (Saphris)
Common side effects include weight gain, drowsiness, dry mouth, decreased libido, and blurred vision. Antipsychotics may also affect memory and attention. They are also known to cause involuntary facial or body movements.
These include serotonin-reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclics.
Antidepressants may be added to help manage depression in bipolar disorder, but they can sometimes trigger manic episodes. To reduce the risk of causing a mixed or manic episode, they are often prescribed along with a mood stabilizer or antipsychotic.
As with any medication, discuss with your doctor the risks and benefits of taking antidepressants for bipolar disorder.
Here are some of the more commonly prescribed antidepressants:
- 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)
- phenelzine (Nardil)
- tranylcypromine (Parnate)
In general, MAOIs are rarely prescribed unless a patient has a poor response to SNRIs or SSRIs. Common side effects include reduced sexual desire, sleep disturbance, increased appetite, dry mouth, gastrointestinal troubles, and menstrual problems.
When taking an MAOI, it’s important to avoid other medications, and foods like wine and cheese, which can cause a rare but 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. Symbyax has properties of both an antidepressant and a mood stabilizer. Side effects can include increased appetite, sexual problems, drowsiness, fatigue, and dry mouth.
If your doctor prescribes this medicine, ask if separate prescriptions for the two components are less expensive. There’s nothing different about the combination pill. It’s simply a new formulation of two existing drugs.
Some medications, such as lithium and valproic acid, can increase your unborn baby’s risk for birth defects. Certain medications may also lower the effectiveness of birth control drugs. If you’re using birth control to prevent pregnancy, make sure to discuss this with your doctor.
You should also talk to your doctor about your medication if you’re breastfeeding. Some medications may not be safe for your child.