Bipolar disorder, in which people can experience acute mood episodes, is first and foremost treated with medication. Manic episodes can be more severe in the case of bipolar 2 disorder and less severe, or hypomanic, in the case of bipolar 1 disorder.

Supportive therapies can also help significantly. These include:

  • talk therapy
  • social support
  • lifestyle strategies

There are two phases of BD treatment:

  • Acute phase. This phase focuses on acute mood episodes (manic, hypomanic, depressive).
  • Maintenance phase. This phase focuses on preventing acute episodes.

Doctors can prescribe different medications for each phase. They routinely monitor and adjust medications to make sure they’re working as they should.

Medication for bipolar disorder can cause side effects. By working closely with your medical support team and engaging in shared decision-making, you can work to find an effective treatment plan, while also managing and preventing side effects.

Many people with BD take more than one medication at a time, or transition from one drug to another. Lithium, for example, is a commonly prescribed mood stabilizer, but it doesn’t work right away. Doctors may suggest taking an antipsychotic medication for an acute manic episode to give lithium time to do its job.

Another example is antidepressants. Clinicians generally only recommend people with BD take antidepressants along with a mood stabilizer or antimanic drug to avoid the risk the antidepressant might trigger an acute manic episode.

The most common medications for BD, used alone or in combination, include:

  • Mood stabilizers. These include lithium, divalproex/valproic acid, and carbamazepine.
  • Atypical antipsychotics. These include aripiprazole, asenapine, cariprazine, lurasidone, paliperidone, quetiapine, risperidone, ziprasidone, and olanzapine.
  • Antidepressants.

Each of these has possible side effects. For some people, these side effects can be a barrier to continuing treatment. A 2019 study of people who took antipsychotic medication found that 70 percent had tried to stop the medication, and 64 percent of them cited side effects as the reason why. If you’re troubled by side effects, it may help to know other people also have this experience.

Your doctor can help you find ways to manage side effects. “If the medication is causing significant side effects that, despite any adjustments, cannot be managed, then it would be appropriate to discuss other treatment options with your prescriber,” Dr. Lindsay Israel, board certified psychiatrist and chief medical officer at Success TMS, tells Healthline.

It’s important to keeping open communication with your doctor, adds Dr. Patricia Celan, MD, a postgraduate psychiatry resident at Dalhousie University.

“Side effects are concerning when they are more severe, such as an intense and widespread rash, seizures, or suicidal ideation,” explains Celan. “Any side effects should be discussed with the prescribing physician so they can be monitored or treated if necessary.”

Below are some side effects of medications for bipolar disorder.

Mood stabilizers

Side effects may include:

  • increased urination and thirst
  • trembling of the hands
  • weight gain
  • fatigue
  • headache
  • drowsiness
  • dizziness
  • nausea
  • vomiting
  • diarrhea
  • blurred vision
  • vision changes
  • impaired memory
  • difficulty concentrating
  • hair loss
  • easy bruising
  • changes in the menstrual cycle
  • low sodium in blood
  • itchiness
  • rash

It’s possible to experience lithium toxicity, especially if you’re dehydrated. Signs of too much lithium in the blood include:

  • gastrointestinal symptoms
  • shaking and twitching
  • loss of balance
  • slurred speech
  • weakness

Atypical antipsychotics

Side effects may include:

  • dry mouth
  • dizziness
  • blurred vision
  • seizures
  • weight gain
  • type 2 diabetes
  • tremor
  • stiffness
  • agitation
  • sleepiness
  • low energy
  • sedation
  • decreased sex drive
  • discharge from breast
  • missed menstrual periods

Antidepressants

Side effects may include:

  • weight gain
  • diarrhea
  • nausea
  • vomiting
  • restlessness
  • vivid dreams
  • nervousness
  • anxiety
  • loss of appetite
  • sleepiness
  • sexual dysfunction

Doctors monitor people taking BD medication for side effects. In many cases, your doctor can help you make changes to your treatment plan so symptoms are easier to manage.

“One strategy is the timing of the dose,” Israel tells Healthline. “If the medication is sedating when it is peaking in the system, [it is] best to take before bedtime. If a medication is causing nausea or upset stomach, best to take with food.”

The dosing can impact the side effects, Israel says. Your doctor might suggest a decreased dose or dose divided into a twice-a-day regimen if that means you will tolerate the medication better, provided it’s still effective.

Your doctor can recommend what changes work best for you. If appropriate, they may prescribe an adjunctive medication to help counter side effects. For example, when people experience restlessness from antipsychotics, the clinician may consider lowering the dose or prescribing a beta blocker in addition.

Side effects can sometimes make it hard for people to stay on the prescribed medication. They can also impact quality of life. Forty-one percent of respondents in the 2019 study of people who took antipsychotic medication found these drugs “helpful,” while 43 percent found them “unhelpful.”

Adverse side effects may lead clinicians to recommend a lower dose of medication. This can impact the effectiveness of the medication.

But there’s also evidence some BD medications can markedly improve quality of life, given the disruptive nature of the disorder. BD is typically defined by mood episodes lasting longer than 7 days, but sometimes much longer. Bipolar 1 manic episodes were found to last a median of 13 weeks in a 2010 study.

A paper presented at the 2021 annual meeting of the American Psychiatric Association found that patients experiencing bipolar mood episodes who took a combination of lithium and antipsychotic medications had hospital stays that were an average of 2.8 days shorter. Stays ranged from 1 to 3 weeks.

Regular and vigorous exercise help with mood and with sleep. The National Institute of Mental Health recommends jogging, swimming, and cycling.

Celan notes that physical wellbeing is an important piece of a care plan. While many psychiatric medications can cause some weight gain, Celan says, greater weight gain can put people at risk for metabolic disorders. In that case, your doctor may shift your medication.

There are other changes you can make to help reduce side effects. Cutting back on caffeine, for example, can reduce the potential for tremor from mood stabilizers. People with BD often also avoid alcohol and recreational drugs in order to respond better to their medication regimen.

Celan notes that staying hydrated can help prevent a serious side effect of some mood stabilizers. “Lithium can cause organ damage such as kidney damage. Drinking lots of water every day is a way to prevent that side effect.”

Ideally, you’ll discuss treatment options with your doctor in a process of what is called “shared decision-making.” This is a common practice in other forms of health care, but according to a 2019 study, is underutilized in mental health.

However, there’s evidence shared decision-making in treatment of psychosis improves the care experience. In shared decision-making, the doctor explains treatment options. The person with BD discusses their values and preferences with the clinician and thinks about the options. Together they make a decision about the next steps to take.

This is quite different from some people’s experience with BD treatment. In the 2019 survey of people taking antipsychotic medication, 70 percent weren’t told in advance about side effects, let alone asked to participate in a shared decision-making model.

BD is a lifelong experience, and you should feel comfortable asking for a shared decision-making model or requesting more information about ways to handle medication side effects.

Side effects are common with medications for bipolar disorder. These medications can help people with BD to manage symptoms.

Sometimes the side effects are intolerable, but your doctor can help. They can recommend dosage changes, different medications, lifestyle changes, and adjunctive medications to help find a good balance.