Finding the right medication or combination of medications to manage bipolar disorder can be a challenging and frustrating process.

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Bipolar disorder is a mood disorder characterized by extreme changes in mood, behavior, energy, and thought patterns. A person with bipolar disorder has significant highs and lows. The clinical terms for these states are mania and depression.

The National Institute of Mental Health estimates that 2.8% of adults in the United States have bipolar disorder.

Doctors often find it challenging to treat because everyone responds to the medications differently.

Many people with bipolar disorder try several medications before they find one that works for them. And some people find that managing their symptoms requires more than one type of medication.

There are different types, or classes, of drugs that can safely and effectively treat bipolar disorder.

Finding the right medication

Finding the right combination of medications to treat bipolar disorder can take some time. A doctor considers all of a person’s symptoms and tries to find the right medications to match them. A person should be open with their doctor about any new or changing symptoms and side effects. The doctor can then adjust the treatment accordingly.

Lithium goes by the generic names lithium carbonate, which comes as capsules and tablets, and lithium citrate, which comes as a liquid. There are several brand names, such as Eskalith, Eskalith CR, and Lithobid.

Lithium works in the brain to help stabilize moods. Doctors may prescribe it to help treat bipolar disorder or acute mania.

The dosage is usually 600–1,800 milligrams (mg) of lithium carbonate daily.

Lithium can take weeks to start working. A person must take it every day for it to be effective.

Doctors have prescribed lithium to treat bipolar disorder for decades, despite the range of possible side effects. These can include:

  • nausea
  • shaking
  • dry mouth
  • frequent urination
  • diarrhea
  • weight gain
  • increased thirst
  • loss of appetite
  • kidney damage
  • reduced thyroid activity
  • fatigue
  • emotional numbness or a “dull” feeling

It is essential for people taking lithium to stay hydrated. This keeps lithium levels in the blood from becoming toxic. A doctor monitors these levels regularly.

Signs of lithium toxicity, or too much lithium in the blood, include:

  • trouble concentrating
  • confusion
  • fatigue
  • vomiting
  • diarrhea
  • poor coordination
  • muscle weakness, twitching, and tremors
  • an irregular heart rhythm
  • seizures

If anyone has symptoms of lithium toxicity, call 911 or the local emergency number. Lithium overdoses can result in coma and death.

A doctor also monitors levels of creatine in the blood to ensure that the kidneys are handling the drug well. Creatinine is a waste product that the kidneys create. When blood creatinine levels are high, it is often a sign that the kidneys are not working correctly.

Anticonvulsants treat conditions that cause seizures, but they can also help manage mania and bipolar disorder.

Doctors often refer to anticonvulsants that treat bipolar disorder as “mood stabilizers.”

They may prescribe the following anticonvulsants for bipolar disorder:

  • divalproex sodium (Depakote)
  • lamotrigine (Lamictal)
  • valproic acid (Depakene)
  • carbamazepine (Equetro)
  • topiramate (Topamax)

Some of the most common side effects of anticonvulsant medications include:

  • nausea
  • shaking
  • weight gain
  • dizziness
  • drowsiness
  • blurred vision
  • decreased white blood cell or platelet count
  • dry mouth
  • skin rashes

Topiramate may have different or additional side effects, including:

  • weight loss
  • memory problems
  • emotional numbness or a “dull” feeling
  • kidney stones

Also, lamotrigine can sometimes cause a rash that requires medical attention.

Doctors may not prescribe valproic acid to anyone who is pregnant, as it may cause some congenital abnormalities.

Doctors typically prescribe antipsychotic medications to treat schizophrenia.

However, antipsychotics can also help manage bipolar disorder, especially when periods of psychosis occur during severe depression or mania.

A doctor may prescribe an antipsychotic drug “off-label” to help manage bipolar disorder. This means that the Food and Drug Administration (FDA) has not approved the use of this drug for this purpose.

However, a few antipsychotics do have FDA approval to treat bipolar disorder, including:

  • olanzapine (Zyprexa)
  • risperidone (Risperdal)
  • quetiapine (Seroquel)
  • asenapine (Saphris)
  • aripiprazole (Abilify)
  • ziprasidone (Geodon)

Some possible side effects of antipsychotic medications include:

  • drowsiness and sedation
  • dry mouth
  • shaking
  • increased appetite
  • weight gain
  • constipation
  • low blood pressure
  • restlessness
  • increased saliva
  • reduced libido or sexual dysfunction

Asenapine can cause numbness of the mouth and a strange taste in the mouth. And ziprasidone may cause heart problems.

Antidepressants can help manage the symptoms of bipolar depression, though their efficacy is still being researched. They work by acting on brain chemicals called neurotransmitters.

A person who takes antidepressants to help treat bipolar disorder also needs to take a mood stabilizer to prevent the risk of mania.

One medication, called Symbyax, is a mix of both an antidepressant, fluoxetine, and an antipsychotic, olanzapine. This can help treat depression while also stabilizing mood.

There are several classes of antidepressant, each of which targets a different neurotransmitter or set of neurotransmitters. The FDA has not approved specific antidepressants to treat bipolar disorder, so any prescription may be off-label.

Some classes of antidepressants that may reduce symptoms of bipolar disorder include:

Serotonin and norepinephrine reuptake inhibitors, or SNRIs

  • levomilnacipran (Fetzima)
  • duloxetine (Cymbalta, Yentreve)
  • venlafaxine (Effexor)

Selective serotonin reuptake inhibitors, or SSRIs

  • citalopram (Celexa)
  • fluvoxamine (Luvox)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

Tricyclics and tetracyclics

  • clomipramine (Anafranil)
  • amitriptyline (Elavil)
  • desipramine (Norpramin)
  • imipramine (Tofranil)
  • nortriptyline (Pamelor)

Monoamine oxidase inhibitors, or MAOIs

  • phenelzine (Nardil)
  • tranylcypromine (Parnate)

Each group of antidepressants and each specific drug can have different side effects. Some of the most common side effects of antidepressants include:

  • sexual dysfunction
  • dizziness
  • insomnia
  • sleepiness
  • dry mouth
  • agitation, anxiety, and nervousness
  • weight gain
  • low blood pressure

A doctor may prescribe antianxiety medication, such as a benzodiazepine, for short-term use. These can also help with sleep. Doctors typically do not prescribe these drugs for long periods due to the risk of tolerance and dependence.

Examples include:

  • diazepam (Valium)
  • alprazolam (Xanax)
  • clonazepam (Klonopin)

Doctors often prescribe medications as the first line of treatment for bipolar disorder. Some people find that other approaches, including some self-care strategies, help manage their condition.

Some additional ways to help manage bipolar disorder include:

Each medication can cause side effects. These vary from drug to drug and class to class.

For example, side effects of antipsychotics can include:

  • drowsiness
  • lack of emotion
  • anxiety
  • dry mouth
  • weight gain

Lithium, one of the most commonly prescribed mood stabilizers, can cause:

  • thirst
  • excessive urination
  • nausea
  • diarrhea
  • tremor
  • weight gain
  • cognitive issues
  • kidney and thyroid issues

Some of the side effects may go away within a few days or weeks, while others may last longer.

A healthcare professional may be able to describe ways of reducing side effects, such as taking medications at different times of day or with food.

Always consult a doctor about any severe, concerning, or persistent side effects. They may modify the dosage or recommend a different treatment.

It may take several weeks for most medications to work. Let the doctor know if any treatment is still not reducing the symptoms.

Finding the right medication can be a slow, frustrating process, but it is best to speak with a doctor before ending the treatment. A person should also let a doctor know if they have missed more than one or two doses.

Several types of medication can effectively treat bipolar disorder. Each can cause side effects, however.

Many mild or moderate side effects may go away within the first weeks or months. But if side effects are concerning or bothersome, speak with the doctor.

If any side effect seems dangerous, contact emergency services. Some medications, especially lithium-based drugs, can cause complications that require urgent care.

Seek emergency care if any of the following arise:

  • severe or sudden changes of any kind
  • muscle weakness, a tremor, or a twitch
  • trouble concentrating
  • confusion
  • a severe rash
  • jaundice, which is yellowing of the skin or the whites of the eyes
  • an irregular heartbeat or other heart-related symptoms
  • a fever
  • thoughts of suicide
  • hallucinations, such as hearing voices that are not there

In many cases, finding the right treatment requires patience and a trial-and-error approach. Combining drug-based treatment with other methods, such as psychotherapy and stress-management techniques, can reduce symptoms and improve the quality of life.

Below are answers to common questions about medications for bipolar disorder.

What is the most common drug used to treat bipolar disorder?

Mood stabilizers may be the most common approach, though doctors often prescribe a combination of medications. More common mood stabilizers include lithium (Eskalith, Lithobid), carbamazepine (Equetro, Tegretol), divalproex sodium (Depakote), lamotrigine (Lamictal), and valproic acid (Depakene).

What is the newest drug for bipolar disorder?

In December 2021, the FDA approved lumateperone (Caplyta) to treat bipolar disorder in adults. This is the only antipsychotic drug that the agency has approved as a treatment for depressive episodes, either alone or alongside lithium or valproic acid.

What is the best treatment for bipolar disorder?

Doctors often recommend one or more medications and psychotherapy. For example, the combination may involve a mood stabilizer and an antidepressant. A person should work with their doctor to identify the most effective approach to treatment.