A doctor may prescribe antipsychotic medications alongside other mood stabilizers to help reduce symptoms of bipolar disorder and regulate mood. The type will depend on the person’s symptoms and response to other therapies.

Bipolar disorder is a mental health condition that causes intense shifts in mood and energy. There are three types of bipolar disorder, defined based on the severity of symptoms.

People with bipolar I or bipolar II disorder may experience recurring episodes of depression and mania — or hypomania — intermixed with long stretches without mood symptoms.

Cyclothymic disorder is a milder form of bipolar disorder involving chronic mood instability with less intense highs and lows.

There is no cure for bipolar disorder, but most people can manage their symptoms with a combination of talk therapy and medication.

Alongside mood stabilizers, doctors commonly use antipsychotic medications to help manage symptoms of bipolar disorder. These medications work by blocking neurotransmitter activity in the brain, which may contribute to mood episodes in bipolar disorder.

This article answers some frequently asked questions about antipsychotics for bipolar disorder, including their uses and what to expect with treatment.

Antipsychotic medications fall into the following categories:

  • first-generation antipsychotics
  • second-generation antipsychotics
  • third-generation antipsychotics

Antipsychotics work by modulating dopamine activity in the brain. Atypical antipsychotics, or second-generation antipsychotics, also modulate serotonin signaling.

According to a 2023 review, atypical antipsychotics tend to provide better management over a broader range of psychological symptoms and are less likely to cause neurological side effects, such as tremors and stiffness, than typical antipsychotics, aka first-generation antipsychotics.

Antipsychotics for the treatment of bipolar disorder typically include:

  • aripiprazole (Abilify)
  • asenapine (Saphris)
  • brexpiprazole (Rexulti)
  • cariprazine (Vraylar)
  • lumateperone (Caplyta)
  • lurasidone (Latuda)
  • olanzapine (Zyprexa)
  • olanzapine/fluoxetine combination (Symbyax)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)

Antipsychotic medications may have several uses during bipolar disorder treatment.

Some are suitable in the short term to help treat acute symptoms — that is, manic or depressive episodes — whereas others can be part of long-term maintenance therapy.

Most atypical antipsychotics treat bipolar disorder and a doctor can use them for manic or mixed episodes. Only a few are suitable for depressive symptoms, and their effectiveness varies.

Some antipsychotics — alone or in combination with other medications — can be used for long-term maintenance therapy in bipolar disorder to prevent mood episodes.

Several atypical antipsychotics, including risperidone and aripiprazole, are also now available as long-acting injectable therapies. Doctors may also use these formulations for maintenance therapy, particularly for people who have difficulties remembering to take their medications.

Studies on long-acting injectables suggest that they may safely and effectively help manage symptoms of bipolar disorder long term. However, more research is necessary.

Some antipsychotics can help prevent or relieve symptoms of depression with bipolar disorder.

Antipsychotics that have Food and Drug Administration (FDA) approval to manage bipolar depression include:

  • cariprazine
  • lurasidone
  • quetiapine
  • lumateperone
  • olanzapine-fluoxetine combination

The effects of long-acting injectable antipsychotic therapy on the prevention of depression episodes are less clear, and most studies have shown no effect.

The right medication for bipolar disorder depends on the person requiring treatment. If a doctor prescribes medication during a mood episode, they may consider the symptoms an individual is experiencing during that episode — for example, mania vs. depression.

Other considerations may include:

  • other medications a person is taking
  • the occurrence of other mental health conditions
  • previous response to antipsychotic therapy
  • safety concerns
  • personal preferences

Several antipsychotic medications are considered first-line treatment for managing bipolar disorder. However, antipsychotics can cause various side effects, including:

  • atypical muscle movements
  • sedation or drowsiness
  • fatigue
  • nausea
  • anxiety
  • weight gain
  • neurologic complications

These side effects may make medication adherence challenging. Finding the right balance between effective treatment and manageable side effects is crucial for most people taking antipsychotics for bipolar disorder.

It is also important for people to talk with a doctor if side effects become too difficult. Stopping antipsychotic treatment is not recommended without medical supervision. If an individual stops them too quickly, it can lead to a relapse of symptoms.

A doctor can help determine the best medications and treatment options based on the person’s severity of symptoms and response to other therapies.

Antipsychotic medications are common for the treatment of bipolar disorder and can help reduce the frequency and severity of mood episodes.

A variety of options are available that can help manage episodes of both mania and depression, as well as mixed episodes. Long-acting injectable forms for maintenance therapy are also available.

A psychiatrist can help answer questions about the use of antipsychotics in the treatment of bipolar disorder. People can also find out more about bipolar disorder and treatments via various organizations.