Medications for Bipolar Disorder

Mood Stabilizers

• Lithium

This drug helps to make mood stable. It is often used as the first way to stop manic and depressive attacks. It helps control feelings. It is the only drug known to stop people with mood disorders from taking their own life.

Some problems are:

• Frequent urination or loss of bladder control
• Thirst
• Upset belly
• Shakiness of the hands
• Loss of hair
• Acne or other skin problems

Antiseizure Medicines

• Valproate
• Carbamazepine
• Lamotrigine
• Gabapentin
• Topiramate

These drugs can make mood stable. They may be useful in people who are hard to treat. In some people, these drugs are used with lithium.

The safety of these drugs on children and teens is being studied. Valproate may lead to hormonal changes in teenage girls. It may also lead to polycystic ovary syndrome in women who began taking it before age 20. Young women who take valproate should be watched by their doctors.

Some problems are:

• Stomach cramps or upset
• Diarrhea
• Change in menstrual periods
• Upset belly and vomiting
• Lack of hunger
• Hair loss
• Weight loss or gain
• Shaking of arms, hands
• Greater risk of suicidal thoughts and actions
• Liver injury
• Pancreatitis
• Bone marrow suppression, which causes blood cells to lower
• Rash

Benzodiazepines

• Clonazepam
• Lorazepam

These drugs can help with sleep and ease an upset mood. But they can be addictive. It may also not work as well when more of it is taken. They are often given on a short-term basis or in times of crisis.

Problems may be:

• Sleepiness
• Lightheadedness, mostly in older adults

Antidepressants—Selective Serotonin Reuptake Inhibitors (SSRIs)

• Citalopram
• Fluvoxamine
• Paroxetine
• Fluoxetine
• Sertraline
• Escitalopram

Serotonin levels play a role in depression. They may be used with other drugs.

Some problems are:

• Upset belly
• Diarrhea
• Problems having sex, such as decreased arousal, erectile dysfunction, and delayed time to orgasm
• Serotonin syndrome, a health problem caused by too much serotonin
• Feeling tired or having problems sleeping
• Changes in hunger
• Mood and behavior changes, such as thoughts of self-harm—young adults may be at a higher risk for this problem

Other Antidepressants

• Bupropion
• Venlafaxine
• Duloxetine
• Mirtazapine

These drugs affect the levels of serotonin, norepinephrine, and dopamine. These are known to steady a person's mood.

It is not known how bupropion works. It is often used in people who are depressed and cannot take SSRIs. It is sometimes used along with a mood stabilizer.

Some problems are:

• Upset belly
• Nervousness
• A decrease or increase in hunger
• Feeling tired or having problems sleeping
• Sexual problems
• Mood and behavior changes, such as thoughts of self-harm some people—young adults may be at a higher risk

Venlafaxine and duloxetine increase the amount of serotonin and norepinephrine. They are used as a last choice with a mood stabilizer.

Some problems are:

• Upset belly
• Nervousness
• Anxiety
• Sexual problems
• An increase or decrease in hunger
• High blood pressure
• Mood and behavior changes, such as thoughts of self-harm in some people—young adults may be at a higher risk for this

Some problems are:

• Feeling tired
• Weight gain
• Upset belly
• Mood and behavior changes, such as thoughts of self-harm in some people—young adults may be at a higher risk for this

Atypical Antipsychotics

• Clozapine
• Olanzapine
• Risperidone
• Ziprasidone
• Quetiapine
• Aripiprazole
• Iloperidone
• Paliperidone

In some people, these drugs are added to ones they already take to help ease manic symptoms. Quetiapine can help ease the symptoms of both mania and depression.

Some problems are:

• Weight gain, metabolism changes
• High cholesterol
• High blood sugar
• Feeling tired
• Lightheadedness
• Constipation
• Mood and behavior changes, such as thoughts of self-harm in some people—young adults may be at a higher risk for this

Combination (Atypical Antipsychotic and SSRI Antidepressant)

A drug called Symbyax has both olanzapine and fluoxetine. This has both an atypical antipsychotic and an SSRI antidepressant.

Some problems are:

• High blood sugar
• Feeling tired
• Lightheadedness
• Problems thinking clearly
• Diarrhea
• Dry mouth
• Weight gain
• Mood and behavior changes, such as thoughts of self-harm in some people—young adults may be at a higher risk for this

Special Note

Women who want to have a baby must think about the risks. Some of these drugs can cause harm to a growing baby. Women who are pregnant or thinking about breastfeeding should talk to their doctor about the risks.

When to Contact Your Doctor

Call your doctor if your medicine does not seem to be working. You should also call if you have any reactions.