Carl R. Darnall Army Medical Center - Health Library

Medications for Bipolar Disorder

Here are the basics about each of the medicines below. Only the most common reactions are listed. Ask your doctor if you need to take any special steps. Use each of these drugs as advised by your doctor or the booklet they came with. If you have any questions, call your doctor.

Psychiatrists are doctors that treat mental health problems. They can give you drugs for problems like bipolar disorder. Some primary care doctors may also give you these drugs. Often, they will treat people by working with a psychiatrist.

Drugs called mood stabilizers are used to help control mood swings. There are many types. You may need to take them for years. Other drugs are added when needed for a short time. These may be used to treat times of mania or depression.

Prescription Medications

Mood stabilizers

  • Lithium

Antiseizure medicines

  • Valproate
  • Carbamazepine
  • Lamotrigine
  • Gabapentin
  • Topiramate

Benzodiazepines

  • Clonazepam
  • Lorazepam

Antidepressants—Selective Serotonin Reuptake Inhibitors (SSRIs)

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

Other Antidepressants

  • Bupropion
  • Venlafaxine
  • Duloxetine
  • Mirtazapine

Atypical Antipsychotics

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

Combination (atypical antipsychotic and SSRIs)

  • Olanzapine/fluoxetine
 

Mood Stabilizers

  • Lithium

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

Do not drink a lot of caffeinated drinks, such as coffee, tea, and sodas when you are taking this drug.

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 your 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 a blood cells to lower
  • Rash
 

Benzodiazepines

  • Clonazepam
  • Lorazepam

These drugs can help you sleep and ease an upset mood. But they can be addictive. It may also not work as well the more you take it. 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 your level of 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 can't 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 incease 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 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. If you are thinking about breastfeeding and take medicine, talk to your doctor about the risks before you start.

When to Contact Your Doctor

Call your doctor if your medicine doesn't seem to be working. You should also call if you have any reactions.

Special Considerations

If you are taking medicine:

  • Take your medicine as advised. Do not change the amount or schedule.
  • Ask what reactions could happen. Tell your doctor if you have any.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Do not share your prescription medicine.
  • Medicines can be harmful when mixed. Talk to your doctor or pharmacist if you are taking more than one, including over-the-counter products and supplements.
  • Plan ahead for refills.
REFERENCES:

Bipolar disorder. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T114738/Bipolar-disorder. Updated August 20, 2018. Accessed September 25, 2018.

Bipolar disorder in adults. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/bipolar-disorder-tr-15-3679/index.shtml. Updated November 2015. Accessed September 25, 2018.

Deeks ED, Keating GM. Olanzapine/fluoxetine: a review of its use in the treatment of acute bipolar depression. Drugs. 2008;68(8):1115-1137.

Management of bipolar disorder in adults. US Department of Veterans Affairs website. Available at: https://www.healthquality.va.gov/bipolar/bd_305_full.pdf. Published May 2010. Accessed September 26, 2018.

Miklowitz DJ, Scott J. Psychosoical treatments for bipolar disorder: cost effectiveness, mediating mechanisms, and future directions. Bipolar Disord. 2009;11 Suppl 2:110-122.

Pisanu C, Papadima DM, Del Zompo M, Squassina A. Understanding the molecular mechanisms underlying mood stabilizer treatments in bipolar disorder: Potential involvement of epigenetics. Neurosci Lett. 2016 Jun 23 [Epub ahead of print].

Price AL, Marzani-Nissen GR. Bipolar disorders: a review. Am Fam Physician. 2012;85(5):483-493.

Salvadore G, Drevets WC, Henter ID, Zarate CA, Manji HK. Early intervention in bipolar disorder, part II: therapeutics. Early Interv Psychiatry. 2008;2(3):136-146.

Last reviewed September 2018 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated 9/26/2018