Antipsychotic Medication for Bipolar Disorder

Antipsychotic medications are sometimes used for treatment when individuals are in a manic episode or a depressive episode. They vary in their effectiveness for treating these episodes. Your doctor will help you choose the best one for you.

Be Patient!

All antipsychotic medications must be taken as prescribed. Their effects can sometimes be noticed within the same day of the first dose. However, the full benefit of the medication may not be realized until after a few weeks of treatment. It is important that you don’t stop taking your medication because you think it’s not working. Give it time!

Keep Working to Find the Right Fit

Like mood stabilizers, the antipsychotic medication you try first may not lead to improvements in symptoms. It may be necessary to try another medication or combination of medications. Talk to your doctor if your symptoms do not improve.

Prevent Relapse: Don’t Stop!

Once you have responded to treatment, it is important to continue taking your medication as prescribed to prevent your symptoms from coming back or worsening. Do not abruptly stop taking your medications, even if you are feeling better as this may result in a relapse. Medication should only be stopped under your doctor’s supervision. If you want to stop taking your medication, talk to your doctor about how to correctly stop.

Injectables

Some antipsychotic medications are available as long-acting injectables. Use of injectable medications is one strategy that can be used for individuals who regularly forget to take their medication.

Antipsychotic Medications

These are sometimes referred to as conventional, typical or first-generation antipsychotic medications:

• Chlorpromazine (Thorazine)
• Fluphenazine (Prolixin)
• Haloperidol (Haldol)
• Loxapine (Loxitane or Loxapac)
• Perphenazine (Trilafon)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)

These are sometimes referred to as atypical or second-generation antipsychotic medications:

• Aripriprazole (Abilify)
• Asenapine (Saphris)
• Clozapine (Clozaril)
• Iloperidone (Fanapt)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Ziprasidone (Geodon)

Long-Acting Injectable Antipsychotic Medications

Certain antipsychotic medications are available as long-acting injectables. These medications are given every two to four weeks. Some patients find these more convenient because they don’t have to take the medications daily. The side effects of these medications are similar to their oral counterparts.

• Fluphenazine (Prolixin decanoate)
• Haloperidol (Haldol decanoate)
• Olanzapine (Zyprexa Relprevv)
• Paliperidone (Sustena)
• Risperidone (Risperdal Consta)

Side Effects of Antipsychotic Medications

Like all medications, antipsychotic medications can have side effects. In many cases they are mild and tend to diminish with time. Many people have few or no side effects, and the side effects people typically experience are tolerable and subside within a few days. Your doctor will discuss some common side effects with you. Check with your doctor if any of the common side effects persist or become bothersome. If you experience side effects, talk to your doctor before making any decisions about discontinuing treatment.

In rare cases, these medications can cause severe side effects. Contact your doctor immediately if you experience one or more severe symptoms.

Parkinsonian or Extrapyramidal Symptoms

Some individuals experience side effects that mimic symptoms of Parkinson’s disease, which are called parkinsonian or extrapyramidal symptoms. These include tremor, shuffling walk, and muscle stiffness. A related side effect is akathisia, which is a feeling of internal restlessness. Additionally, prolonged use of antipsychotics may cause tardive dyskinesia, a condition marked by involuntary muscle movements in the face and body. An uncommon, but serious side effect is called Neuroleptic Malignant Syndrome (NMS). These symptoms include high fever, muscle rigidity, and irregular heart rate or blood pressure. Contact your doctor immediately if any of these symptoms appear.

Other Side Effects

People taking antipsychotic medications can also experience a variety of other side effects including: unusual dreams; blank facial expression; blurred vision; breast enlargement or pain; breast milk production; constipation; decreased sexual performance in men; diarrhea; dizziness or fainting when you sit up or stand up; difficulty urinating; drowsiness; dry mouth; excessive saliva; missed menstrual periods; mood changes; nausea; nervousness; restlessness and sensitivity to the sun.

Weight gain, changes in blood sugar regulation, and changes in blood levels of lipids (cholesterol and triglycerides) are common with some antipsychotics. Therefore, your doctor will check your weight and blood chemistry on a regular basis. If you have a scale at home, it would be helpful to regularly check your own weight. Each of these medications differs in their risk of causing these side effects. If you start to gain weight, talk to your doctor. It may be recommended that you switch medications or begin a diet and exercise program.

Clozapine can cause agranulocytosis, which is a loss of the white blood cells that help a person fight off infection. Therefore, people with who take clozapine must get their white blood cell counts checked frequently. This very serious condition is reversible if clozapine is discontinued. Despite this serious side effect, clozapine remains the most effective antipsychotic available and can be used safely if monitoring occurs at the appropriate time intervals.

Here are some additional articles you might find helpful:

• What Causes Bipolar Disorder
• Bipolar Disorder: The Symptoms
• Evidence-Based Treatments for Bipolar Disorder 
• Bipolar Disorder Medication: What You Should Know
• Mood Stabilizers for Bipolar Disorder: What You Should Know
• Antidepressants for Bipolar Disorder: What You Should Know