Bipolar Disorder is considered a medical disorder, similar to diabetes. There are a variety of medications and therapies available to those suffering from bipolar disorder. Medications can help reduce symptoms and are recommended as the first-line treatment. Three different types of medication are used- mood stabilizers, antipsychotic medication, and antidepressant medication.

How Long Does It Take To See Improvement? 

All Bipolar Disorder medications must be taken as prescribed.  It is important that you don’t stop taking your medication because you think it’s not working. Give it time.

  • Mood stabilizers: After achieving the desired, effective dose, it may take an additional one to two weeks before you can expect to see improvement in manic symptoms. It may take up to four weeks for depressive symptoms to lessen. 
  • Antipsychotic medications: The 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. 
  • Antidepressants: It can take three to four weeks before you can expect to see positive changes in your symptoms.

Keep Working to Find the Right Fit 

You and your doctor have a lot of choices of medications. It’s hard to know which one may work best for you. Sometimes the medication you first try may not lead to improvements in symptoms. This is because each person’s brain chemistry is unique; what works well for one person may not do as well for another.

Be open to trying a different medication or combination of medications in order to find a good fit. Let your doctor know if your symptoms have not improved or have worsened, and don’t give up searching for the right medication! 

Prevent Relapse: Don’t Stop!

Once you have responded to medication treatment, it is important to continue taking your medication as prescribed. In general, it is necessary for individuals with bipolar disorder to continue taking medications for extended periods of time (at least 2 years).

To prevent symptoms from returning or worsening, do not abruptly stop taking your medications, even if you are feeling better, as this may result in a relapse. You should only stop taking your medication under your doctor’s supervision. If you want to stop taking your medication, talk to your doctor about how to correctly stop. 

Side Effects 

Like all medications, mood stabilizers, antipsychotic medication, and antidepressants can have side effects. In many cases, these side effects 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.

To learn more, use the buttons below to navigate to the different types of Bipolar Disorder medication.

Mood Stabilizers: What You Should Know

Mood stabilizers are usually the first choice to treat bipolar disorder. Except for lithium, many of these medications are anticonvulsants. They’re usually used to treat seizures, but they also help control mood.

Research has found that mood stabilizers are effective for treating the symptoms of bipolar disorder, but it is not clear exactly how they work. Brain chemicals called neurotransmitters (chemical messengers) are believed to regulate mood.

  • Lithium: It is thought that lithium may affect the activity of two of these neurotransmitters, serotonin and dopamine.
  • Anticonvulsants: These are believed to work by increasing the neurotransmitter, GABA, which has a calming effect on the brain. It is also believed that they decrease glutamate, which is an excitatory neurotransmitter.

Drug Interactions

Mood stabilizing medications can interact with other medications to create potentially serious health consequences. Be sure to tell your doctor about all the medications you are taking, including prescription medications, over-the-counter medications, herbal supplements, vitamins, and minerals. 

Mood Stabilizing Medications

  • Lithium (Eskalith or Lithobid)
  • Valproate/Valproic Acid/Divalproex Sodium (Depakote or Depakene)
  • Carbamazepine (Equetro or Tegretol)
  • Lamotrigine (Lamictal)
  • Oxcarbazepine (Trileptal)
  • Gabapentin (Fanatrex, Gabarone, Horizant, or Neurontin)
  • Topiramate (Topamax or Topiragen)
  • Oxcarbazepine (Trileptal)  

Side Effects of Mood Stabilizers

Lithium

Common side effects of lithium: acne; fine hand tremor; increased thirst; nausea; low thyroid hormone (associated with brittle hair, low energy, and sensitivity to cold temperatures); rash; weight gain.

Lithium toxicity is a serious condition caused by having too much lithium in your system. For this reason, your doctor will require you to do periodic blood tests to ensure that lithium is not impacting your kidney or thyroid functioning. In addition, use of certain pain medications (such as ibuprofen) or physical activity with significant sweating can cause your lithium level to increase. You should talk to your doctor about how to exercise safely. Some signs of lithium toxicity include new onset of nausea, vomiting, diarrhea, headache, loss of coordination, slurred speech, nystagmus (abnormal eye movements), dizziness, seizure, confusion, increased thirst, and worsening tremors. You should contact your doctor right away if you experience any of these symptoms.

Anticonvulsants

Common side effects of anticonvulsants: appetite change; dizziness; double vision; headache; irritability; loss of balance/coordination; nausea; sedation; vomiting; weight gain or loss.

Lamotrigine and Carbamazepine may affect white blood cells, the liver, and other organs. Individuals prescribed these medications will need to have their blood checked periodically to make sure the medications are not impacting their organs in a negative way.

Lamotrigine and Carbamazepine can also cause a serious skin rash that should be reported to your doctor immediately. In some cases, this rash can cause permanent disability or be life threatening. The risk for getting this rash can be minimized by very slowly increasing your dose of Lamotrigine. This rash occurs to a lesser extent with Carbamazepine although the risk is higher for individuals of Asian ancestry, including South Asian Indians. 

Anticonvulsant medications may increase suicidal thinking and behaviors. Close monitoring for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior is advised.

Antipsychotic Medications

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.

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

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.

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)

Parkinsonian or Extrapyramidal Symptoms Side Effects

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.

Antidepressants: What You Should Know

Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. Individuals who are prescribed antidepressants are usually required to take a mood-stabilizing medication at the same time to reduce the risk of switching from depression to mania or hypomania.

Research has found that antidepressants are effective for treating depression, but it is not clear exactly how they work. Brain chemicals called neurotransmitters (chemical messengers) are believed to regulate mood. Antidepressant medications work to increase the following neurotransmitters: serotonin, norepinephrine, and/or dopamine.

Five Classes of Antidepressant Medications

There are five different classes of antidepressant medications. This post lists antidepressant medications by class along with their common side effects.

Antidepressant Class #1: Selective Serotonin Reuptake Inhibitors (SSRI)
SSRIs are the most commonly prescribed class of antidepressants because they tend to have the fewest side effects. SSRIs increase the level of serotonin by inhibiting reuptake of the neurotransmitter.

  • Fluoxetine (Prozac)
  • Citalopram (Celexa)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Escitalopram (Lexapro)

Common side effects for SSRIs: Abnormal dreams; anxiety; blurred vision; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; flu-like symptoms (e.g., fever, chills, muscle aches); flushing; gas; increased sweating; increased urination; lightheadedness when you stand or sit up; loss of appetite; nausea; nervousness; runny nose; sore throat; stomach upset; stuffy nose; tiredness; trouble concentrating; trouble sleeping; yawning; vomiting; weight loss.

Antidepressant Class #2: Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)
SNRIs are similar to SSRIs in that they increase levels of serotonin in the brain. They also increase norepinephrine in the brain to improve mood.

  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Desvenlafaxine (Pristiq)

Common side effects for SNRIs: Anxiety; blurred vision; changes in taste; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; fatigue; flushing; headache; increased sweating; loss of appetite; nausea; nervousness; sore throat; stomach upset; trouble sleeping; vomiting; weakness; weight loss; yawning.

Antidepressant Class #3: Atypical Antidepressants
In addition to targeting serotonin and/or norepinephrine, atypical antidepressants may also target dopamine. They also tend to have fewer side effects than the older classes of medication listed below (Antidepressant Classes 4 and 5). The common side effects differ for each of the medications in this class of antidepressants.

Bupropion (Wellbutrin)
Common side effects: Constipation; dizziness; drowsiness; dry mouth; headache; increased sweating; loss of appetite; nausea; nervousness; restlessness; taste changes; trouble sleeping; vomiting; weight changes.

Mirtazapine (Remeron)
Common side effects: Constipation; dizziness; dry mouth; fatigue; increased appetite; low blood pressure; sedation; weight gain.

Trazodone (Desyrel)
Common side effects: Blurred vision; constipation; decreased appetite; dizziness; drowsiness; dry mouth; general body discomfort; headache; light-headedness; muscle aches/pains; nausea; nervousness; sleeplessness; stomach pain; stuffy nose; swelling of the skin; tiredness; tremors.

Nefazodone (Serzone)
Common side effects: Abnormal dreams; abnormal skin sensations; changes in taste; chills; confusion; constipation; decreased concentration; decreased sex drive; diarrhea; dizziness; drowsiness; dry mouth; fever; frequent urination; headache; incoordination; increased appetite; increased cough; indigestion; lightheadedness; memory loss; mental confusion; ringing in the ears; sleeplessness; sore throat; swelling of the hands and feet; tremor; urinary retention; urinary tract infection; vaginal infection; weakness.

Antidepressant Class #4: Tricyclics and Tetracyclics (TCA and TeCA)
This is an older class of antidepressants that also work by increasing levels of serotonin and norepinephrine in the brain. These medications are good alternatives if the newer medications are ineffective.

  • Amitriptyline (Elavil or Endep)
  • Amoxapine (Asendin)
  • Clomipramine (Anafranil)
  • Desipramine (Norpramin or Pertofrane)
  • Doxepin (Sinequan or Adapin)
  • Imipramine (Tofranil)
  • Nortiptyline (Pamelor)
  • Protriptyline (Vivactil)
  • Trimipramine (Surmontil)
  • Maprotiline (Ludiomil)

Common side effects for the TCAs: Abnormal dreams; anxiety or nervousness; blurred vision; change in appetite or weight; changes in blood pressure; change in sexual desire or ability; clumsiness; confusion; constipation; decreased memory or concentration; dizziness; drowsiness; dry mouth; excess sweating; excitement; headache; heartburn; indigestion; nausea; nightmares; pounding in the chest; pupil dilation; restlessness; sleeplessness; stuffy nose; swelling; tiredness; tremors; trouble sleeping; upset stomach; urinary retention; vomiting; weakness.

Antidepressant Class #5: Monoamine Oxidase Inhibitors (MAOI)
MAOIs are an older class of antidepressants that are not frequently used because of the need to follow a special diet to avoid potential side effects. However, these medications can be very effective. These drugs work by blocking an enzyme called monoamine oxidase, which breaks down the brain chemicals serotonin, norepinephrine, and dopamine.

When taking MAOIs, it is important to follow a low “tyramine” diet, which avoids foods such as cheeses, pickles, and alcohol, and to avoid some over-the-counter cold medications. Most people can adopt to a low tyramine diet without much difficulty. Your doctor will provide a complete list of all food, drinks, and medications to avoid.

  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Selegiline (Emsam) patch

Common side effects for MAO/MAOIs: Blurred vision; changes in sexual function; diarrhea, gas, constipation, or upset stomach; difficulty swallowing or heartburn; dizziness, lightheadedness or fainting; drowsiness; dry mouth; headache; nausea, muscle pain or weakness; purple blotches on the skin; rash, redness, irritation, or sores in the mouth (if you are taking the orally disintegrating tablets); sleeping problems; stomach pain, tiredness; tremors; twitching; unusual muscle movements; vomiting, unusual dreams; upset stomach; weakness.

This post provides only general information about medications used for the treatment of bipolar disorder. It does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines mentioned. This information does not constitute medical advice or treatment and is not intended as medical advice for individual problems or for making an evaluation as to the risks and benefits of taking a particular medication. The treating physician, relying on experience and knowledge of the patient, must determine dosages and the best treatment for the patient.

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