Bipolar medications: Everything you need to know

Finding the right medication or combination of drugs to manage bipolar disorder can be a challenging and frustrating process.

Bipolar disorder is a mood disorder characterized by extreme changes in mood, behavior, energy, and thought patterns. A person with bipolar will experience severe highs (mania) and lows (depression) in their mood.

The National Institute of Mental Health estimate that 2.8 percent of adults in the United States have bipolar disorder.

Doctors often find bipolar disorder challenging to treat because everyone responds to medications differently.

Many people with bipolar will try several medications before they find one that works for them. Some people will also need to take more than one class of drug to manage their symptoms.

There are different classes of drugs, and each of these contains several medications that can safely and effectively treat bipolar disorders. These include:

Lithium

Lithium goes by the generic names lithium carbonate (capsules and tablet form) and lithium citrate (liquid form), as well as several trade names, such as Eskalith, Eskalith CR, and Lithobid.

Lithium works in the brain to help stabilize moods. Doctors may prescribe it to help treat bipolar disorder and acute mania.

Lithium can take weeks to months to start working. A person must take it every day for it to be effective.

The dose is usually between 600 and 1,800 milligrams (mg) of lithium carbonate daily.

Doctors have prescribed lithium to treat bipolar disorder for decades, but it still has many possible side effects. These can include:

• nausea
• shaking
• dry mouth
• frequent urination
• diarrhea
• weight gain
• increased thirst
• loss of appetite
• kidney trouble
• lowered thyroid activity
• fatigue
• emotional numbness or a dull feeling

It is essential that people taking lithium stay hydrated to prevent their lithium blood levels becoming too high and toxic.

When somebody takes lithium, a doctor will need to check their blood lithium levels regularly.

Signs of lithium toxicity, or too much lithium in the blood, include:

• trouble concentrating
• confusion
• fatigue
• vomiting and diarrhea
• poor coordination
• muscle weakness, twitching, and tremors
• an abnormal heart rhythm
• seizures

If someone has symptoms of lithium toxicity, call 911 or the local emergency number. Lithium overdoses can result in coma and even death.

A doctor will also check the blood creatine levels of people taking lithium. This is to ensure their kidneys are handling the drug well.

Creatinine is a waste product that the kidneys create. When blood creatinine levels are high, it is often a sign that the kidneys are not working correctly.

Anticonvulsant medications

Anticonvulsants treat conditions that cause seizures, but they can also help manage mania and bipolar disorders.

When a person is taking anticonvulsants to treat bipolar disorder, doctors often call them mood stabilizers.

A doctor may prescribe the following anticonvulsants for bipolar disorder:

• divalproex sodium (Depakote)
• lamotrigine (Lamictal)
• valproic acid (Depakene)
• carbamazepine (Equetro)
• topiramate (Topamax)

Some of the most common side effects of anticonvulsant medications include:

• nausea
• shaking
• weight gain
• dizziness
• drowsiness
• blurred vision
• decreased white blood cell or platelet count
• dry mouth
• skin rashes

Topiramate may have different or additional side effects, including:

• weight loss
• memory problems
• emotional numbness or a dull feeling
• kidney stones

Lamotrigine can sometimes cause a severe rash that requires medical attention.

Doctors may not prescribe valproic acid to anyone who is pregnant, as it may cause some congenital abnormalities.

Antipsychotic medications

Doctors typically prescribe antipsychotic medications to treat schizophrenia.

However, antipsychotics can also help manage bipolar disorders, especially those accompanied by periods of psychosis during severe depression or mania.

A doctor may prescribe an antipsychotic off-label to help manage bipolar conditions.

Off-label means the U.S. Food and Drug Administration (FDA) have not approved the use of the medication to treat this specific condition.

However, a few antipsychotics do have FDA approval to treat bipolar disorders, including:

• olanzapine (Zyprexa)
• risperidone (Risperdal)
• quetiapine (Seroquel)
• asenapine (Saphris)
• aripiprazole (Abilify)
• ziprasidone (Geodon)

Some of the potential side effects of antipsychotic medications include:

• drowsiness and sedation
• dry mouth
• shaking
• increased appetite
• weight gain
• constipation
• low blood pressure
• restlessness
• increased saliva
• reduce libido or sexual dysfunction

Asenapine often causes numbness of the mouth and a strange taste in the mouth.

Aripiprazole and ziprasidone may cause insomnia and restlessness. Ziprasidone can also cause heart problems.

Antidepressant medications

Antidepressants can help manage the symptoms of bipolar depression. They work by acting on brain chemicals called neurotransmitters.

Some people who take antidepressants to help treat bipolar disorders may also take a mood stabilizer to prevent the risk of mania.

One medication, called Symbyax, is a mix of both an antidepressant (fluoxetine) and an antipsychotic (olanzapine). Taking both drugs can help treat depression while also stabilizing a person’s mood.

There are several classes of antidepressant, each of which targets a different neurotransmitter or set of neurotransmitters. The FDA has not approved specific antidepressants for the treatment of bipolar, so doctors may prescribe them off-label.

Some classes of antidepressants that may reduce bipolar symptoms include:

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

• levomilnacipran (Fetzima)
• duloxetine (Cymbalta, Yentreve)
• venlafaxine (Effexor)

Selective serotonin reuptake inhibitors (SSRIs)

• citalopram (Celexa)
• fluvoxamine (Luvox)
• escitalopram (Lexapro)
• fluoxetine (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)

Tricyclics and tetracyclics

• clomipramine (Anafranil)
• amitriptyline (Elavil)
• desipramine (Norpramin)
• imipramine (Tofranil)
• nortriptyline (Pamelor)

Monoamine oxidase inhibitors (MAOIs)

• phenelzine (Nardil)
• tranylcypromine (Parnate)

Each class and type of antidepressant can have different side effects. But some of the most common side effects of antidepressants include:

• sexual dysfunction
• dizziness
• insomnia
• sleepiness
• dry mouth
• agitation, anxiety, and nervousness
• weight gain
• low blood pressure

Anti-anxiety medications

A doctor may prescribe anti-anxiety medication, such as benzodiazepines, for short-term use. These drugs may also help a person sleep.

These include:

• diazepam (Valium)
• alprazolam (Xanax)
• clonazepam (Klonopin)

Other management tools

Doctors often prescribe medications as the first line of treatment for bipolar disorder, but most people also use other tools and make lifestyle changes to help manage their condition.

Some additional ways to help manage bipolar disorders include:

• psychotherapy
• exercising regularly
• keeping a good sleep schedule
• eating a healthful diet and not skipping meals
• using relaxation or mindfulness techniques
• reducing or avoiding alcohol use

Side effects

Nearly all medications that people take to treat bipolar disorders have potential side effects. Some of the most common of these side effects include:

• sleepiness
• constipation
• dry mouth
• sexual dysfunction
• blurred vision
• weight gain or loss
• dizziness

Some of the side effects of bipolar medications are temporary and go away within a few days to weeks of taking the drug, while others are long-term.

A person can ask their doctor about ways to reduce side effects, such as taking medications at different times of the day or with food.

Always talk to a doctor about any severe, concerning, or persistent side effects of bipolar medications. A doctor may suggest changing doses or trying a different drug.

Although it can take several weeks for most bipolar medications to function, a person should speak to a doctor if their drugs are not helping reduce symptoms.

Finding the right medication can be a slow and frustrating process, but it is best to speak to a doctor before stopping or changing medications.

People on bipolar medications should also call their doctor if they miss more than one or two doses.

Takeaway

Several medications from different drug classes can effectively treat bipolar disorder or various elements of the condition.

All bipolar medications have a risk of side effects. Many mild to moderate side effects go away within the first weeks to months of taking bipolar medications.

If the side effects are severe or unbearable, it is essential to talk to a doctor. Some bipolar medications, especially lithium-based drugs, can cause complications that require urgent care.

People taking bipolar medications should seek emergency care if they experience:

• muscle weakness, tremor, or twitch
• trouble concentrating or confusion
• severe rash
• jaundice (yellowing of the skin or eyes)
• irregular heartbeat or heart problems
• a fever
• severe, sudden, or concerning changes of any kind
• thoughts of suicide
• hallucinations or hear voices

In many cases, patience and trial-and-error can help people find the right medication or combination of medications to help them manage bipolar disorder.

Combining medications with other treatments, such as psychotherapy and stress-management techniques, can reduce a person’s symptoms and improve their quality of life.