The main bipolar medications are mood stabilizers (such as lithium, valproate, carbamazepine and lamotrigine) and atypical antipsychotics, which help control manic and depressive episodes and prevent new ones. Antidepressants are sometimes added with caution, but they are not used alone because they can trigger mania. Most people need ongoing treatment, and finding the right medication or combination can take patience and close work with a prescriber.
This guide explains how each type of bipolar medication works, common side effects and safety steps to know. It is for education only; your prescriber will tailor treatment to you. Never start, stop or change a medication on your own.
Why Medication Matters in Bipolar Disorder
Bipolar disorder is a long-term condition marked by shifts between mania or hypomania and depression. (For a refresher, see bipolar I vs. bipolar II or our bipolar disorder hub.) The National Institute of Mental Health (NIMH) notes that mood stabilizers help prevent mood episodes or reduce their severity, and that long-term, ongoing treatment can help people manage symptoms and live healthy lives. Medication works best alongside therapy such as CBT or family-focused therapy.
Mood Stabilizers
Mood stabilizers are the foundation of treatment for many people. Mayo Clinic explains they help control manic or hypomanic episodes and may help with depression, too. Common options include lithium, valproic acid, divalproex sodium, carbamazepine and lamotrigine.
Lithium
The NIMH guide to mental health medications describes lithium as an effective mood stabilizer approved for the treatment of mania and bipolar disorder. NIMH also notes long-term lithium use may reduce suicide risk.
Lithium requires regular monitoring of blood levels and of kidney and thyroid function. According to MedlinePlus:
- Common side effects include hand tremor, increased thirst, stomach upset, appetite or weight changes, dry mouth, acne and hair loss.
- Hydration and salt matter. Severe diarrhea, heavy sweating and fever can raise the risk of toxicity, and diuretics (“water pills”) and some pain relievers (NSAIDs) can affect lithium levels.
- Know the warning signs. Drowsiness, uncontrollable shaking, muscle weakness, loss of coordination, vomiting, diarrhea, slurred speech or blurred vision need prompt medical attention. Call 911 for confusion, hallucinations, fainting, a fast or irregular heartbeat or chest tightness.
Anticonvulsant Mood Stabilizers
Some seizure medications also stabilize mood. NIMH notes they may be used when lithium is less suitable, for example for people with “mixed” symptoms or rapid cycling. They also require regular monitoring.
- Valproic acid and divalproex: Mayo Clinic notes these carry specific warnings against use during pregnancy.
- Carbamazepine: May make hormonal birth control less effective.
- Lamotrigine: MedlinePlus explains it is used to increase the time between mood episodes in bipolar I disorder, but it does not treat an episode that is already happening. It carries a risk of serious rash, most often in the first 2 to 8 weeks, so any rash, blistering, hives or mouth sores should be reported right away.
MedlinePlus also notes that in clinical studies, about 1 in 500 people taking anticonvulsants developed suicidal thoughts or behavior. Report any new or worsening mood changes to your provider.
Atypical Antipsychotics
Atypical (second-generation) antipsychotics have mood-stabilizing properties and can be used alone or with a mood stabilizer. Mayo Clinic lists options such as olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone, asenapine, lumateperone and cariprazine. NIMH notes they are used to address acute symptoms.
NIMH notes that people taking atypical antipsychotics may need monitoring of weight, blood sugar (glucose) and lipid levels. Long-term use of older, typical antipsychotics can cause tardive dyskinesia, a condition involving uncontrollable muscle movements.
Antidepressants and Bipolar Depression
Depression is often the hardest part of bipolar disorder, but it is treated differently than unipolar depression. NIMH states antidepressants are not used alone in bipolar disorder because they can trigger a manic episode. When they are used, providers usually pair them with a mood stabilizer to reduce the risk of switching into mania.
Mayo Clinic also notes a combination medicine, fluoxetine-olanzapine (Symbyax), is used to treat bipolar depression. If you’ve been prescribed an antidepressant and notice signs like needing little sleep, racing thoughts or unusual energy, tell your provider right away. Our guide to the signs of mania can help you spot changes, and our overview of types of antidepressants explains how these medicines work.
Anti-Anxiety Medications
Anxiety and sleep problems are common with bipolar disorder. Mayo Clinic notes benzodiazepines may help with anxiety and sleep but are typically used short term because they can be misused. Be sure your prescriber knows about any past alcohol or drug use.
Tips for Taking Bipolar Medications Safely
- Be patient. Mayo Clinic notes some medicines take weeks to months to reach full effect, and providers often adjust one medication at a time.
- Don’t stop on your own. Stopping suddenly can lead to withdrawal effects, worsening symptoms, depression, suicidal thoughts or a manic episode.
- Avoid alcohol and drugs. NAMI advises avoiding drugs and alcohol, which can disturb emotional balance and interact with medications.
- Plan ahead for pregnancy. Talk with your provider before becoming pregnant, since some bipolar medications carry pregnancy risks.
- Keep lab appointments and track your moods, sleep and side effects to share at visits.
Wondering who should manage your prescriptions? See psychiatrist vs. therapist. If you’re having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline, or call 911 in an emergency.
Frequently Asked Questions
What is the most common medication for bipolar disorder?
Mood stabilizers, especially lithium, and atypical antipsychotics are among the most widely used bipolar medications. Many people take a combination.
How long do bipolar medications take to work?
It varies. Some medicines need weeks to months to reach full effect, and finding the right combination can take time.
Can I stop my bipolar medication if I feel better?
Not without your provider. Feeling better often means the medication is working, and stopping suddenly can bring back symptoms or trigger mania or depression.
Can I drink alcohol on bipolar medications?
Alcohol can worsen mood symptoms and interact with medications. Ask your prescriber, and get help if you’re finding it hard to cut back.
Get Help for Bipolar Disorder in Lancaster, PA
Medication is most effective as part of a complete plan. Mayo Clinic notes that intensive outpatient and partial hospitalization programs can provide intensive support, and that substance misuse needs to be treated at the same time. The Ranch Pennsylvania Outpatient Services offers mental health treatment with psychiatric evaluation and medication management, therapy and integrated care for bipolar disorder and substance use. Learn about bipolar treatment in Pennsylvania or verify your insurance. Our admissions team is available 24/7, and calls are free and confidential.
