Bipolar Disorder Medication: What You Need to Know

Bipolar disorder is a global issue impacting approximately 40 million individuals [18], leading to severe mood swings that significantly disrupt daily life. Its impact extends beyond the individual, posing challenges for families and communities. In this article, we will explore the symptoms and consequences of bipolar disorder, as well as the various treatment options available, with a focus on bipolar disorder medication designed to stabilize mood swings and improve overall functioning.

What is Bipolar Disorder?

Bipolar disorder, once known as manic-depressive illness, is a mental health condition that leads to significant changes in mood, energy, and activity levels, making everyday tasks challenging. People with this disorder go through intense emotional states during distinct periods known as mood episodes [9,12].

Types of Bipolar Disorder

1. Bipolar I Disorder: This type is characterized by manic episodes that last at least seven days or are so severe that immediate medical attention is required. Depressive episodes often accompany these manic episodes, typically lasting at least two weeks. Sometimes, individuals may experience mixed episodes, displaying both manic and depressive symptoms simultaneously. Rapid cycling, where four or more episodes occur within a year, is also possible [9,12].
2. Bipolar II Disorder: It involves a pattern of depressive episodes and hypomanic episodes, which are less severe than full-blown manic episodes [9,12].
3. Cyclothymic Disorder (Cyclothymia): This form includes numerous periods of hypomanic and depressive symptoms that are not severe or long-lasting enough to qualify as hypomanic or depressive episodes [9,12].

Sometimes, individuals may exhibit symptoms that don’t neatly fit into these three categories, which are referred to as “other specified and unspecified bipolar and related disorders” [9,12].

Related: Understanding and Managing Types of Bipolar Disorder

Symptoms of Bipolar Disorder

People with bipolar disorder have mood episodes that are different from their usual moods and behaviors, lasting most of the day, nearly every day, for several days or weeks [9,12].

Manic Episode Symptoms

Manic or hypomanic episodes can escalate quickly and can include [9,12]:

• Feeling extremely “up,” elated, or irritable
• Increased activity or energy
• Decreased need for sleep
• Racing thoughts and talking very fast
• Taking on many activities at once
• Excessive involvement in pleasurable activities

Depressive Episode Symptoms

Depressive episodes are marked by a profound low mood and decreased energy that impacts one’s ability to function normally and can include [9,12]:

• Feeling very sad, hopeless, or anxious
• Decreased activity or energy
• Trouble sleeping or sleeping too much
• Difficulty concentrating
• Lack of interest in almost all activities
• Thoughts of death or suicide

Mixed episodes can also occur, in which someone may feel sad or hopeless while extremely energized.

What Does Untreated Bipolar Disorder Look Like?

Untreated bipolar disorder (BD) can have serious consequences. It often leads to frequent and disruptive episodes of depression and mania or hypomania, significantly impacting daily lives [22]. Without treatment, the disorder worsens, leading to more hospitalizations, increased suicidal thoughts, and poorer overall outcomes [22].

The longer it goes untreated, the harder it becomes to manage, often resulting in rapid cycling and a worse prognosis [22]. Untreated bipolar disorder can lead to severe and persistent symptoms affecting personal relationships, professional life, and physical health. Early intervention and ongoing treatment are crucial for managing symptoms and improving quality of life [22].  

Purpose of Bipolar Disorder Medications

Medications for bipolar disorder are intended to manage and alleviate the symptoms of both manic and depressive episodes. They work to stabilize mood swings, thereby reducing the intensity of the extreme highs of mania and the lows of depression [15]. Additionally, these medications help prevent future episodes, promoting a more stable mood over time [15].

It is important to regularly monitor individuals taking these medications to check for potential side effects, such as movement disorders and liver function changes, and to ensure the medication is effective [15]. Dosages may need to be adjusted based on individual responses and the emergence of new symptoms [15].

Mental Health Medications Used to Treat Bipolar Disorder

Treating bipolar disorder with medication should be approached carefully by mental health professionals. Adverse side effects from medications can contribute to the severity of manic or depressive episodes. In turn, proper medication management can provide much needed relief if you’re suffering from bipolar disorder symptoms that significantly impact your quality of life. Listed below are the types of medications used to treat bipolar disorder, along with how they work, possible side effects, as well as their generic and brand names.

Mood Stabilizers

Mood stabilizers are essential for managing bipolar disorder, addressing both manic and depressive episodes by balancing brain chemicals [9, 17]. They help control mood swings and prevent episodes.

How They Work

Mood stabilizing medication works to balance mood swings between manic and depressive states. Each medication affects brain chemistry in its own way [17]:

• Lithium (Lithobid, Eskalith): Reduces neuronal excitation by inhibiting specific enzymes involved in neurotransmitter signaling. This is a popular maintenance treatment for bipolar disorder and in some cases, lithium can be used for severe depression symptoms.
• Divalproex (Depakote): Enhances the neurotransmitter GABA to calm excessive brain activity.
• Carbamazepine (Tegretol, Carbatrol, Epitol) Alters brain signaling pathways to reduce the frequency of mood episodes.
• Lamotrigine (Lamictal): Balances neurotransmitter activity by reducing excitatory signals and increasing inhibitory signals.

Side Effects of Mood Stabilizers

A mood stabilizer can be effective but may cause side effects [9, 17]. Common side effects include:

• Increased thirst
• Hand tremors
• Frequent urination
• Weight gain
• Thyroid issues
• Nausea
• Hair loss
• Liver damage (rare)
• Diarrhea
• Dizziness

More Serious Side Effects

More serious side effects can include liver damage, pancreatitis, or kidney issues [17]. It’s important to watch for any unusual symptoms and report them to a healthcare provider.

Antipsychotic Medications

Antipsychotic medications are used to treat conditions characterized by severe mood swings, psychosis, and agitation. They are categorized into two main groups: first-generation antipsychotics (Typical) and second-generation antipsychotics (Atypical) [6].

• First-Generation Antipsychotics: These medications work by blocking certain brain chemicals known as dopamine receptors. Dopamine is a brain chemical that can be overly active in conditions like schizophrenia. By blocking these receptors, first-generation antipsychotics help reduce symptoms such as hallucinations and delusions. However, they can also affect other brain chemicals, leading to potential side effects [6].
• Second-Generation Antipsychotics: These medications function by blocking both dopamine and another brain chemical called serotonin. This approach helps manage a broader range of symptoms, including those that first-generation antipsychotics might not fully address, such as lack of motivation or social withdrawal. Second-generation antipsychotics typically have fewer movement-related side effects compared to first-generation ones [6].

Side Effects of Antipsychotics

Common side effects when taking an antipsychotic drug may include [6].

Common Side Effects:

• Sedation
• Dry mouth
• Blurred vision
• Constipation
• Weight gain
• Photosensitivity (increased sensitivity to sunlight)
• Dizziness

More Serious Side Effects:

More serious side effects, though less common, are possible and may include [6]:

• Extrapyramidal symptoms (movement disorders like tremors or stiffness)
• Tardive dyskinesia (involuntary facial movements)
• Neuroleptic malignant syndrome (a life-threatening reaction that includes high fever, muscle rigidity, and altered mental status)
• Urinary retention (difficulty urinating)
• Metabolic changes (altered blood sugar and cholesterol levels)
• Seizures
• Cardiovascular issues (problems related to the heart and blood vessels)

Generic and Brand Names

The following are antipsychotic drugs that are FDA-approved for treating bipolar disorder in the US [2]:

• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Cariprazine (Vraylar)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Olanzapine/fluoxetine combination (Symbyax)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Ziprasidone (Geodon)

Antidepressants

Specific types of antidepressants are used to manage depressive episodes but must be handled carefully in bipolar disorder due to the risk of triggering manic episodes [7].

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective Serotonin Reuptake Inhibitors (SSRIs) help increase the level of serotonin in the brain by preventing its reabsorption into nerve cells. This has the potential to boost mood and ease symptoms associated with depression.

Common Side Effects

Common side effects include [9-10]:

• Insomnia
• Drowsiness
• Dizziness
• Dry Mouth
• Nausea
• Diarrhea
• Headaches
• Increased appetite
• Weight Gain
• Sexual Dysfunction

Generic and Brand Names

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

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs work by increasing the levels of serotonin and norepinephrine, neurotransmitters that affect mood and emotional response. By preventing the reabsorption (reuptake) of these neurotransmitters in the brain, SNRIs help alleviate symptoms of depression.

Common side effects

• Nausea
• Dry Mouth
• Fatigue

More Serious Side Effects

Less common side effects can include [4]:

• Increased blood pressure
• Increased heart rate

Generic and Brand Names

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

Bupropion

Bupropion (Wellbutrin) affects neurotransmitters like dopamine and norepinephrine in the brain. It is often used when other antidepressants are not effective or cause unwanted side effects [10].

Common Side Effects

Common side effects include [10]:

• Headache
• Dry mouth
• Nausea
• Insomnia

More Serious Side Effects

Bupropion is also associated with a very low risk of seizures. Bupropion generally has lower rates of sexual dysfunction and weight gain compared to SSRIs [10].

Monoamine oxidase inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) are one of the oldest classes of antidepressants still in use today. Although they are not as commonly prescribed as they once were due to the availability of newer medications, MAOIs remain an option, especially for individuals who haven’t found relief with other treatments [11]

MAOIs work by inhibiting the action of monoamine oxidase, an enzyme that breaks down neurotransmitters in the brain. By blocking this enzyme, MAOIs increase the levels of key neurotransmitters—serotonin, dopamine, and norepinephrine. These chemicals regulate mood, energy, and overall mental well-being. While most antidepressants mainly target serotonin, MAOIs affect all three neurotransmitters, which can help improve mood and alleviate symptoms of depression [11].

Common Side Effects

Common side effects include [11]:

• Dizziness and fainting
• Drowsiness or trouble sleeping
• Nausea

Less Common Side Effects

Less common side effects might include [11]:

• Weight gain
• Muscle cramps or involuntary muscle jerks
• Reduced sexual desire or difficulty reaching orgasm
• Increased blood pressure
• Prickling or tingling sensations in the skin (paresthesia)

Serotonin Syndrome: A rare but serious side effect that can cause symptoms like twitching, sweating, shivering, diarrhea, or seizures. If these symptoms occur, it is important to contact a healthcare provider immediately [11].

Generic and Brand Names

• Isocarboxazid (Marplan)
• Phenelzine (Nardil)
• Selegiline (EMSAM – a skin patch)
• Tranylcypromine (Parnate) [11]

What Is The Best Medication For Bipolar Disorder?

There isn’t a single “best” medication for bipolar disorder because the condition varies significantly among individuals. Treatment typically involves a mix of medications tailored to each person’s specific symptoms and medical history.

Common options include lithium, which works well for many people in managing both manic and depressive episodes, and anticonvulsants like divalproex and lamotrigine, which are also effective for mood stabilization. Atypical antipsychotics may be used, especially for severe manic or mixed episodes [16].Ultimately, the right choice depends on how a person responds to different medications and their particular needs [16].

Precautions for Medications in Bipolar Disorder

When managing bipolar disorder with medications, it’s important to follow certain precautions to avoid complications like manic episodes or mood swings. Here’s what you need to know about different types of medications [6-7, 9 14]

General Precautions

Regardless of the type of medication you’re taking, consider these important points:

• Adherence to Prescriptions: It’s important to take your medication exactly as your doctor instructs. This means taking each dose on time and not stopping the medication without your doctor’s approval. Sticking to your prescription helps keep your symptoms under control and prevents relapses.
• Regular Check-ups: Visit your healthcare provider regularly to monitor how the medication is working and check for any side effects.
• Health Monitoring: Your doctor may need to run tests to monitor your kidney, liver, and heart functions since some medications can affect these organs.
• Medication Interactions: Inform your doctor about all other medications, vitamins, and over-the-counter products you are taking. Some substances can interact with your bipolar medication, affecting its effectiveness or leading to unwanted side effects. Your healthcare provider can assist you in safely managing these interactions.
• Stay Informed: Learn about the signs of mood changes, such as increased energy, irritability, or risky behaviors. Let your healthcare provider know if you notice these symptoms.
• Safe Handling and Storage: Store your medications in their original containers, out of direct sunlight, and in a safe place where children and pets cannot reach them. You should not share your medications with others.
• Pregnancy: If you are pregnant or planning to become pregnant, discuss the risks and benefits of your medications with your doctor, as some medications may pose risks to the unborn baby.

Precautions for Antidepressants

Antidepressants can help with depression but need to be used carefully to avoid triggering manic episodes. Here’s what to know [7, 20]:

• Tricyclic Antidepressants (TCAs): CAs have a higher risk of causing manic episodes, making them less commonly used for people with bipolar disorder. These medications can provoke manic symptoms, so they require close monitoring.
• Selective Serotonin Reuptake Inhibitors (SSRIs) and Bupropion: SSRIs and bupropion generally have a lower risk of inducing mania compared to TCAs but still carry some risk. It’s crucial to monitor mood changes closely when using these medications.
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Venlafaxine, an SNRI, has a notable risk of triggering manic episodes. While other SNRIs might have a lower risk, it’s important to be cautious and combine these medications with mood stabilizers to mitigate the risk of mania.

Antidepressants are often combined with mood stabilizers or antipsychotics to manage depressive symptoms while reducing the risk of mania. It is generally advised to avoid using antidepressants alone due to the increased risk of mood instability [3,9].

Precautions for Mood Stabilizers

Mood stabilizers help control mood swings but require specific precautions [17]:

• Kidney or Liver Health: These medications can affect kidney and liver functions, so regular monitoring is important.
• Heart Health: If you have heart issues, especially arrhythmias, mood stabilizers might worsen your symptoms.

Precautions for Antipsychotics

Antipsychotics can be effective but need careful management [6]:

• Medical Conditions: If you have severe heart, liver, or kidney issues or certain neurological conditions, you may need to avoid these drugs.
• Allergic Reactions: If you’ve had severe allergic reactions to antipsychotics in the past, let your doctor know so they can choose an alternative.

Other Treatment Options

Aside from medications, there are other ways to treat bipolar disorder including transcranial magnetic stimulation, psychotherapy, or a combination of treatments which can yield positive outcomes.

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) is a non-invasive method that uses magnetic fields to stimulate brain activity. Repetitive TMS (rTMS) involves applying a series of magnetic pulses to specific brain regions over several sessions, which can have a more significant impact than single-pulse TMS [13].

TMS involves placing a coil on the scalp to administer magnetic pulses. These pulses create electrical currents in the brain, which can either increase or decrease brain activity. High-frequency rTMS (>1 Hz) boosts brain activity, while low-frequency rTMS (<1 Hz) decreases it [13].

Side Effects

Side effects may include [13]:

• Pain at the stimulation site
• Headaches
• Neck pain
• Muscle twitching
• Changes in hearing sensitivity
• Risk of seizures, especially for those with epilepsy or a lower seizure threshold

Most side effects are mild and temporary but require careful monitoring [13].

Who Should Avoid TMS

TMS is not recommended for individuals with [13]:

• Epilepsy or a history of seizures
• Certain neurological conditions or those using substances that may increase seizure risk
• Metallic implants

TMS is used off-label in the treatment of bipolar disorder and has shown a lot of promise, particularly in bipolar depression. Studies indicate that high-frequency, bilateral TMS significantly reduces depressive symptoms, with about 80% of patients responding well to this treatment [8].

Results are mixed in terms of treating mania. Some studies suggest benefits from right-sided TMS, while others show no significant improvement [8]. Additionally, TMS has been explored for maintaining treatment and addressing mixed episodes, with some positive results reported [8]. Despite these encouraging findings, more research is needed to fine-tune treatment protocols and identify which patients are most likely to benefit from TMS [8].

Psychotherapy

Psychotherapy, or talk therapy, involves structured conversations with a therapist to help manage bipolar disorder. It works alongside medication by addressing emotional and mental challenges.

Types of Psychotherapy for Bipolar Disorder

Several psychotherapies are used to manage bipolar disorder [19]:

• Psychoeducation: Psychoeducation provides knowledge about the condition and how to manage it, improving recovery and preventing relapse.
• Cognitive-behavioral therapy (CBT): CBT helps people change negative thought patterns and behaviors, essential for long-term management.
• Family-focused therapy (FFT): FFT involves family developing strategies for managing symptoms together.
• Interpersonal and Social Rhythm Therapy (IPSRT): IPSRT focuses on stabilizing daily routines and relationships to help control mood swings.
• Mindfulness-Based Cognitive Therapy (MBCT): MBCT combines mindfulness practices with cognitive techniques to help manage mood, and it is supported by evidence from several trials [19].

Combining Treatments for Bipolar Disorder

Medications with Psychotherapies

Managing bipolar disorder often involves combining treatments. Medications typically address acute episodes, while psychotherapy can address broader challenges and improve overall outcomes [5]. Combining medication with therapies like FFT, IPSRT, and CBT has enhanced clinical stability compared to medication alone [5].

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) demonstrated that patients receiving intensive psychotherapies, such as family-focused treatment, interpersonal and social rhythm therapy, and cognitive behavioral therapy, were more likely to achieve clinical stability compared to those who only received brief psychoeducation [5]. This combination of medication and psychotherapy aims to optimize treatment outcomes, addressing both the symptoms of bipolar disorder and associated challenges, such as medication adherence [5].

TMS with Medications

Combining Transcranial Magnetic Stimulation (TMS) with medication is a promising approach for treating bipolar disorder, particularly when traditional treatments are insufficient [21].

A recent pilot study on high-frequency rTMS for bipolar depression found notable results. The study reported a 77% response rate and 41% remission rate with rTMS [1]. It also highlighted that the effectiveness of rTMS could vary depending on concurrent medications; for example, lithium was associated with higher depression scores, while lamotrigine correlated with lower scores [1].

These findings suggest that combining rTMS with medications may enhance treatment outcomes for bipolar depression. However, the study’s limitations, such as a small sample size and lack of control groups, indicate the need for further research [1]. More extensive studies could help clarify the optimal integration of rTMS and medications for better managing bipolar disorder [1].

Bipolar Disorder Treatment for You

Living with bipolar disorder or other mental disorders can be incredibly challenging for both the person affected and their loved ones. Fortunately, there are numerous medication options available to help manage mood swings and improve daily functioning. Finding the proper medication is essential for effective management and a better quality of life. Each treatment option has pros and cons, so working closely with a healthcare provider is important to identify the most suitable approach.

If you or a loved one is struggling with bipolar disorder, Neuro Wellness Spa is here to help. Our expert team offers personalized in-person and online psychiatry for medication management to alleviate depressive and manic symptoms, in-person and online psychotherapy for addressing the emotional and emotional impact of bipolar disorder, and TMS therapy, which stimulates areas of the brain that have been affected by mental health conditions. Contact us today to explore your treatment options and start your journey to a better quality of life.

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