We all have good moods and bad moods. But if you have bipolar disorder , the highs and lows feel more intense and last longer. Bipolar disorder is a mental health condition that involves periods of intense emotion called mood episodes. These episodes can last for days or weeks and interfere with your normal life. During a manic episode, you might feel extremely happy or energized and need much less sleep. During a depressive episode, you could feel deeply sad or irritable and may not be able to experience pleasure.
If you are diagnosed with bipolar disorder, there are many medicines available that can help stabilize your mood. Managing your condition should be a team effort between you and your doctor. They can help find the best treatments for your symptoms and personality. After you start taking medicine, it's important to share any changes in your symptoms with your doctor. If your medicine causes unwanted side effects or isn't helping with your symptoms, your doctor can adjust your dose or recommend other options.
After remission from an acute episode of bipolar disorder, there's an especially high risk of relapse. Ongoing therapy often is recommended. Generally, anyone who has had two or more manic episodes (or less severe hypomanic episodes) is considered to have lifetime bipolar disorder. Maintenance therapy minimizes the risk of future episodes. Once your doctor has helped stabilize the moods of the acute phase of the disorder (either a manic or depressive episode), medication therapy is usually continued indefinitely — sometimes at lower doses.
What Are the Medications for Bipolar Disorder?
Mood-stabilizing drugs
If you have bipolar disorder, your moods may swing back and forth between highs (manic episodes) and lows (depressive episodes). You could also struggle to manage either extreme highs or extreme lows. Your health care provider may prescribe medicine to help keep your moods from swinging from high to low and back again. There are two categories of mood-stabilizing drugs, known as lithium and anticonvulsants, and different brand name versions of each. These medicines can be very different from each other, but all can help balance your mood.
Lithium
Lithium is a type of mood-stabilizing medicine that's been used since the 1970s. "Lithium works best for the newly diagnosed, the very classic types of bipolar — people who have clear euphoria followed by clear depression, followed by a clear period of being well," said Po Wang, PhD, a clinical professor of psychiatry and behavioral sciences at Stanford University.
Lithium can upset your stomach, causing nausea or diarrhea, especially if you start out taking a higher dose. You may need regular blood tests to measure the amount of lithium in your blood to ensure the correct dosage.
Brands of lithium for bipolar disorder include:
Eskalith. This is an extended release form of lithium. A coating on the tablet slows down its absorption in the body to avoid an upset stomach, according to Wang. It's taken twice a day.
Lithobid. This extended release lithium tablet is taken twice a day. It can reduce manic episodes and make episodes less intense.
Anticonvulsants
Anticonvulsants have long been used to treat epilepsy and other seizure disorders. They were later found to be helpful for bipolar disorder. These medicines can help stabilize your mood, according to Wang. Below are different types and brands of anticonvulsant medicine:
Carbamazepine (Equetro, Tegretol). For people who have bipolar disorder, this medicine helps treat manic episodes, according to Wang. Tablets and liquid forms are available, and some tablets are extended release. Your dose may vary from two to four times per day, depending on which version you take.
Lamotrigine (Lamictal). This medicine helps prevent bipolar depression, according to Wang. Tablets are taken daily. The number of doses per day can vary.
Valproic acid (Depakote). This anticonvulsant medicine comes in tablet form. It can help stabilize your mood by treating manic episodes and keeping it from happening. You may need to take this medicine more than once a day. Your health care provider can tell the right dose and frequency of medicine for you.
Antipsychotics
Taking an antipsychotic medication does not mean you have psychosis, according to Wang. Older (first-generation) antipsychotics sometimes caused depression, but the newer versions — known as second-generation antipsychotics — are formulated differently.
"These have a serotonin effect, so they actually don't cause people to be depressed,” Wang said. "Some of them actually help the depression [or] are good for depression and mania together."
Some of the second-generation antipsychotics commonly used to treat bipolar disorder include:
Aripiprazole (Abilify, Abilify Maintena, Aristada). This medicine can be taken alone to treat acute manic episodes. It's also taken along with lithium or an anticonvulsant to treat mixed episodes of depression and mania. Tablets are taken once a day. The injectable form (Abilify Maintena) is extended release. It's injected into a muscle by a health care provider every four, six, or eight weeks.
Asenapine (Saphris, Secuado). This medicine is used as a patch on the skin (Secuado) or a tablet placed under the tongue (Saphris) to treat manic episodes or mixed episodes of depression and mania. The patch is changed daily. The tablet is taken twice daily.
Cariprazine (Vraylar). This medicine can be taken alone to treat acute manic episodes or mixed episodes of depression and mania in people with bipolar disorder. Capsules are taken once a day.
Lumateperone (Caplyta). This medicine can treat bipolar depression. It can be used alone or together with lithium or an anticonvulsant medicine. Capsules are taken once a day.
Lurasidone (Latuda). This medicine can be taken alone, or along with lithium or an anticonvulsant, to treat major depressive episodes of bipolar disorder. Tablets are taken once a day.
Olanzapine (Lybalvi, Symbyax, Zyprexa). This medicine can be used in a few different ways for people with bipolar disorder. It can treat acute manic episodes, help manage mixed episodes of mania and depression, or treat bipolar depression. Sometimes, it's used along with other antidepressant medicines for bipolar depression. It comes in tablet form and is taken once a day.
Risperidone (Risperdal). This medicine can treat acute manic episodes and help manage mixed episodes of mania and depression. Tablets are taken by mouth once or twice a day.
Quetiapine (Seroquel). This medicine can be used to treat both depression and mania, Wang said. It's used alone or together with lithium for manic episodes. Tablets are taken once a day for bipolar depression and twice daily for bipolar mania.
Ziprasidone (Geodon). This medicine can treat acute manic episodes as well as mixed episodes of mania and depression. It can also be used with lithium or anticonvulsants to help control your mood. It's taken as a capsule twice daily.
Antidepressants
Bipolar depression is different from other types of depression. Mood-stabilizing and antipsychotic drugs are more helpful for bipolar depression than classic antidepressant medicines, according to Wang. If you're taking medicine for bipolar disorder but still struggling with depression or anxiety, you might need to start taking an antidepressant, too. But for many people with bipolar disorder, taking an antidepressant can further destabilize their mood.
"You don't use antidepressants right away. It's not only that they don't work as well, but some people get manic on them," Wang said.
If your doctor prescribes an antidepressant along with other medication for your bipolar disorder, it may be a selective serotonin-reuptake inhibitor (SSRI), such as:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
Therapy for Bipolar Disorder
"Therapy is critical in the management of bipolar disorder," said Melvin McInnis, MD, director of the Heinz C. Prechter Bipolar Research Program, University of Michigan, Ann Arbor. It should help you set and measure progress toward goals, he says.
Your doctor can help figure out the best type of therapy based on your symptoms and specific challenges related to bipolar disorder. For example:
Cognitive behavioral therapy may help you change direction if you get stuck in negative thought patterns.
Interpersonal social rhythm therapy could help if you're not getting along with your spouse, colleagues, or friends.
Family focus therapy can bring in other family members to support you.
"The nature of the therapy should be worked out with an experienced clinical psychologist or social worker," says McInnis.
What Are Other Treatment Options for Bipolar Disorder?
If medicine doesn't improve your symptoms, alternative treatments are available. Electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine are a few options to consider with your health care provider.
"They're all good for bipolar depression, with varying degrees of evidence," Wang said. Of the three alternative treatments, ECT is supported by the most evidence.
Electroconvulsive therapy (ECT)
You may be a good candidate for ECT if you have bipolar depression and medicine isn't helping. ECT can help "reset" the brain and improve your mood, McInnis said.
A doctor uses electrodes (small stickers placed on your scalp) to apply an electric current to the brain. This causes a brief seizure that lasts a minute or less. The entire procedure takes only 10-15 minutes. It can be repeated two or three times a week for about three to six weeks. It's done under general anesthesia and a muscle relaxant.
Transcranial magnetic stimulation (TMS)
TMS is "less aggressive than ECT," McInnis said. A magnet is applied to an area of the brain to stimulate brain tissue. This can help ease bipolar depression symptoms. In rare cases, it can also cause mania. TMS is a noninvasive procedure, so you won't need anesthesia. It can be done daily for four to six weeks (also called repetitive TMS).
Ketamine treatment
Ketamine therapy should be approached with extreme caution, McInnis said. It can help some patients with treatment-resistant depression, but it can also destabilize moods and cause psychotic symptoms.
"There needs to be a specific plan," McInnis said. You and your doctor can form a treatment plan that measures positive or negative effects, he says, by considering questions such as:
- Is it improving your mood?
- Are there any complications?
- Is it destabilizing things for you or not?
Takeaways
If you are diagnosed with bipolar disorder, there are many medicines available that can help stabilize your mood. Some medicines prevent or treat manic episodes, others prevent or treat depressive episodes, and others help manage both. The main types of medicines for bipolar disorder include mood-stabilizing drugs and antipsychotic drugs, sometimes along with antidepressant medications. Most people take more than one drug, such as a mood-stabilizing drug and an antipsychotic or antidepressant. But it's important that treatment be ongoing — even after you feel better — to keep mood symptoms under control. Even if you have been without bipolar symptoms for many months, do not stop taking your medications. Your doctor may lower your doses, but discontinuation of medications will put you at risk for recurrence of bipolar symptoms. Before stopping any medications, discuss it with your doctor. Therapy is also an important part of managing bipolar disorder. Managing your condition should be a team effort between you and your doctor.
Bipolar Disorder FAQs
What is the most effective treatment for bipolar disorder?
Medication such as lithium and electroconvulsive therapy (ECT) are among the most effective ways to manage bipolar disorder, according to McInnis. But not everyone can tolerate lithium, and ECT isn't right for everyone. Having a strong relationship with your provider as well as sharing your symptoms and medical history with them can help find the best treatment for you.
How can I treat bipolar disorder on my own?
Medicine prescribed by your doctor is necessary to treat bipolar disorder. But you can take steps on your own to manage your moods, according to Wang. For instance, maintain a healthy lifestyle with regular exercise, balanced nutrition, and a sleep routine. Light therapy can also help ease depression symptoms, especially during the fall and spring, Wang said.
Can bipolar disorder be fully cured?
Bipolar disorder can't be fully cured. It is a lifelong condition. But with medication, therapy, and a healthy lifestyle, you can manage bipolar disorder over the long term.
