Munson Health
 
Medications for Bipolar Disorder

Back to Document

by Scholten A
 
The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor or according to the instructions provided. If you have further questions about medications or their potential side effects, contact your doctor.
Psychiatrists are medical doctors (MDs) with expertise in the diagnosis and treatment of disorders of mental health. They can prescribe medications for medical conditions including bipolar disorder . Some primary care doctors, who do not specialize in psychiatry, may also prescribe these medications. In less severe cases, they will treat patients in consultation with a psychiatrist.
Medications known as mood stabilizers are the mainstay of treatment used to help control the mood swings associated with bipolar disorder. Several different types of mood stabilizers are available. You may continue treatment with mood stabilizers for an extended period of time (years). Other medications are added when necessary, sometimes only for shorter periods of time, to treat acute episodes of mania or depression .

Prescription Medications

  • Lithium
  • Valproate (Depakote)
  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)
  • Gabapentin (Neurontin)
  • Topiramate (Topamax)
  • Clonazepam (Klonopin)
  • Lorazepam (Ativan)
  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)
  • Bupropion (Wellbutrin)
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Mirtazapine (Remeron)
  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Ziprasidone (Zeldox)
  • Quetiapine (Seroquel)
  • Aripiprazole (Abilify)
  • Iloperidone (Fanapt)
  • Paliperidone (Invega)
Combination (atypical antipsychotic and SSRIs)
  • Olanzapine/Fluoxetine (Symbyax)
  Anticonvulsants
  • Valproate (Depakote)
  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)
  • Gabapentin (Neurontin)
  • Topiramate (Topamax)
Anticonvulsant medications, such as valproate (Depakote) or carbamazepine (Tegretol), can also have mood-stabilizing effects. They may be especially useful for difficult-to-treat bipolar episodes. In some people, anticonvulsant medications are combined with lithium, or with each other, for maximum effect.
Possible side effects include:
  • Stomach cramps
  • Diarrhea
  • Change in menstrual periods
  • Nausea and vomiting
  • Loss of appetite
  • Indigestion
  • Hair loss
  • Weight loss or gain
  • Trembling of arms, hands
  • Increased risk of suicidal thinking and behavior
  • Aseptic meningitis—inflammation of the layers of tissue that surround the brain
  • Liver injury
  • Pancreatitis
  • Bone marrow suppression, which causes a decrease in blood cells
  • Rash
  Antidepressants—Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)
Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in depression . They may occasionally be used in the treatment of bipolar disorder, in combination with other medications.
Possible side effects include:
  • Nausea
  • Diarrhea
  • Insomnia
  • Sexual dysfunction, ranging from decreased arousal, to erectile dysfunction , and/or delayed time to orgasm
  • Serotonin syndrome, a serious medical condition caused by an overload of serotonin
  • Sedation or insomnia
  • Increase or decrease in appetite
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
  Other Antidepressants
  • Bupropion (Wellbutrin)
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Mirtazapine (Remeron)
There are several other antidepressants that work in a variety of different ways and affect the concentrations of the neurotransmitters serotonin, norepinephrine, and dopamine, which are all known to be involved in the regulation of mood.
The exact mechanism of bupropion is poorly understood. But, it is thought to be mediated through norepinephrine and dopamine pathways. It is often used in patients who are depressed and unable to tolerate SSRIs. It is also sometimes used in the treatment of bipolar disorder, along with a mood stabilizer.
Possible side effects include:
  • Nausea
  • Nervousness
  • Appetite increase or decrease
  • Sedation or insomnia
  • Sexual dysfunction, not commonly experienced with Wellbutrin, but it is possible
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
Venlafaxine (Effexor) and Duloxetine (Cymbalta) are in the class of medications called serotonin norepinephrine reuptake inhibitors (SNRIs). They work by increasing the amount of both serotonin and norepinephrine. SNRIs are considered a last option for treatment of bipolar disorder and should always be used in conjunction with a mood stabilizer.
Possible side effects include:
  • Nausea
  • Nervousness
  • Anxiety
  • Sexual dysfunction
  • Appetite increase or decrease
  • Increased blood pressure
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
Mirtazapine (Remeron), a tetracyclic antidepressant, has a unique mechanism of action. The medication increases the release of norepinephrine from certain neurons through a complicated process.
Possible side effects include:
  • Sedation
  • Weight gain
  • Fatigue
  • Nausea
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
 

References


Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Updated August 12, 2010. Accessed September 5, 2013.


Bipolar disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated August 15, 2013. Accessed September 5, 2013.


Bipolar disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml . Accessed September 5, 2013.


Cipriani A, Pretty H, et al. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: A systematic review of randomized trials. Am J Psychiatry. 2005;162:1805-1819.


Deeks ED, Keating GM. Olanzapine/fluoxetine: a review of its use in the treatment of acute bipolar depression. Drugs. 2008;68:1115-1137.


Miklowitz DJ, Scott J. Psychosoical treatments for bipolar disorder: cost effectiveness, mediating mechanisms, and future directions. Bipolar Disord
. 2009;11 Suppl 2:110-122.


Price AL, Marzani-Nissen GR. Biploar disorders: a review. Am Fam Physician. 2012;85:483-493.


Salvadore G, Drevets WC, et al. Early intervention in bipolar disorder, part II: therapeutics. Early Interv Psychiatry. 2008;2(3):136-146.


2/4/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Zyprexa (olanzapine): use in adolescents. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm198402.htm . Updated September 3, 2013. Accessed September 5, 2013.


5/14/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Patorno E, Bohn RL, et al. Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death. JAMA. 2010;303(14):1401-1409.


8/23/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : US Food and Drug Administration. Aseptic meningitis risk with use of seizure drug lamictal. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm222212.htm . Updated April 22, 2013. Accessed September 5, 2013.

 

Revision Information