Bipolar disorder is marked by a significant shift in brain functionality and emotions. These shifts are categorized by manic and depressive episodes, both of which can inhibit daily responsibilities. To better manage these shifts, doctors will recommend medication. But which is best for you and what are the side effects?

Bipolar Medication List

To manage the symptoms of bipolar disorder, your healthcare provider will likely recommend medication. The type of medication that’s best for you ultimately depends on which symptoms bother you most.

Still, medication is not a cure for bipolar disorder. It simply helps to ease the weight of symptoms while you go through other treatment options, such as psychotherapy. Remember that the only cure is to identify the underlying cause of bipolar disorder.

Here’s a list of the most common bipolar medications:

Lithium

Since lithium can regulate mood, it’s usually one of the first recommendations by healthcare professionals. More specifically, lithium helps control the nervous system. In turn, makes it easier to control emotions and cope with mood swings. ¹

In other words, lithium softens the dramatic mood shifts of bipolar disorder. There are a few different types of lithium a doctor may recommend, depending on your circumstances. For example:

• Children and teenagers are more likely to receive an extended-release lithium tablet, whereas;
• Doctors may avoid this type with older adults as it can lead to heart, kidney, or liver complications.

If you’re currently on medication for another condition, it’s important to discuss this with your doctor before taking lithium. As you can see from this list, lithium has an assortment of negative drug interactions.

Side Effects

The side effects of lithium include: ²

• Dry mouth
• Gradual weight gain
• Increased thirst
• Nausea

Anticonvulsants

While most common in the treatment of seizures, anticonvulsants may have applications for bipolar disorder. The reason is that this medication helps to control abnormal electrical activity in the brain. ³

This electrical control can help alleviate symptoms of manic episodes. ⁴ If mania is your top inhibition with bipolar, you’ll likely be recommended a single anticonvulsant. However, over time, your healthcare provider may combine this with a mood stabilizer or an antidepressant.

Side Effects

The side effects of anticonvulsants include: ⁵

• Dizziness
• Fatigue
• Increase or decrease in appetite
• Nausea
• Upset stomach

Antipsychotics

Antipsychotics are most commonly prescribed for schizophrenia due to their ability to reduce psychotic symptoms, such as hallucinations or delusions. However, antipsychotics may have applications for the mania and severe depression associated with bipolar disorder.

Research reveals that bipolar patients with severe mania symptoms have found a therapeutic response to typical antipsychotics, such as olanzapine and quetiapine. More so, olanzapine alone was shown to reduce depression symptoms. ⁶

Side Effects

The side effects of antipsychotics include: ⁷

• Constipation
• Dizziness and sedation
• Dry mouth
• Heart problems
• Immune disruption
• Movement disorders
• Weight gain

Antidepressants

While more common in clinical depression, antidepressants may help relieve depressive episodes of bipolar disorder. They work by increasing certain neurotransmitters in the brain, such as:

• Dopamine
• Norepinephrine
• Serotonin

Antidepressants may help to lift moods and symptoms associated with depressive episodes. Still, they can have an adverse effect of causing more frequent or severe manic episodes. As a result, they’re often prescribed alongside a mood stabilizer. ⁸

Side Effects

The side effects of antidepressants include: ⁹

• Constipation
• Diarrhea
• Fatigue
• Headaches and dizziness
• Loss of appetite
• Lower sex drive
• Sleep changes
• Stomach issues
• Temporary anxiety increase

Benzodiazepines

Benzodiazepines are commonly prescribed for anxiety, epilepsy, and alcohol withdrawal. This is because they help to slow down the nervous system and, therefore, reduce symptoms of these conditions. ¹⁰

That said, benzodiazepines may provide bipolar patients with a calmer state, especially during a manic episode. Still, other research has found this medication can worsen depressive-related symptoms. ¹¹ Furthermore, they may lead to addiction.

Due to these negative attributes, benzodiazepines are usually a later resource for bipolar treatment. Initially, you’re more likely to receive a mood stabilizer or anticonvulsant.

Side Effects

The side effects of benzodiazepines include: ¹²

• Confusion
• Drowsiness
• Dry mouth
• Lightheadedness
• Memory issues
• Muscle weakness
• Nausea

Symbyax

Symbyax is a combo of the atypical antipsychotic Zyprexa and an SSRI antidepressant (usually Prozac). For bipolar disorder, Symbyax is most commonly prescribed for depression-related symptoms.

Still, this is undoubtedly the most restrictive drug on this list. Therefore, it’s not commonly utilized today for the treatment of bipolar disorder. ¹³

Side Effects

The side effects of Symbyax include: ¹⁴

• Constipation
• Dizziness
• Dry mouth
• Fatigue
• Increased appetite
• Sleep changes
• Weight gain

Which Medication is Best for Bipolar Disorder?

Ultimately, you and your doctor will need to determine which is the best medication for you. The medication (or combination thereof) comes down to which type of bipolar you struggle with and which symptoms are most prevalent. ¹⁵

Remember that medication is just one step in bipolar treatment. You’ll want to also incorporate psychotherapy and potentially holistic remedies. The best way to determine the right treatment path is by talking to your healthcare provider.

References

¹ Ferensztajn-Rochowiak E, Rybakowski JK. Long-Term Lithium Therapy: Side Effects and Interactions. Pharmaceuticals (Basel). 2023 Jan 3;16(1):74. doi: 10.3390/ph16010074. PMID: 36678571; PMCID: PMC9867198.

² Gitlin M. Lithium side effects and toxicity: prevalence and management strategies. Int J Bipolar Disord. 2016 Dec;4(1):27. doi: 10.1186/s40345-016-0068-y. Epub 2016 Dec 17. PMID: 27900734; PMCID: PMC5164879.

³ Davies JA. Mechanisms of action of antiepileptic drugs. Seizure. 1995 Dec;4(4):267-71. doi: 10.1016/s1059-1311(95)80003-4. PMID: 8719918.

⁴ Leo RJ, Narendran R. Anticonvulsant Use in the Treatment of Bipolar Disorder: A Primer for Primary Care Physicians. Prim Care Companion J Clin Psychiatry. 1999 Jun;1(3):74-84. doi: 10.4088/pcc.v01n0304. PMID: 15014689; PMCID: PMC181066.

⁵ Akyüz E, Köklü B, Ozenen C, Arulsamy A, Shaikh MF. Elucidating the Potential Side Effects of Current Anti-Seizure Drugs for Epilepsy. Curr Neuropharmacol. 2021;19(11):1865-1883. doi: 10.2174/1570159X19666210826125341. PMID: 34525933; PMCID: PMC9185788.

⁶ Gao K, Gajwani P, Elhaj O, Calabrese JR. Typical and atypical antipsychotics in bipolar depression. J Clin Psychiatry. 2005 Nov;66(11):1376-85. doi: 10.4088/jcp.v66n1106. PMID: 16420074.

⁷ Muench J, Hamer AM. Adverse effects of antipsychotic medications. Am Fam Physician. 2010 Mar 1;81(5):617-22. PMID: 20187598.

⁸ Patel R, Reiss P, Shetty H, Broadbent M, Stewart R, McGuire P, Taylor M. Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study. BMJ Open. 2015 Dec 14;5(12):e008341. doi: 10.1136/bmjopen-2015-008341. PMID: 26667012; PMCID: PMC4679886.

⁹ Saha K, Torous J, Kiciman E, De Choudhury M. Understanding Side Effects of Antidepressants: Large-scale Longitudinal Study on Social Media Data. JMIR Ment Health. 2021 Mar 19;8(3):e26589. doi: 10.2196/26589. PMID: 33739296; PMCID: PMC8077932.

¹⁰ Edinoff AN, Nix CA, Hollier J, Sagrera CE, Delacroix BM, Abubakar T, Cornett EM, Kaye AM, Kaye AD. Benzodiazepines: Uses, Dangers, and Clinical Considerations. Neurol Int. 2021 Nov 10;13(4):594-607. doi: 10.3390/neurolint13040059. PMID: 34842811; PMCID: PMC8629021.

¹¹ Guina J, Merrill B. Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. J Clin Med. 2018 Jan 30;7(2):17. doi: 10.3390/jcm7020017. PMID: 29385731; PMCID: PMC5852433.

¹² Vgontzas AN, Kales A, Bixler EO. Benzodiazepine side effects: role of pharmacokinetics and pharmacodynamics. Pharmacology. 1995 Oct;51(4):205-23. doi: 10.1159/000139363. PMID: 8577815.

¹³ Bobo WV, Shelton RC. Efficacy, safety and tolerability of Symbyax for acute-phase management of treatment-resistant depression. Expert Rev Neurother. 2010 May;10(5):651-70. doi: 10.1586/ern.10.44. PMID: 20420487.

¹⁴ Conley RR, Meltzer HY. Adverse events related to olanzapine. J Clin Psychiatry. 2000;61 Suppl 8:26-9; discussion 30. PMID: 10811240.

¹⁵ Shah N, Grover S, Rao GP. Clinical Practice Guidelines for Management of Bipolar Disorder. Indian J Psychiatry. 2017 Jan;59(Suppl 1):S51-S66. doi: 10.4103/0019-5545.196974. PMID: 28216785; PMCID: PMC5310104.