Key takeaways:
Bipolar disorder is a health condition that can cause unusual changes in mood, energy, and behavior.
Lithium (Lithobid), anticonvulsants like divalproex (Depakote), and antipsychotics like olanzapine (Zyprexa) are common medications that treat bipolar disorder.
There’s no single best medication for bipolar disorder. The best treatment depends on a person’s symptoms, preferences, and medical history.
Save on related medications
Bipolar disorder is a health condition that can cause people to experience unusual changes in mood, energy, and behavior. Often diagnosed in adolescence or early adulthood, it’s characterized by intense experiences of positive and negative emotions.
Bipolar disorder is relatively common, too. It affects people regardless of age, race, or gender identity. It’s among the leading causes of disability worldwide, but thanks to advancements in modern medicine, many people with bipolar disorder are able to lead a normal life.
Here, we’ll discuss how bipolar disorder is treated and what the best bipolar disorder medications are.
Quiz: Am I Bipolar?
What medications are used to treat bipolar disorder?
Several medications treat bipolar disorder. A combination of medications may even be prescribed at the same time. These medications generally include:
Mood stabilizers
Antipsychotics
Antidepressants
Benzodiazepines
Some medications are used to help treat manic, mixed, or depressive episodes when they’re happening (called acute treatment). Others are used for maintenance treatment. This is when medications are used to manage and prevent symptoms after experiencing an episode. Many can be used for both acute and maintenance treatment.
Other therapies aside from medications can also treat bipolar disorder, such as psychotherapy and electroconvulsive therapy (ECT). This discussion focuses specifically on medications.
Can medications treat different types of bipolar disorder?
Yes, medications are available to treat different types of bipolar disorder. Your prescriber will be in charge of choosing the best medication(s) for your symptoms.
People living with bipolar disorder have mood episodes that come and go. Manic episodes, a type of euphoric experience, can cause you to have high amounts of energy, activity, and irritability. On the other hand, depressive episodes can cause people to feel sad, hopeless, and potentially suicidal.
Tips for managing bipolar disorder: Mental health professional and author Jamie Goudeau shares her personal experiences with bipolar disorder and what she’s learned along the way.
Typical vs. atypical antipsychotics: Also called first- and second-generation antipsychotics, pharmacists break down these two groups of medications and what makes them unique.
Providing support: Here’s how to help someone going through a manic episode.
There are three main forms of bipolar disorder — bipolar I disorder, bipolar II disorder, and cyclothymia. These different forms can cause different symptoms.
Bipolar I disorder: People with bipolar I disorder can have episodes of mania, depression, and hypomania. Manic episodes may last for at least 7 days, and depressive episodes may last for at least 14 days. For some people, manic episodes may be so severe that immediate medical attention is needed.
Bipolar II disorder: People with bipolar II disorder have episodes of depression and hypomania. Hypomanic episodes are similar to mania, but the symptoms tend to be less severe.
Cyclothymia: People with cyclothymia have hypomanic and depressive symptoms that aren’t as severe and don’t last as long as they do for people with bipolar II disorder. It’s considered to be a mild form of bipolar disorder.
Mixed episodes — symptoms of both manic and depressive episodes happening at the same time — are also possible. They were once considered to happen only in bipolar I disorder, but now it’s thought that they can occur along the entire bipolar spectrum.
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Other health conditions, such as substance use disorder and other mental health conditions, can also impact how severe symptoms are. Depending on your form of bipolar disorder and overall medical history, the best treatment for a particular person can vary.
1. Lithium
Lithium (Lithobid) is a medication that’s a type of mood stabilizer. It’s been approved since 1970, but it remains a first-choice treatment option today. It’s not specifically known how it works, but it’s considered effective for manic episodes, depressive episodes, mixed episodes, and maintenance treatment.
Lithium is typically prescribed to people ages 7 years or older and is taken 2 to 3 times daily. It’s available as a tablet, capsule, and oral liquid.
Although it’s noted to be effective for treating bipolar disorder, lithium has a number of possible side effects. Common side effects can include being thirsty, frequently needing to go to the bathroom, and having general discomfort. But, the amount of lithium in the bloodstream needs to remain consistent, and if levels get too high, it’s possible to develop lithium toxicity.
Lithium toxicity, if experienced, is a medical emergency. Symptoms include, but are not limited to, dizziness and weakness, slurred speech, and a lowered heart rate.
2. Anticonvulsant medications
Certain anticonvulsant (anti-seizure) medications are also widely used as mood stabilizers for bipolar disorder. Carbamazepine extended-release (Equetro), divalproex (Depakote), and lamotrigine (Lamictal) are a few of the most notable.
There are many things to keep in mind with these complex medications. Choosing the best one is an individualized decision made by a healthcare professional. Their side effects are variable, they have medication interactions to consider, and they’re available in different dosage forms.
Divalproex: Also known as valproate or valproic acid, divalproex is the anticonvulsant with the most uses in bipolar disorder. Dosages can vary, but it’s available as a tablet, capsule, sprinkle capsule, oral liquid, and injection.
Lamotrigine: Available in various tablet forms — such as standard, chewable, and disintegrating tablets — lamotrigine is a preferred medication for depressive episodes and maintenance treatment.
Equetro: Of these three anticonvulsants, carbamazepine extended-release has the least amount of supporting evidence, particularly for maintenance therapy. It’s more so effective for mania and mixed episodes.
3. Atypical antipsychotics
Certain antipsychotic medications — also known as atypical antipsychotics or second-generation antipsychotics — are also used to treat bipolar disorder. They’re helpful for treating manic episodes and mixed episodes. Several also treat bipolar depression or are used as a maintenance treatment.
Many antipsychotics are available. When choosing an antipsychotic, healthcare professionals usually keep side effects and dosage form in mind. Tablet, oral liquid, or injections are all available, and side effects can vary considerably.
Two preferred atypical antipsychotics include:
Olanzapine (Zyprexa): Available as a tablet, disintegrating tablet, and injection, olanzapine can be given to people ages 13 or older. Its dosage frequency depends on how it’s used — for acute episodes or for maintenance treatment — and how it’s given.
Risperidone (Risperdal, Risperdal Consta): Available as a tablet, disintegrating tablet, oral liquid, and injection, risperidone’s oral forms can be used in people ages 10 and older and the injection can be used in adults. Its dosages vary depending on how it’s used and given.
A combination medication, called olanzapine / samidorphan (Lybalvi), is also available. The samidorphan portion of the medication helps prevent weight gain, which is a common side effect of olanzapine.
Other atypical antipsychotics that treat bipolar disorder include:
Quetiapine (Seroquel)
Aripiprazole (Abilify, Abilify Maintena, Abilify Asimtufii)
Ziprasidone (Geodon)
Asenapine (Saphris)
Cariprazine (Vraylar)
Lurasidone (Latuda)
Lumateperone (Caplyta)
Iloperidone (Fanapt)
Good to know: Typical (first-generation) antipsychotics may also be used in certain situations. For instance, chlorpromazine or haloperidol injections may be administered to manage acute manic episodes. These are typically given in a hospital setting.
4. Other bipolar disorder medication options
If you’re experiencing symptoms that aren’t managed well with the medications listed above, others are also available.
Antidepressants
Antidepressants may be considered for bipolar disorder — specifically depressive episodes — if you’re also taking a mood stabilizer, such as lithium.
Possible options include bupropion (Wellbutrin SR, Wellbutrin XL), selective serotonin reuptake inhibitors (SSRIs) like paroxetine (Paxil), or serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor XR).
A combination medicine called olanzapine / fluoxetine (Symbyax) is also available.
Benzodiazepines
If you get very agitated during manic episodes, short-term benzodiazepines — such as clonazepam (Klonopin) or lorazepam (Ativan) — can be prescribed to help treat symptoms quickly. These are usually only given while in the hospital.
What is the best bipolar order medication?
There’s no one best medication for bipolar disorder. Bipolar disorder is a very variable condition, and the best medication varies by person. Different people may respond better to certain medication combinations than others.
That said, the American Psychiatric Association is an organization that puts together treatment guidelines for bipolar disorder. The U.S. Department of Veterans Affairs and U.S. Department of Defense also compile similar information. These guidelines help show which medications can typically be considered first.
Situation | Possible medications to consider |
|---|---|
Manic episodes — mild to moderate | Lithium Divalproex Antipsychotic |
Manic episodes — severe | Lithium + antipsychotic ± benzodiazepine Divalproex + antipsychotic ± benzodiazepine |
Depressive episodes — mild to moderate | Lithium Lamotrigine |
Depressive episodes — severe | Lithium Lamotrigine Quetiapine |
Mixed episodes — severe | Divalproex + antipsychotic ± benzodiazepine |
Maintenance — preferred | Lithium Divalproex Antipsychotic |
Frequently asked questions
Some people living with bipolar disorder can manage milder symptoms or have long periods of stability without medication, but this isn’t common. Most experts recommend medication as a mainstay of treatment for bipolar disorder. Without medication, the risk of manic, hypomanic, or depressive episodes increases, which can disrupt daily life and relationships. Therapy and lifestyle changes can help, but they’re not always enough on their own.
People with bipolar disorder should be cautious with certain prescription medications, especially antidepressants when used alone. They could trigger mania or mood swings. Corticosteroids, such as prednisone, and stimulants, like those for ADHD, can also be problematic. It’s best to only take these under close medical supervision.
Other medications may also be risky. Always talk to a healthcare professional before starting or stopping any prescription or over-the-counter (OTC) medications.
At this time, there isn’t a cure for bipolar disorder. It’s considered a lifelong condition. Researchers are continuing to study bipolar disorder as time goes on, though. The exact cause of bipolar disorder isn’t known, but it’s thought to be due to a number of genetic and environmental factors. As more research and potential breakthroughs become available, there’s hope that healthcare professionals will be able to more effectively help people with bipolar disorder in the future.
Some people living with bipolar disorder can manage milder symptoms or have long periods of stability without medication, but this isn’t common. Most experts recommend medication as a mainstay of treatment for bipolar disorder. Without medication, the risk of manic, hypomanic, or depressive episodes increases, which can disrupt daily life and relationships. Therapy and lifestyle changes can help, but they’re not always enough on their own.
People with bipolar disorder should be cautious with certain prescription medications, especially antidepressants when used alone. They could trigger mania or mood swings. Corticosteroids, such as prednisone, and stimulants, like those for ADHD, can also be problematic. It’s best to only take these under close medical supervision.
Other medications may also be risky. Always talk to a healthcare professional before starting or stopping any prescription or over-the-counter (OTC) medications.
At this time, there isn’t a cure for bipolar disorder. It’s considered a lifelong condition. Researchers are continuing to study bipolar disorder as time goes on, though. The exact cause of bipolar disorder isn’t known, but it’s thought to be due to a number of genetic and environmental factors. As more research and potential breakthroughs become available, there’s hope that healthcare professionals will be able to more effectively help people with bipolar disorder in the future.
The bottom line
Bipolar disorder is a health condition that can cause unusual changes in mood, energy, and behavior. Depending on the severity and type of symptoms you have, lithium, anticonvulsants, and antipsychotics can be helpful. Although some medications are generally recommended as first-choice options, the true best medication varies by person.
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