Health Education

Bipolar disorder treatment and medications

Cropped SingleCare logo By | January 23, 2020
Medically reviewed by Raymond Zakhari, DNP, EdM, NP-BC

What is bipolar disorder? | Bipolar disorder diagnosis | Bipolar disorder treatment options | Bipolar disorder medications | Best bipolar disorder medications | Side effects of bipolar disorder | Bipolar disorder natural supplements | FAQ | Resources

Living with bipolar disorder is challenging. Unexpected shifts in mood can be difficult to manage, but the available treatment options continue to expand. Prescription medication, alongside therapies and other natural remedies, can be quite impactful when it comes to preventing and treating bipolar disorder symptoms.

What is bipolar disorder?

Bipolar disorder, formerly known as manic depression, is a mental health condition that causes a person to experience episodes of extreme highs and lows. The highs, or manic episodes, are typically characterized by feelings of elevated energy, racing thoughts, reduced need for sleep, and inflated self-esteem. Depressive episodes are the exact opposite. They typically include depressive symptoms such as low energy, low motivation, and loss of interest in daily activities. The frequency of each episode can vary, lasting anywhere from a few days to a few months. Treatment of this affective disorder is lifelong and often involves a combination of medications and psychotherapy. Nearly 3% of the U.S. adult population had bipolar disorder in the past year, according to the National Institute of Mental Health.

There are two different types of bipolar disorder: bipolar I and bipolar II disorder. Both conditions experience depressive states. The primary difference is the severity of the manic phase. Bipolar I disorder is characterized by a full manic episode, while a person with bipolar II typically experiences hypomania (a less severe manic episode).

How is bipolar disorder diagnosed?

A comprehensive psychiatric evaluation helps psychiatric mental health care providers diagnose bipolar disorder. This evaluation process “includes a detailed inquiry about psychiatric symptoms, medical history, substance use and abuse, trauma history, family history, and social history,” says George Hadeed, MD, board-certified psychiatrist and co-founder of Arizona Psychiatry, PLLC in Tucson. “Ultimately, bipolar disorder is diagnosed if there is a presence of mania, hypomania, and/or major depression.”

This assessment is necessary since there is no single cause for bipolar disorder, and a diagnosis is contingent on the presence of symptoms.

A psychiatrist or psychiatric mental health nurse practitioner is best qualified to oversee the diagnosis process. He or she will ask questions about family members with bipolar disorder and your experiences with severe mental stress or trauma that may contribute to bipolar symptoms. Other questions might revolve around memory, cognitive thinking, behavior in relationships, and substances used—especially stimulants (cocaine) or recent antidepressant prescriptions that can flip a predisposed person into manic episode.

A blood or urine test can check for hormonal imbalances, as well as rule out other potential causes for your symptoms.

Bipolar disorder treatment options

While there is no cure for bipolar disorder, the medical community’s understanding of the mental disorder and the available treatment options have improved greatly over the years. These treatments focus on managing the symptoms of bipolar disorder (i.e., the depressive or manic episodes) when they arise, as well as preventing them in the future.

Prescription medication and other psychotherapies are combined to manage the condition. A patient’s therapy options can include cognitive behavioral therapy, social rhythm therapy, joining a support group, or talking regularly with a psychiatric mental health care provider about the condition and day-to-day life.

Bipolar medications

Antimanic agents (mood stabilizers)

One of the most commonly prescribed medications for bipolar disorder is lithium, which is an antimanic agent. This drug is typically the first medication prescribed to those with bipolar disorder. It is believed to work by acting on the central nervous system to promote stability in your mood and emotions. The primary benefits of lithium are a reduction in the severity of mania, and the prevention of future manic and depressive episodes. Although, patients need to exercise caution with this drug due to its potential side effects, such as hand tremors, drowsiness, and nausea.

Anticonvulsants

Other popular mood-stabilizing medications prescribed for bipolar disorder are anticonvulsants, which can help with episodes of mania and depression. Drugs like Depakote, Tegretol, and Lamictal are good examples of common anticonvulsant medications that help calm brain activity. Calmed brain activity (muted nerve impulses) can ease current bipolar symptoms and prevent severe manic or depressive episodes in the future. Anticonvulsant side effects, however, can include dizziness, tremors, and fatigue.

Antipsychotic drugs

These types of medications affect the release of certain chemicals in the brain, particularly those that are related to your mood, emotions, and behaviors. Popular antipsychotics for bipolar treatment include Abilify, Latuda, and Seroquel. These prescription drugs manage manic behaviors, although certain antipsychotics (like Latuda) can also help with bipolar depression. The side effects of antipsychotic medications can include blurred vision, drowsiness, and weight gain.

Anti-anxiety drugs (benzodiazepines)

While benzodiazepines are more commonly prescribed to patients with anxiety, they can also benefit people with bipolar disorder in the short term for an immediate manic or hypomanic phase. Anti-anxiety drugs are sedative and reduce brain activity. They’re often used for immediate relief, as benzodiazepines can quickly alleviate manic symptoms during an episode. Valium, Xanax, and Klonopin are common anti-anxiety drugs. They may cause side effects like fatigue, dizziness, drowsiness, and impaired memory.

Antidepressants

These medications typically include SSRIs (selective serotonin reuptake inhibitors) that help increase levels of serotonin. Prozac and Fluoxetine are the two antidepressants that are most commonly used in the treatment of bipolar disorder. However, antidepressants are rarely prescribed for patients with bipolar disorder, as they may worsen some symptoms of the condition, including irritability, nervousness, or trouble sleeping. These side effects are never good for brain health. But in certain cases, antidepressants may be given along with other drugs to improve episodes of depression.

What is the best medication for bipolar disorder?

The best medication for bipolar disorder depends on the patient, as each person with the condition may need different treatment. Consult a psychiatrist or other mental health professional about your medical history, current medications, and your specific symptoms to construct an effective treatment plan that is best suited to your needs.

That said, here are some of the most commonly prescribed medications for bipolar disorder:

Best medications for bipolar disorder
Drug name Drug class Administration route Standard dosage Common side effects
Lithobid (lithium) Antimanic agent Oral Two 300 mg extended-release tablets twice a day Poor concentration, tremors, increased thirst, acne
Depakote (divalproex sodium) Anticonvulsant Oral 750 mg per day divided into separate doses Nausea, drowsiness, weakness
Epitol (carbamazepine) Anticonvulsant Oral One 200 mg tablet every 12 hours Nausea, vomiting, dizziness
Lamictal (lamotrigine) Anticonvulsant Oral 100–200 mg per day divided into separate doses Skin rash, blurred or doubled vision, tremors
Seroquel (quetiapine fumarate) Atypical antipsychotic Oral Two tablets taken daily totaling 400–800 mg Drowsiness, dizziness, dry mouth
Latuda (lurasidone) Atypical antipsychotic Oral One 20-140 mg tablet per day Weight gain, muscle stiffness, and drowsiness
Abilify (aripiprazole) Atypical antipsychotic Oral One 15 mg tablet per day Nausea, vomiting, and constipation

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

What are common side effects of bipolar medications?

While medication is helpful and often necessary for bipolar patients, there are some side effects to be aware of, some of the most common ones include:

  • Dizziness
  • Drowsiness
  • Fatigue
  • Nausea
  • Diarrhea
  • Weight gain
  • Constipation
  • Tremors (especially in the hands)
  • Loss of libido
  • Sexual dysfunction

More serious side effects like an increased risk of liver or kidney damage are also possible. Still, these are often a result of overdosage. To combat this risk, your physician should carefully monitor your intake of certain medications via regular blood testing. Women of childbearing age should discuss contraception, as most are teratogenic. Meaning, they can be dangerous to a developing fetus.

Additionally, this is by no means a complete list of all the potential side effects of bipolar medications. It’s best to talk to a healthcare professional for a more in-depth understanding of all the possible adverse effects or drug interactions.

What are the best natural supplements for bipolar disorder?

Fortunately, people living with bipolar disorder have several treatment options. In addition to medication and traditional treatments of bipolar disorder, there are a few natural remedies that are effective for some people. Some natural wellness supplements aid in the management of bipolar depression and mania. These supplements include:

  • Magnesium: This supplement has shown potential as a natural preventative for major depression, and it also may have some mood-stabilizing effects when taken regularly.
  • Vitamin B: There are plenty of B vitamins that can help naturally stabilize mood, especially vitamins B6 and B12. Both are important in the management and function of the nervous system, which is responsible for our thoughts, behaviors, and emotions.
  • Fish oil: Fish oil contains many healthy omega-3s that are essential to a person’s overall health. While it’s unclear how this supplement may work to improve bipolar episodes, there may be a connection between suicidal thoughts and omega-3 deficiency.
  • Rhodiola rosea: Studies show that this herb may offer some natural antidepressant effects that can benefit bipolar patients during depressive phases.

Living with bipolar disorder is not easy, but taking advantage of natural mood stabilizers can be a huge benefit. In addition to dietary supplements, maintaining a proper diet and exercise regimen can promote a healthy mental state and prevent rapid-cycling episodes in the future. Other healthy lifestyle changes can be instrumental in your management of bipolar disorder. These habits include sticking to a regular sleep schedule, practicing relaxation techniques (like meditation), and maintaining a good support system of friends and loved ones.

Frequently asked questions about bipolar disorder

Can bipolar disorder be cured?

No. Bipolar disorder is a lifelong condition that can be improved with treatment such as medication and therapy, but it is not curable.

What does it feel like to have bipolar disorder?

For people with rapid-cycling mood swings, things can feel chaotic at times, while at other times, they feel very slow. A person with bipolar disorder may find it hard to maintain healthy relationships or perform regular, everyday tasks during periods of exacerbation.

How is bipolar disorder commonly treated?

Mood-stabilizing medication used in conjunction with therapies, such as cognitive-behavioral therapy or social rhythm therapy, is a common bipolar disorder treatment.

What is the best mood stabilizer for bipolar?

Lithium is the most popular and well-studied mood-stabilizing medication for bipolar disorder. Still, other anticonvulsants or antipsychotic drugs help manage bipolar symptoms.

What are the major causes of bipolar disorder?

The exact cause of bipolar disorder is unknown, but researchers believe that genetic factors, hormonal issues, medication, illicit substance use, and environmental factors may all contribute to the onset of bipolar disorder.

What triggers bipolar?

Not everyone is cognizant of a “trigger” when they develop bipolar disorder. Still, traumatic events, significant loss, or intense mental stress can be turning points for some people who later receive a bipolar disorder diagnosis.

Related resources for bipolar disorder