Antipsychotic Medications for Bipolar Disorder

Antipsychotic medications were initially developed for the treatment of psychosis, generally found in schizophrenia; however, antipsychotic drugs have been found to be useful in alleviating depression and stabilizing mood even when no psychosis is present. (Read about bipolar with psychosis.)

Antipsychotics alter the dopamine and serotonin (chemical messengers) receptors in the brain. Each antipsychotic medication acts somewhat more or less on these receptors and their effectiveness varies depending on each individual's brain chemistry.

Typical Antipsychotic Medications

The first antipsychotic developed was chlorpromazine (Thorazine), in the 1950s. This remains one of the few first-generation (aka typical) antipsychotic medications still used today for the treatment of bipolar (mania). Typical antipsychotics are used much less frequently now, but some are still used particularly in emergency settings.

Atypical Antipsychotics for Bipolar Disorder

Antipsychotics had a large part in helping many people leave residential mental health care facilities; however, many people found typical antipsychotic side effects intolerable. In the 1970s, second-generation antipsychotics, known as atypical antipsychotics, were developed with fewer motor control side effects.

The following atypical antipsychotics are approved for the treatment of bipolar disorder:¹

• Aripiprazole (Abilify) – actually considered a third generation antipsychotic; is thought to have fewer metabolic side effects than other antipsychotics. Approved for bipolar mania, mixed state and maintenance treatment.
• Asenapine (Saphris) –newly-approved (mid-2009)² ; approved to treat bipolar mania and mixed states.
• Olanzapine (Zyprexa) – approved for people age 13 and over with bipolar disorder type 1. FDA-approved for bipolar mania, mixed state and maintenance treatment.
• Quetiapine (Seroquel) – the only antipsychotic approved for the treatment of bipolar depression. Also approved to treat bipolar mania.
• Risperidone (Risperdal) – approved for those age 10 and over with bipolar disorder type 1. FDA-approved for bipolar mania and mixed state treatment.
• Ziprasidone (Geodon) – approved to treat bipolar manic episodes and mixed episodes.

One additional drug, Symbax is approved for the treatment of bipolar depression and is an olanzapine/fluoxetine (Prozac) combination.

Side Effects of Antipsychotic Medications

Antipsychotic medication may be used alone (monotherapy) or with other medications, typically lithium or valproate. While antipsychotics have helped many, this class of medication tends to have a more serious side effect profile and some estimate 50% of people stop taking the drugs due to side effects.³

In first-generation typical antipsychotics, the primarily concerning side effects surround involuntary muscle movements. This includes side effects like:⁴

• Tardive dyskinesia – involuntary repetitive muscle movements
• Dystonia – sustained muscle contractions cause twisting and repetitive movements of abnormal posture
• Akathisia – inner restlessness and an inability to sit still
• Muscle rigidity and tremor
• Seizures

While atypical antipsychotics were developed to reduce or remove many of these movement disorder side effects, atypical antipsychotics often have side effects like:

• Diabetes
• Blood sugar problems
• Weight gain
• Heart problems
• Other metabolic syndrome symptoms
• Possible reduced life expectancy

Additionally, all antipsychotics may produce side effects like confusion, dizziness, memory impairment, lethargy, decreased feeling of pleasure, gastrointestinal problems, and others specific to the medication.

Some people find antipsychotic medication side effects intolerable while others use them with very few problems. In all cases, the benefits need to be weighed against the risks and side effects of antipsychotic medications. For some, the benefits outweigh the risks dramatically.

See also: Complete List of Mood Stabilizers: Types, Uses, Side-Effects

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