Bipolar Medication: Types, How Bipolar Meds Work

Bipolar medication is often a major part of a treatment plan for bipolar disorder. Medication is the main way psychiatry knows to treat bipolar disorder at this time. A comprehensive plan will also include bipolar therapy, support and education, but bipolar meds are still likely to play a big role.

Types of Medications for Bipolar Disorder

Bipolar disorder is a complex illness with many parts of the brain implicated in its presence. Neurotransmitters and neuromodulators, two types of chemical messengers in the brain, are typically targeted by bipolar medications. The primary types of medication for bipolar disorder treatment are:

• mood stabilizers
• anticonvulsants
• antipsychotics (for bipolar disorder)

Mood Stabilizer Medication for Bipolar Disorder

The only true "mood stabilizer" medication is lithium. Lithium is a chemical salt and typically lithium carbonate is prescribed. Lithium is still the first bipolar disorder medication treatment of choice in many circumstances and is known to effectively treat mania and prevent future bipolar episodes. Lithium also has a unique antisuicide effect. When lithium is used, blood levels must be carefully monitored as too much lithium can be toxic.¹

(In-depth information: Mood Stabilizers for Bipolar Disorder)

Anticonvulsant Medications for Bipolar Disorder

Anticonvulsants are sometimes called mood stabilizers when used to treat bipolar disorder. Anticonvulsant bipolar meds were initially created as anti-seizure medication but were later found to be effective at preventing mood swings. Several anticonvulsants have been shown to be very effective at treating bipolar disorder both acutely and long-term. Common anticonvulsant medication for bipolar includes:

• Carbamazepine (Tegretol)
• Valproate (Depakote)
• Lamotrigine (Lamictal)
• Topiramate (Topamax) and oxcarbazepine (Trileptal)

Antipsychotic Medication for Bipolar Disorder

Antipsychotics have been used in the treatment of bipolar disorder since the 1950s and the advent of the typical antipsychotic, chlorpromazine (Thorazine). Now, newer atypical antipsychotic bipolar medications are mostly used. Antipsychotics can be very useful for mood stabilization and treatment of bipolar mania, whether psychosis is present or not. Often used antipsychotic medications for bipolar disorder include:

• Aripiprazole (Abilify)
• Ziprasidone (Geodon)
• Risperidone (Risperdal)
• Asenapine (Saphris)
• Quetiapine (Seroquel)
• Chlorpromazine (Thorazine)
• Olanzapine (Zyprexa)

(In-depth information: Antipsychotic Medications for Bipolar Disorder)

Medication for Bipolar Mania

Acute hypomania is often not considered an emergency while bipolar mania generally is. The specific bipolar medication choice is based on the presence of aggression, psychosis, agitation and sleep disturbance. Often, patients will be prescribed more than one medication. Common bipolar meds for the treatment of mania include:

• Antipsychotics such as chlorpromazine (Thorazine), ziprasidone (Geodon), quetiapine (Seroquel), risperidone (Risperdal)
• Valproate (Depakote)
• Benzodiazepines such as clonazepam (Klonopin) and lorazepam (Ativan)
• Lithium

Medication for Bipolar Depression

Acute depression can be tremendously dangerous if the person is suicidal or has lost the ability to take care of themselves. Degree of depression severity, including the likelihood of suicide, and presence of psychosis is taken into account when choosing medication for bipolar depression. Common medications for bipolar depression treatment include:²

• Antipsychotics like quetiapine (Seroquel)
• Anticonvulsants like lamotrigine (Lamictal)

Antidepressants can be prescribed but, typically, only with other mood stabilizing medication. For some patients, antidepressants may be considered too destabilizing to risk at all (antidepressants may induce mania). For very severe or treatment-resistant depression, electroconvulsive therapy is often considered a frontline approach.

Bipolar Meds as Long-Term Treatment of Bipolar Disorder

Most of the bipolar medications used during acute treatment can be used long-term. Common long-term bipolar meds include:

• Lithium – still typically the number one choice for future episode prevention
• Anticonvulsants like valproate (Depakote) and lamotrigine (Lamictal)
• Antipsychotics like aripiprazole (Abilify) and olanzapine (Zyprexa)

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