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To manage mood disorders like bipolar 1 disorder, mental health professionals may prescribe a variety of medications. Some work to control your symptoms, called acute therapy. Other medications fall into the category of maintenance therapy and help to delay or prevent mood episodes. In most cases, bipolar 1 disorder requires ongoing, long-term care.
In this article, we’ll discuss six treatments for bipolar 1 disorder, how they work, and what side effects you may experience. Keep in mind that this is not a full list of treatments. The best treatment plan depends on how well a medication works, its side effects, how it fits with any other medications you may be taking, and other factors.
Be sure to reach out to your healthcare provider or a mental health professional with any questions or concerns about your treatment plan.
Bipolar 1 disorder is a mental health condition that causes episodes of mania and depression. During mania, you may feel unusually energized, irritable, or overly excited. You may also need less sleep than usual. These episodes last at least seven days. In some cases, mania can be severe enough to require a hospital stay.
Episodes of depression can also occur, and they typically last for at least two weeks or longer. You may be in a depressive episode if you’re experiencing persistent sadness, hopelessness, or a loss of interest in activities you normally enjoy. Other symptoms of depression may include trouble with daily activities or thoughts of suicide.
Having four or more episodes of mania or depression within one year is called rapid cycling. Some people with bipolar 1 disorder also have depressive episodes with mixed features. This means they have both manic and depressive symptoms at the same time.
Once you’re diagnosed with bipolar 1 disorder, your doctor will work to find the best treatment plan for your needs. They’ll use one or more medications to manage your manic and depressive symptoms. Your treatment plan will also likely include:
Below, we explain six types of medications commonly used to treat bipolar 1 disorder and how they work.
Lithium is a naturally occurring element and an effective treatment for bipolar 1 disorder. In fact, it’s commonly used as a first-line treatment based on how effective it’s been shown to be in studies. Lithium is used as a maintenance treatment to prevent mood episode relapses and has been shown to prevent suicide attempts.
Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988.
If you take lithium, you’ll need regular blood tests to check your kidney and thyroid function and the level of lithium in your blood because high lithium levels can be harmful.
Some people have little to no side effects from lithium therapy. Side effects may show up when you start treatment, but often fade over time.
Examples of lithium side effects may include:
MyDepressionTeam members have shared their experiences taking lithium. One asked, “Has anyone had side effects from lithium? I’m so tired, just sleeping the whole day, and my mouth is constantly dry.”
Another member replied, “I’ve been on lithium before and didn’t get any side effects. Just hang in there, and the side effects should go away.”
Carbamazepine (Equetro) and valproic acid help treat manic episodes in bipolar 1. These medications are mood stabilizers and anti-seizure medications used to treat seizures. Anti-seizure medications are sometimes referred to as anticonvulsants. They work by calming overactive signaling in the brain.
The National Alliance on Mental Illness (NAMI) notes that anti-seizure medications may be better for treating rapid cycling in bipolar 1 disorder. However, the best treatment for your individual case is decided between you and your healthcare providers.
Common side effects of anti-seizure therapy include:
Lamotrigine (Lamictal) is a mood stabilizer and anti-seizure medication used for seizures and bipolar disorder. According to NAMI, lamotrigine delays the time between mood episodes in people with bipolar 1 disorder. This means that you may go longer without experiencing a manic or depressive episode.
Lamotrigine is approved by the U.S. Food and Drug Administration (FDA) to treat bipolar 1 disorder. It can help delay mood episodes, but it may not work well during an acute episode. Your doctor might prescribe lamotrigine alone or with other medications for long-term symptom control.
Side effects of lamotrigine can include:
A rare but serious reaction called Stevens-Johnson syndrome has been reported in some people taking lamotrigine. This condition can be life-threatening. Call your doctor right away if you notice any of the following:
One MyDepressionTeam member shared their experience taking lamotrigine: “Added lamotrigine about a month ago. It seems to have helped some with my depression. Now, I’m having constant nausea and stomach pains. It’s probably a side effect of the lamotrigine.”
Antipsychotic medications are often used to treat mania and depression in bipolar 1 disorder. Doctors also use antipsychotics for bipolar disorder as maintenance treatment. Maintenance treatment is important for preventing or delaying mood episodes in bipolar 1 disorder.
The brain uses neurotransmitters, which are specialized chemical messengers, to send signals. People with bipolar 1 disorder have chemical imbalances that lead to mood episodes consisting of depression, mania, or mixed features. Antipsychotic medications work by blocking receptors for the neurotransmitters serotonin and dopamine, as well as other types of neurotransmitters.
There are many FDA-approved antipsychotics for treating mood disorders. Common side effects of antipsychotics may include:
Some antipsychotics are also called atypical antipsychotics. Because they can help steady mood, they are sometimes grouped with lithium and anti-seizure medications under the general term mood stabilizers. Antipsychotics are their own type of medication. Mood-stabilizing medications help regulate symptoms during mood episodes.
These medications can’t cure your mood episodes, but they can offer relief from manic and depressive symptoms. Most people find that these medications help to treat:
These medications often take several weeks to start working. In some cases, your doctor may recommend combining an antipsychotic with another mood stabilizer for better symptom control.
Antidepressants are used to treat different forms of depression. Mental health prescribers sometimes use them along with a mood stabilizer or antipsychotic to treat bipolar disorder. However, studies suggest that antidepressants don’t offer extra benefits for treating bipolar 1 disorder compared to using the mood stabilizer on its own. Antidepressants for bipolar 1 can increase the risk of mania, so they should be used carefully.
Still, in some cases, certain antidepressants may be used cautiously to treat depressive episodes in bipolar 1 disorder, usually along with a mood stabilizer or antipsychotic. Your healthcare provider can help you weigh the risks and benefits of adding an antidepressant to your treatment plan.
Examples of antidepressants include:
The FDA has approved two medications that combine an antipsychotic medication with a different class of medication.
Olanzapine and samidorphan (Lybalvi) treats bipolar 1 disorder in two ways:
In clinical studies, potential side effects of olanzapine and samidorphan among people only taking this drug included:
Additional side effects are possible among people taking this drug in addition to other medications for bipolar 1.
Olanzapine and fluoxetine (Symbyax) is a combination for treating depressive episodes in people with bipolar 1 disorder. In some trials, this medication treated depression with bipolar disorder better than olanzapine or lamotrigine alone.
In clinical trials, researchers found that olanzapine and fluoxetine can cause:
Some benzodiazepines have been used to treat symptoms of mania associated with bipolar 1 disorder. They work by calming the brain and nervous system, creating a sedative effect. Your doctor may prescribe a benzodiazepine to control manic symptoms when you first start treatment. This gives your other medications, like lithium, time to start working. It usually takes at least five to seven days for lithium to start working.
Lorazepam is a benzodiazepine that’s given by mouth or as a shot into the muscle. Side effects may include:
Benzodiazepine treatment for bipolar disorder alone is typically intended for short-term use due to risks like dependence, falls, and sleepiness. Read more about specific medications in this list of treatments for bipolar disorder, depression, and other mental health conditions.
There is no one-size-fits-all treatment for bipolar 1 disorder. The right plan depends on your symptoms, how well a medication works, and the side effects you may have. Over time, you and your healthcare provider can find an approach that works for you.
On MyDepressionTeam, people share their experiences with depression and related conditions, get advice, and find support from others who understand.
What treatments do you currently take or have you previously taken for bipolar 1 disorder? What side effects did you experience? Let others know in the comments below.
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I take Hadal and mood stabilizer and depressant meds cocktail. Been good for 8 years no side affects.
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