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6 Treatments for Bipolar 1 Disorder

Medically reviewed by Marie Dorsey, Pharm.D., BCPS, AAHIVP
Written by Emily Wagner, M.S.
Posted on May 6, 2024

To manage mood disorders like bipolar 1 disorder, doctors can 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 disorder requires lifelong treatment.

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 though, there are several other treatments that are not listed here. Treatment choice is based on how effective it is, side effects, and if it may be taken with other medication you’re already taking. Be sure to reach out to your health care provider or a mental health professional with any questions or concerns about your treatment plan.

What Is Bipolar 1 Disorder?

Bipolar 1 disorder is characterized by mood swings from episodes of mania and depression. With mania, you may experience excited, irritated, or energetic feelings that last at least seven days. In some cases, manic episodes are intense enough that you need hospitalization.

Episodes of depression can also occur, and they typically last for at least two weeks. You may be in a depressive episode if you’re experiencing feelings of sadness or anxiety or you lose interest in activities you normally enjoy.

Having four or more episodes of mania or depression within one year is known as 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.

After 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:

  • Psychotherapy (talk therapy), like cognitive behavioral therapy (CBT)
  • Family-focused therapy, which offers psychoeducation of bipolar 1 disorder to families

Below, we describe six types of medications used to treat bipolar 1 disorder and how they work.

1. Lithium

Lithium (Lithobid, Eskalith) is a chemical element that works well for treating bipolar disorder. In fact, it’s used as a first-line treatment based on how effective it has proved in studies. Lithium is used as a maintenance treatment to prevent mood episode relapses and has 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.

When taking lithium, you’ll need regular blood tests to check your kidney and thyroid function. This is because higher doses of lithium can become harmful.

Most people experience little to no side effects of lithium therapy. You may notice some side effects when you start the treatment, but they likely are temporary and will eventually go away on their own.

Examples of lithium side effects include:

  • Fatigue
  • Stomach cramps and nausea
  • Thirst
  • Headache
  • Tremor (uncontrollable shaking)

MyDepressionTeam members have shared their experiences taking lithium. One asked, “Has anyone had side effects on 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 and the side effects should go away.”

2. Anticonvulsants

Carbamazepine (Carbatrol, Tegretol) and valproic acid (Depakene, Depakote) help treat manic episodes. These medications are mood stabilizers and anticonvulsants used to treat seizure disorders. (Anticonvulsants are sometimes referred to by the broader term “anti-seizure medications.”) They work by calming overactive signaling in the brain. The National Alliance on Mental Illness (NAMI) notes that anticonvulsants may be better for treating rapid cycling in bipolar 1 disorder.

Potential side effects of anticonvulsant therapy include:

  • Muscle aches or weakness
  • Dizziness
  • Diarrhea or constipation
  • Fatigue
  • Nausea or loss of appetite
  • Skin rashes
  • Weight gain

Lamotrigine

Lamotrigine (Lamictal) is a mood stabilizer and anticonvulsant 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 and delays the time to occurrence of mood episodes, but it does not work well for acute episodes. Your doctor might prescribe lamotrigine alone or with other medications for long-term symptom management.

Side effects of lamotrigine can include:

  • Nausea
  • Skin rashes
  • Headache
  • Fatigue or drowsiness
  • Dizziness
  • Weight gain

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.”

3. Antipsychotics

Antipsychotics are a class of medications used to treat mania and depression from bipolar 1 disorder. Doctors also use antipsychotics as maintenance treatment. Maintenance treatment is important for preventing or delaying mood episodes in bipolar 1 disorder.

The brain uses specialized chemical messengers — known as neurotransmitters — to send signals. People with bipolar 1 disorder have chemical imbalances that lead to mood episodes consisting of anxiety, agitation, or depression. Antipsychotic medications work by blocking receptors for the neurotransmitters serotonin and dopamine.

The FDA has approved several antipsychotics for treating mood disorders, including:

  • Aripiprazole (Abilify)
  • Cariprazine (Vraylar)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel XR)

It’s worth noting that only three of these — cariprazine, lurasidone, and quetiapine — are FDA-approved for depression in bipolar disorder. Doctors prescribe the other medications off-label or outside of their approved use for bipolar 1 disorder.

Side effects you may experience when taking antipsychotics include:

  • Dry mouth
  • Tremors or unusual body movements
  • Increased appetite and weight gain
  • Drowsiness
  • Blurry vision
  • Increased risk of high cholesterol or diabetes

Treatments like lithium, anticonvulsants, and antipsychotics (including atypical antipsychotics) may be referred to as “mood stabilizers.” As this name suggests, mood stabilizers help “stabilize” (regulate) symptoms of mood episodes.

These medications can’t cure your mood swings, but they can offer significant relief from manic and depressive symptoms. Most people find these medications help to treat:

  • Sleep problems
  • Agitation
  • Severe psychosis symptoms like hallucinations and delusions

You’ll need to take a mood stabilizer for several weeks before it begins working. Your doctor may also prescribe an antipsychotic with a mood stabilizer to better control your symptoms.

Mood stabilizers take several weeks to begin working.

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4. Antidepressants

Antidepressants are medications used to treat several forms of depression. Doctors sometimes prescribe antidepressants along with a mood stabilizer or antipsychotic. However, studies suggest that there aren’t any extra benefits to using an antidepressant for treating bipolar 1 disorder.

Examples of antidepressants include:

  • Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta)
  • Atypical antidepressants like bupropion (Wellbutrin SR and XL)

Mental health experts note that people with bipolar 1 disorder shouldn’t take an antidepressant on its own because antidepressants can trigger mania in some people. Your doctor can help you weigh the risks and benefits of taking an antidepressant with your other bipolar 1 disorder treatments.

People with bipolar 1 disorder should not take an antidepressant on its own — it can trigger mania in some people.

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5. Combination Antipsychotic Medications

The FDA has approved two medications that combine an antipsychotic medication with a different class of medication.

Olanzapine and Samidorphan

Olanzapine and samidorphan (Lybalvi) treats bipolar 1 disorder in two situations:

  • On its own as a short-term or maintenance therapy for manic or mixed episodes
  • Together with lithium or valproate for manic or mixed episodes

In clinical studies, potential side effects of olanzapine and samidorphan included:

  • Low blood pressure and fainting
  • Metabolism problems
  • Constipation
  • Difficulty controlling body temperature
  • Low levels of immune cells
  • Uncontrollable body movements, known as tardive dyskinesia

Olanzapine and Fluoxetine

Olanzapine and fluoxetine (Symbyax) is a combination for treating depressive episodes in people with bipolar 1 disorder. Studies show that this medication treats depression with bipolar disorder better than olanzapine or lamotrigine alone.

In clinical trials, researchers found that olanzapine and fluoxetine can cause:

  • Dry mouth
  • Increased appetite and weight gain
  • Fatigue
  • Drowsiness or sleepiness
  • Increased risk of high cholesterol or diabetes

6. Benzodiazepines

Benzodiazepines treat 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. Remember, it can take around five days for lithium to become effective.

Your doctor may prescribe a benzodiazepine to help control manic symptoms while waiting for other medications to start working.

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Lorazepam (Ativan) is a benzodiazepine that’s given by mouth or as a shot into the muscle. Side effects you may experience include:

  • Agitation
  • Nausea
  • Sedation (sleepiness)
  • Depression
  • Memory problems

Read more about specific medications in this list of treatments for bipolar, depression, and other mental health conditions.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and related conditions and their loved ones. On MyDepressionTeam, more than 146,000 members diagnosed with depression and related conditions come together to ask questions, give advice, and share their stories with others who understand life with depression and bipolar disorder.

What treatments do you currently take or have you previously taken for bipolar 1 disorder? What side effects did you experience? Share your story in the comments below, or start a conversation by posting on your Activities page.

Posted on May 6, 2024
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Marie Dorsey, Pharm.D., BCPS, AAHIVP is currently a clinical pharmacist at Bridgewell Medical, specializing in medication therapy management and holds a certification as an HIV pharmacist through the American Academy of HIV Medicine. Learn more about her here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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