Medications for Bipolar Disorder

Most people with bipolar disorder take some combination of lithium, valproate, and carbamazepine to manage their symptoms and prevent the recurrence of bipolar episodes. Besides needing these medications — which are often called mood stabilizers — to even out their emotional highs and lows, people with bipolar disorder sometimes need other medications to treat the agitation, anxiety, and sleep disturbances that may accompany their illness.
Bipolar Disorder: Antidepressants
If you have depressive symptoms associated with your bipolar disorder that aren't being controlled by the mood stabilizers, an antidepressant could help. In people with depression, antidepressants can help manage or reduce feelings of sadness, guilt, worthlessness, or hopelessness, and other symptoms.
Antidepressants work by affecting brain chemicals that control mood and emotion. The side effects associated with antidepressants are usually not serious, but may include:

• Dry mouth
• Constipation
• Nausea
• Trouble urinating
• Sexual problems
• Vision problems
• Dizziness
• Headache
• Sleepiness
• Sleep disturbances
• Elevated heart rate
• Agitation
• Nervousness

The problem with antidepressants is that the evidence supporting their effectiveness in treating bipolar disorder is lacking, says Gary Sachs, MD, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, and an associate professor of psychiatry at Harvard Medical School in Boston, Mass. There are no major studies of any antidepressants that have been shown to be helpful," says Dr. Sachs. But, "that doesn't mean they don't work" for some people.
If you're taking an antidepressant as part of your bipolar treatment , it is important that you continue taking any mood stabilizers that your doctor has prescribed. Antidepressants taken by themselves to treat bipolar disorder have been associated with an increased risk of a manic episode or rapid cycling (frequent bipolar mood swings).
Bipolar Disorder: Anti-Psychotic Medications
Another class of drugs that your doctor may prescribe to be taken along with a mood stabilizer are antipsychotic medications such as aripiprazole (Abilify), risperidone (Risperdal), quetiapine (Seroquel), clozapine (Clorazil), ziprasidone (Geodon), or olanzapine (Zyprexa), known as dopamine-blocking agents.
Dopamine is a brain chemical that plays a role in schizophrenia and mania, and is thought to be elevated in bipolar disorder. Dopamine-blocking agents are designed to block dopamine receptors in the brain, which may ease some symptoms of acute mania and slow racing thoughts.
Since other medications, like lithium, often take weeks or months to take effect, dopamine-blocking agents are particularly useful in helping to stabilize a manic episode until your other medication begins working.
Side effects of dopamine-blocking agents vary, depending on the specific medication you are taking, but may include:

• Sleepiness
• Elevated heartbeat
• Dizziness
• Weight gain
• Sexual problems
• Irregular menstrual periods
• Skin sensitivities

Bipolar Disorder: Anti-Anxiety Medications
Some people with bipolar disorder also experience persistent anxiety despite treatment. In this case, anti-anxiety medications could help. These medications can provide relief for people who are experiencing symptoms such as irritability, jumpiness, and nervousness.
Anti-anxiety medications include the benzodiazepines, which can be taken on an "as-needed" basis, and buspirone (BuSpar), which is taken for at least two weeks to relieve persistent symptoms of anxiety. Anti-anxiety medications affect chemicals in the brain in order to make one feel more relaxed. These medications can also be helpful if you are having trouble sleeping.
Potential side effects of anti-anxiety medications may include:

• Sleepiness
• Problems with coordination
• Fatigue
• Mental slowing
• Confusion
• Tolerance or dependence on anti-anxiety medications
• Withdrawal when the medication is discontinued suddenly

It may take a while before you and your doctor come up with the best combination of medications for you, and your medication needs may change over time. But with some patience and commitment, you can find the right combination of bipolar treatments to ease your individual symptoms.