What medication is available?
If you are diagnosed with bipolar disorder, it’s likely that your psychiatrist or GP will offer to prescribe medication. Which medication you are offered will depend on:
- Your current symptoms, for example, if you are currently experiencing a manic or depressive episode.
- Your past symptoms, such as whether you are mainly manic or mainly depressed, and how long the episodes have lasted.
- How you have responded to treatments in the past.
- The risk of another episode, and what has triggered episodes in the past.
- Your physical health, in particular whether you have kidney problems, weight problems or diabetes.
- How likely you are to take the medication consistently.
- Your sex and age (for example, if you are female and could become pregnant your doctor shouldn’t offer you valproate, as it carries significant risks to your baby).
- In older people, a test of mental processes such as the one used to diagnose dementia.
Before prescribing you any medication, your doctor should explain to you what the medication is for, and discuss any possible side effects and alternative treatment options.
Lithium for bipolar disorder
Lithium can be a very effective treatment for mania, but is less effective at treating severe depression. It seems to be most effective for:
- repeated episodes of mania without depression
- episodes of mania and depression with stable periods in between
- people who have a family history of bipolar disorder
- forms of the problem where there is no rapid cycling.
It’s still sometimes considered as a possible treatment if you have had three or more periods of serious depression within five years, involving hospital admission, especially if you had symptoms of psychosis. However, in these situations, people often experience repeated episodes, even with lithium treatment.
“Lithium helps [me cope] and I just have to keep reminding myself that whichever feeling I’m going through won’t last forever.”
Anticonvulsants for bipolar disorder
There are three anticonvulsant drugs used as mood stabilisers which are licensed to treat bipolar disorder: carbamazepine (Tegretol); valproate (Depakote, Epilim) and lamotrigine (Lamictal).
Carbamazepine and valproate are comparatively effective in treating:
- mixed episodes
- rapid cycling
- very severe mania with psychosis
- additional anxiety disorders or substance misuse
- people who have little or no family history of bipolar disorder
- symptoms that occur after neurological illness or brain injury.
Lamotrigine has antidepressant effects and is licensed to treat severe depression in bipolar disorder.
Antipsychotics for bipolar disorder
You are most likely to be prescribed an antipsychotic if you have an episode of mania or severe depression in which you experience psychotic symptoms, such as hearing voices. However, some antipsychotics are increasingly prescribed even if you haven’t had psychotic symptoms, as their side effects might be less unpleasant, and they’re safer in pregnancy Those most likely to be prescribed are:
- olanzapine (Zalasta, Zyprexa, ZypAdhera)
- quetiapine (Atrolak, Biquelle, Ebesque, Seroquel, Tenprolide, Zaluron)
- aripiprazole (Abilify)
- risperidone (Risperdal, Risperdal Consta).
The antipsychotic asenapine (Sycrest) is also licensed as a mood stabiliser for moderate to severe manic episodes in bipolar disorder. It’s not likely you’ll be offered asenapine after your first episode, or if your symptoms are not very severe, but you might be offered asenapine if you’ve found that other medications aren’t right for you.
Antidepressants for bipolar disorder
In some circumstances you might also be offered antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs) – a commonly prescribed type of antidepressant. You might be offered antidepressants in combination with one of the medications described above.
Note: You should always check with your doctor or pharmacist before taking any drugs together, or closely following one another, in case they could interact with each other badly. For example, combining lithium with SSRI antidepressants can increase the risk of serotonin syndrome (a serious side effect).
(For more detailed information about all the drugs described above, including potential side effects and how to take them safely, see our online booklets Making sense of lithium and other mood stabilisers, Making sense of antipsychotics and Making sense of antidepressants.)