What medication is available?
If you are diagnosed with bipolar disorder, it’s likely that your psychiatrist or GP will offer to prescribe medication. This might include:
- antipsychotics
- lithium
- anticonvulsants
- antidepressants
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 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 may be carried out prior to, and after commencing medications.
Before you take any medication Before you decide to take any medication, you should make sure you have all the facts you need to feel confident about your decision. For guidance on the basic information you might want to know about any drug before you take it, see our pages on:
- what you should know before taking any psychiatric drug
- receiving the right medication for you
- your right to refuse medication
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.
The National Institute for Health and Care Excellence (NICE) treatment guidelines recommend the following antipsychotics:
- haloperidol (Dozic, Haldol, Haldol decanoate, Serenace)
- olanzapine (Zalasta, Zyprexa, ZypAdhera)
- quetiapine (Atrolak, Biquelle, Ebesque, Seroquel, Tenprolide, Zaluron)
- risperidone (Risperdal, Risperdal Consta)
If your first antipsychotic doesn’t work, you should be offered a different one from the list above. If the second antipsychotic doesn’t work you may be offered lithium to take together with an antipsychotic.
If you’re prescribed an antipsychotic, you’ll need to have regular health checks with your doctor.
(See our pages on antipsychotics for more information about these drugs, including potential side effects.)
Lithium for bipolar disorder
Lithium can be effective for reducing the likelihood of:
- mania
- recurrent depression
- further mood episodes
- suicidal feelings
It is typically a long-term method of treatment, usually prescribed for at least six months. For lithium to be effective, the dosage must be correct. You’ll need regular blood and health checks while taking lithium, to make sure your lithium levels are right for you.
(For more information see our pages about lithium, and taking lithium safely.)
“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
- valproate
- lamotrigine
Carbamazepine (Tegretol) is also sometimes prescribed to treat episodes of mania. It can be prescribed if lithium is ineffective or unsuitable for you.
Valproate (Depakote, Epilim) can be used to treat episodes of mania and is typically a long-term method of treatment. It can be prescribed if lithium is ineffective or unsuitable for you. However, if you could become pregnant your doctor shouldn’t offer you valproate unless there is a pregnancy prevention programme in place, as it carries significant risks to your baby.
Lamotrigine (Lamictal) has antidepressant effects and is licensed to treat severe depression in bipolar disorder. NICE guidelines recommend that it is not used to treat mania. If you are pregnant and taking Lamotrigine, NICE recommends you are checked regularly.
(See our pages on mood stabilisers for more information about these drugs.)
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.
Remember: 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).
(See our pages on antidepressants for more information about these drugs, including potential side effects.)
