You can try different medications to treat bipolar disorder. These may carry risks, ranging from physical to mental side effects. A doctor can best guide you on safe treatment options for bipolar disorder and how to manage any side effects.
Bipolar disorder, in which people can experience acute mood episodes, is first and foremost treated with medication. Manic episodes can be more severe in the case of bipolar 1 disorder and less severe, or hypomanic, in the case of bipolar 2 disorder.
Doctors can prescribe different medications for each phase. They routinely monitor and adjust medications to make sure they’re working as they should.
Medication for bipolar disorder can cause side effects. By working closely with your medical support team and engaging in shared decision making, you can work to find an effective treatment plan while also managing and preventing side effects.
Many people with BD take more than one medication at a time or transition from one drug to another.
Lithium, for example, is a commonly prescribed mood stabilizer, but it doesn’t work right away. Doctors may suggest taking an antipsychotic medication for an acute manic episode to give lithium time to do its job.
Another example is antidepressants. Clinicians generally only recommend people with BD take antidepressants along with a mood stabilizer or antimanic drug to avoid the risk the antidepressant might trigger an acute manic episode.
The most common medications for BD, used alone or in combination, include:
- Mood stabilizers: These include lithium, divalproex/valproic acid, and carbamazepine.
- Atypical antipsychotics: These include aripiprazole, asenapine, cariprazine, lurasidone, paliperidone, quetiapine, risperidone, ziprasidone, and olanzapine.
- Antidepressants: these can help alleviate depression and related symptoms, including medications that might include SSRI medications citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
Each of these has possible side effects. For some people, these side effects can hinder continuing treatment.
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Below are some side effects of medications for bipolar disorder.
Mood stabilizers
Side effects may include:
- increased urination and thirst
- trembling of the hands
- weight gain
- fatigue
- headache
- drowsiness
- dizziness
- nausea
- vomiting
- diarrhea
- blurred vision
- vision changes
- impaired memory
- difficulty concentrating
- hair loss
- easy bruising
- changes in the menstrual cycle
- low sodium in blood
- itchiness
- rash
It’s possible to experience lithium toxicity, especially if you’re dehydrated. Signs of too much lithium in the blood include:
- gastrointestinal symptoms
- shaking and twitching
- loss of balance
- slurred speech
- weakness
Atypical antipsychotics
Side effects may include:
- dry mouth
- dizziness
- blurred vision
- seizures
- weight gain
- type 2 diabetes
- tremor
- stiffness
- agitation
- sleepiness
- low energy
- sedation
- decreased sex drive
- discharge from breast
- missed menstrual periods
Antidepressants
Side effects may include:
- weight gain
- diarrhea
- nausea
- vomiting
- restlessness
- vivid dreams
- nervousness
- anxiety
- loss of appetite
- sleepiness
- sexual dysfunction
Doctors monitor people taking BD medication for side effects. In many cases, your doctor can help you change your treatment plan so symptoms are easier to manage.
Your doctor can recommend what changes work best for you.
They may prescribe an adjunctive medication to help counter side effects. For example, when people experience restlessness from antipsychotics, the clinician may consider lowering the dose or prescribing a beta-blocker.
Side effects can sometimes make it difficult for people to stay on the prescribed medication. They can also impact quality of life.
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Adverse side effects may lead clinicians to recommend a lower dose of medication. This can impact the effectiveness of the medication.
However, given the disruptive nature of the disorder, there is also evidence that some BD medications can markedly improve quality of life.
A paper presented at the 2021 annual meeting of the American Psychiatric Association found that patients experiencing bipolar mood episodes who took a combination of lithium and antipsychotic medications had hospital stays that were an average of 2.8 days shorter. Stays ranged from 1 to 3 weeks.
Ideally, you’ll discuss treatment options with your doctor in a process called “shared decision making.” This is a common practice in other forms of healthcare, but according to a
However, there’s evidence that shared decision making in the treatment of psychosis improves the care experience. In shared decision making, the doctor explains treatment options. The person with BD discusses their values and preferences with the clinician and considers the options. Together, they make a decision about the next steps to take.
This is quite different from some people’s experience with BD treatment.
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BD is a lifelong experience, and you should feel comfortable asking for a shared decision making model or requesting more information about ways to handle medication side effects.
Side effects are common with medications for bipolar disorder. These medications can help people with BD to manage symptoms.
Sometimes, the side effects are intolerable, but your doctor can help. They can recommend dosage changes, different medications, lifestyle changes, and adjunctive medications to help find a good balance.
