Which bipolar medications are best for me?
There is no best medication when it comes to bipolar disorder and your psychiatrist will help you find the most effective treatment.
Key takeaways
- Types of bipolar medication include mood stabilizers, anticonvulsants, and antidepressants.
- Mood stabilizers encompass medications like lithium, anticonvulsants, as well as antipsychotics.
- Depending on what type of episodes you have, you may take a combination of medications.
- Long-term treatment can make a difference in your life and is best paired with therapy.
Bipolar disorder is a mood disorder that causes extreme mood episodes that can cause intense distress and make it hard to function day-to-day. However, if you have bipolar disorder, psychiatric medications can help get your symptoms under control.
Bipolar depression is a phase of bipolar disorder, but patients also struggle with acute mania without necessarily having bipolar depression
Medication can help reduce symptoms of bipolar disorder including acute mood episodes as well as reduce the frequency of manic, mixed, or depressive episodes. However, it’s important to find the medication or combination of medications that’s best for you. This can depend on whether you have bipolar I or bipolar II and if you’re currently experiencing a mood episode or not. The combo of medications you need to take may vary depending on the mood episode. Some medications may also be important to take for maintenance even when your mood is euthymic (normal) to prevent emergence of an acute manic or bipolar depressive episode
Read on for a comprehensive overview of the best medications for bipolar depression, including mood stabilizers, antidepressants, and antipsychotics.
How is bipolar depression treated?
Many medications can treat bipolar depression. There are two main types of mood episodes in bipolar disorder: manic and depressive. Depending on what type of bipolar disorder you have and whether you’re experiencing an acute mood episode, different medications are used. There are certain medications that have the strength to treating mania versus depression, and there’s evidence that some others (like quetiapine, Lithium) can actually help with both mood states.
Manic episodes are considered the “highs” of bipolar disorder. Symptoms include:
- Euphoria or elevated mood
- Feeling “wired”
- Irritability
- Talking very fast
- Racing thoughts
- Feeling very powerful or talented
- Risky, impulsive, reckless behavior
- Requiring less sleep
Depressive episodes are the “lows” of bipolar disorder. Symptoms include:
- Sadness and hopelessness
- Losing interest in things you usually enjoy
- Trouble carrying out simple tasks
- Fatigue
- Sleeping too much
- Worthlessness
- Isolating yourself from other people
- Appetite changes
- Thoughts about death or suicide
Mixed episodes are also possible –– when you have symptoms of both mania and depression at the same time. Mixed episodes are known to have a higher risk for suicide. Additionally, hypomania is a more mild form of mania. Patients with hypomania (bipolar II disorder) often do NOT end up in the psychiatric hospital, and their duration of hypomania is often shorter than patients with bipolar I disorder.
Mood stabilizers for bipolar depression
Mood stabilizers are a popular treatment option for bipolar disorder. As the name suggests, mood stabilizers help stabilize and level out the highs and lows of bipolar disorder.
Examples of mood stabilizers are:
Lithium
Lithium is a mood-stabilizing medication with two FDA-approved indications for bipolar disorder: treating acute mood episodes (mixed or manic) and bipolar maintenance treatment.
Maintenance treatment means it helps extend the time between episodes of mania, hypomania, and depression, preventing frequent mood swings and providing some more overall stability. Lithium can also help to reduce symptoms of mania while someone is at the height of a manic or mixed episode.
Researchers don’t know the exact way that lithium helps stabilize mood, but it’s theorized that it can help regulate chemical messengers in the brain, known as neurotransmitters. Additionally, it might affect the brain’s cellular signaling pathways, which play a role in regulating mood.
Depakote
Depakote (valproate) is an anticonvulsant/antiepileptic drug. It is FDA-approved for both epilepsy and treating manic or mixed episodes in people with bipolar disorder. It is more effective for these situations rather than depressive episodes.
This mood-stabilizing medication can help level out your mood to stay at a neutral baseline level, mellowing you out during manic episodes. You’ll feel relief from symptoms like intense euphoria, agitation, and risk-taking behavior.
Lamictal
Like Depakote, Lamictal (lamotrigine) is technically an anticonvulsant, used in people with epilepsy. However, it’s also FDA-approved for maintenance treatment for people with bipolar I disorder. Lamotrigine's greatest strength is with treating bipolar depression. There is less evidence regarding successful treatment ofmania/hypomania The exact way that Lamictal helps with bipolar symptoms isn’t fully understood, but it may be due to the medication’s ability to decrease the activity of “excitatory” neurons in the brain.
As a maintenance treatment, Lamictal extends the time between episodes of mania, hypomania, and depression, preventing frequent mood swings and providing some more overall stability. However, Lamictal can be used off-label for more acute mania or depression, or for rapid cycling bipolar disorder.
Antidepressants
Antidepressants are not typically used as a monotherapy or standalone treatment for bipolar depression since there is a risk of mood destabilization. However, a psychiatrist might prescribe a selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI) in addition to a mood stabilizer to help reduce symptoms of depressive episodes. They can also be of use if you have anxiety, PTSD, or OCD alongside bipolar disorder. SSRIs increase serotonin levels available in the brain, and SNRIs increase levels of both serotonin and norepinephrine. This has a mood-lifting effect for those with depression.
Examples of SSRIs that could be used off-label to treat bipolar disorder are:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Prozac (fluoxetine)
- Paxil (paroxetine)
- Zoloft (sertraline)
SNRIs that could be used off-label to treat bipolar depression are:
- Cymbalta (duloxetine)
- Effexor (venlafaxine)
- Fetzima (levomilnacipran)
- Pristiq (desvenlafaxine)
Taking SSRIs/SNRIs alone can increase the risk of having a manic or hypomanic episode. Some research points to SNRIs and TCAs having a larger risk of inducing these. Antidepressants could also cause more frequent mood episodes. This is why they should only be prescribed alongside a mood stabilizer, if they are prescribed at all.
Learn more about which antidepressant is best for you.
Antipsychotic medications
Antipsychotics are a type of mood stabilizer and that they are used in the treatment of bipolar disorder, even when patients do not have psychotic symptoms. In some cases, a psychiatrist might decide an antipsychotic is a good fit for you and your symptoms, often prescribed alongside another bipolar medication. They are most effective for treating symptoms of mania, as well as preventing future manic episodes.
Three examples of antipsychotics that can help treat bipolar disorder include Risperdal (risperidone), Vraylar (cariprazine), Abilify (aripiprazole), as well as:
Seroquel
Seroquel (quetiapine) is FDA-approved for treating bipolar depression and bipolar I manic episodes. For acute episodes, it may be prescribed alone, or alongside a mood stabilizer.
The exact way that Seroquel helps bipolar symptoms isn’t known, but it’s theorized that the medication affects the receptors of neurotransmitters serotonin and dopamine.
Latuda
Latuda (lurasidone hydrochloride) is FDA-approved for treating bipolar I and bipolar II depressive episodes. You can take it alone or together with a mood stabilizer.
Like Seroquel, Latuda’s exact mechanism of action is not fully understood, but it could be due to the medication affecting serotonin and dopamine receptors.
Zyprexa
Zyprexa (olanzapine) is also FDA-approved to treat bipolar I disorder, especially manic or mixed episodes. It also can be prescribed on top of a mood stabilizer as a maintenance treatment.
It may also be prescribed alongside the SSRI Prozac (fluoxetine) for the treatment of bipolar I depressive episodes.
Again, the efficacy of this medication could be related to its effect on serotonin and dopamine receptors.
What is the most effective medication for bipolar depression?
There isn’t a single most effective medication for bipolar depression. Everyone is different and has different responses to medications. The medication that’s best for you might not be as effective for another person, and vice versa.
A psychiatrist will be your guide to determining which medication (or combination of medications) could be most effective for relieving your symptoms. However, it’s important to keep in mind that this process can take some trial and error. If you haven’t experienced adequate symptom relief from one medication, your psychiatrist might try a different one.
If you’re looking for a psychiatrist to help you determine the most effective treatment plan to manage your bipolar disorder, consider Talkiatry.
We’re a national psychiatry practice that treats a wide variety of mental health conditions, including mood disorders like bipolar depression. We provide virtual, in-network services so you can get the care you need from the comfort of your home. To get started, complete our free online assessment to get matched with a psychiatrist.
FAQ
How else can you treat bipolar depression?
In addition to medications, psychotherapy, AKA talk therapy, is a great tool to treat bipolar depression. Some therapy modalities that can help you manage bipolar disorder include:
- Cognitive behavioral therapy (CBT)
- Interpersonal and social rhythm therapy (IPSRT)
- Family-focused therapy
- Psychoeducation
For many people, a mix of therapy and medication is most effective for treating mental health conditions like bipolar disorder.
What are the different types of bipolar disorder?
Bipolar I disorder is related to severe manic episodes and depressive episodes. There may also be mixed episodes. Bipolar II disorder doesn’t typically involve intense manic episodes, rather there are hypomanic episodes. Cyclothymic disorder is another possibility. With this disorder, there are more mild, shorter-lasting episodes of hypomania and depression.
How many bipolar medications do you need to take?
There is no specific number of bipolar medications you “need” to take. Some people may take just one medication for their bipolar disorder, while others may take a combination of medications. It depends on you and your unique symptoms. Your psychiatrist will determine the best treatment plan for you.
The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.
