Patient information from BMJ

Bipolar disorder: what medicines work?

Last published:Aug 04, 2021

Most of us have ups and downs in our moods. But if you have bipolar disorder your mood swings are much more extreme. Bipolar disorder is a long-term mental health condition. It can make life hard, but treatment can help you keep your symptoms under control.

This leaflet tells you about the medicines you might need to take for bipolar disorder. You can use our information to talk to your doctor and family, and to plan your treatment.

How is bipolar disorder treated?

If you have bipolar disorder your mood swings much further than is usual in most people. Sometimes you might feel very high and have lots of energy. That is called mania. Other times, you might feel very low. That is called depression.

Most people with bipolar disorder need to take medicines every day to keep their mood stable. The type of medicine and the dose you take might change, depending on how well you are and what symptoms you are getting.

All the medicines used for bipolar disorder can cause unwanted side effects. But some medicines might suit you better than others. It can take a while for you and your doctor to find the right medicine, or combination of medicines, for you.

As you are reading about the side effects, bear in mind that you won’t get them all. It’s really important not to stop taking your medicines without talking to your doctor first, even if you get side effects.

If you stop, you might have a relapse of mania or depression. Your doctor might be able to adjust your dose or switch you to another type of medicine.

Medicines to treat and prevent mania

If you are having a bout of mania you might be racing around, having big ideas, taking lots of risks. You'll need treatment that will calm your mood quickly.

There are three main types of medicine used to treat mania. You might need to take more than one type to bring your mania under control and prevent a relapse.

Antipsychotics are medicines that calm down the activity in your brain. This should bring your mania under control and help you feel calmer. These medicines are sometimes used over the long term, to help prevent a relapse.

You might also need to take mood stabilisers. They help prevent mood swings. Mood stabilisers are usually taken over the long term, to help prevent a relapse.

Side effects of mania medicines

The lists of side effects for bipolar medications can look long and worrying. But remember, they don't happen to everyone, and you won't get all of them. Some people have very few problems.

But if you do have side effects that bother you, talk to your doctor. You might be able to change to a different drug or a different dose.

Antipsychotics can sometimes cause high blood sugar and diabetes. You should have regular checks to avoid these problems.

Antipsychotics can also cause muscle stiffness and shaking. These side effects are sometimes called parkinsonism, because they can look a bit like Parkinson’s disease.

Other common side effects can include:

• drowsiness

• weight gain

• dry mouth

• headache

• constipation

• dizziness, and

• trouble sleeping.

Mood stabilisers can cause side effects such as:

• tiredness or drowsiness

• shaking and dizziness

• problems concentrating

• hair loss

• thirst

• thyroid problems

• clumsiness

• rash, and

• eyesight problems.

You need to be careful not to take too much of any of these medicines, because it can be dangerous. This is especially true of a drug called lithium. If you take lithium you’ll have regular blood tests to make sure you’re not taking too much.

The mood stabiliser valproate can cause serious birth defects and other problems in babies and children. So it is not prescribed for pregnant women. And it is not prescribed for women and girls of childbearing age unless:

• no other treatments work, or all other treatments cause serious side effects, and

• the patient is using reliable contraception (you might hear your doctor talk about a 'pregnancy prevention programme').

Medicines to treat depression

Some of the same medicines used to treat mania can also help with depression in bipolar disorder. These include some antipsychotics and mood stabilisers.

Antidepressants are also sometimes used, but they are usually prescribed along with an antipsychotic, a mood stabiliser, or both. This is because taking an antidepressant alone for bipolar disorder can sometimes trigger a bout of mania.

Side effects of medicines for depression

Antidepressants can cause stomach upsets, trouble sleeping, and anxiety.

However, the main concern about using antidepressants to treat depression in bipolar disorder is that they can trigger a mood swing that turns into mania. It’s not clear how likely this is.