Medicines for bipolar disorder

What is bipolar disorder?

Bipolar disorder is a serious, long-term (chronic) mental health condition that involves having extreme mood swings. Someone with bipolar disorder can swing between periods of depression and periods of feeling ‘high’, irritable, agitated or excited, known as mania or hypomania. Some people with bipolar disorder also experience psychosis. This means that they lose touch with reality and may experience hallucinations, delusions and paranoia.

If you have bipolar disorder, treatment can help make the episodes of depression and mania shorter, easier to get through and less likely to happen.

How is bipolar disorder treated?

Most people with bipolar disorder manage the condition with a combination of medicines and psychotherapy. Psychological treatment on its own is usually not enough. Medicines play a vital role and are used to:

• treat episodes of depression
• treat episodes of mania or hypomania
• reduce the chance of these episodes from happening again

Long-term treatment of bipolar disorder also includes lifestyle changes such as:

• regular exercise
• maintaining a stable sleep schedule
• maintaining a healthy diet
• ensuring adequate social support from your family, friends
• getting support from a bipolar disorder support group, if available

What types of medicine might I be prescribed for bipolar disorder?

People with bipolar disorder often need to take a combination of medicines. They work by correcting an imbalance in the chemicals in the brain.

Mood stabilisers

Mood stabilisers are medicines that treat or prevent mania by reducing mood swings. They include:

• lithium, which is also commonly used as a long-term treatment
• anticonvulsants such as sodium valproate, carbamazepine and lamotrigine

Antipsychotics

Antipsychotics, such as risperidone, quetiapine, asenapine and ziprasidone, may be used if there are psychotic symptoms (i.e. hallucinations or delusions). Antipsychotics are more likely to be used short-term to treat an episode of mania, but some people with bipolar disorder take them long-term.

Antidepressants

If you have bipolar disorder and are going through an episode of depression, or have suicidal thoughts, your doctor may prescribe antidepressants to help you recover. You will usually need to be on a mood stabiliser as well.

Learn more about antidepressant medicines and how to use them.

You and your doctor will work out which medicines work best for you. Sometimes the first one isn’t the right one. Many people will need a combination of medicines. It’s important to talk to your doctor and work with them to find the right one/s, and to take them as prescribed.

How long will I need to take medicines for bipolar disorder?

Bipolar disorder is a long-term (chronic) condition. Most people will take medicines for bipolar disorder for years.

Never stop your medicine or adjust doses on your own without talking to your doctor. Sudden changes to your medicines and doses can cause serious side effects and increase your chance of relapse. It’s also important to tell your doctor about any other medicines you take, including over-the-counter and herbal medicines. Some medicines can interact with medicines for bipolar disorder.

What are the possible side effects of medicines used for bipolar disorder?

Medicines used for bipolar disorder can cause side effects in some people.

Antipsychotic medicines

Side effects of antipsychotic medicines can include:

• drowsiness
• weight gain
• dry mouth
• problems with sexual function
• constipation
• blurred vision

Mood stabilisers

Anticonvulsant mood stabilisers, such as valproate, can cause side effects including:

• drowsiness
• weight gain
• dizziness
• tremor
• diarrhoea
• nausea

Side effects of lithium can include:

• tremor
• weight gain
• drowsiness
• thyroid problems
• nausea, abdominal pain or diarrhoea
• muscle weakness
• memory problems

Some of these side effects may improve as your body gets used to the medicine.

Lithium can be very effective for bipolar disorder, but it can build up in the body and eventually cause harm to the thyroid, kidneys or central nervous system. If you are taking lithium carbonate, you will need regular blood tests to make sure you are taking the right level.

What is lithium toxicity?

If you have too much lithium, it can be toxic. Your doctor may refer you for regular blood tests to make sure your lithium levels aren’t too low or high.

Contact your doctor immediately if you are taking lithium carbonate and you experience new symptoms, including:

• nausea, vomiting or diarrhoea
• increased thirst
• increased urination frequency
• difficulty concentrating
• unsteadiness

You can reduce the chance of lithium toxicity by having blood tests to check your lithium levels as per your doctor’s recommendation. Other things you can do include:

• keeping your salt and caffeine intake at about the same level; sudden changes can affect your lithium levels
• avoid alcohol
• drink at least 8 to 10 glasses of water a day
• make sure your doctor or pharmacist know that you are taking lithium, so they can be aware of possible medicine interactions

When should I see my doctor?

You should see your doctor if you are experiencing ongoing symptoms of bipolar disorder despite treatment. You should also see your doctor if you are experiencing side effects. These are signs that your medicines may need to be adjusted or changed.

For most people, the benefits of treatment outweigh the risks of being on medicine. However, if you aren’t sure about taking medicines for bipolar disorder, here are some questions you might like to ask your doctor:

• What are the benefits of medicines for bipolar disorder?
• What are the risks of the medicine?
• What are the side effects?