There are generally four different classes of medications used to treat bipolar disorder- lithium, anticonvulsants, antidepressants and antipsychotics. Most people with bipolar take a combination of different medications. Which medications are prescribed depends on the severity of the person’s disorder, how well the medication works for them and how well they tolerate the side effects. Some of the strongest medications used to treat bipolar disorder are antipsychotics. They are used in both acute situations and for maintenance.

There are two different classes of antipsychotics used to treat bipolar disorder. There are first-generation or typical antipsychotics and atypical antipsychotics. First-generation antipsychotics are mostly used to treat psychosis. Their use is limited due to the severity of side effects, most notably tardive dyskinesia.

Atypical antipsychotics are growing in use as treatment for bipolar disorder, both to treat acute mania as well as in maintenance therapy. More than half of patients treated for bipolar disorder are prescribed antipsychotics for acute therapy for manic episodes. Just over 40% take them as maintenance therapy. They have fewer side effects that first-generation antipsychotics and are generally better tolerated.

Common typical antipsychotics:

  • Chlorpromazine (Thorazine)
  • Fluphenazine (Prolixin)
  • Haloperidol (Haldol)
  • Loxapine (Loxitane)
  • Molindone (Moban)
  • Thiothixene (Navane)
  • Trifluoperazine (Stelazine)

Common atypical antipsychotics:

  • Aripiprazole (Abilify)
  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

How they work:

Antipsychotics act as sedatives. They decrease the impact of dopamine in the brain. An overabundance of dopamine is thought to contribute to psychosis. They also block some serotonin receptors. Some atypical antipsychotics are thought to increase dopamine in the prefrontal cortex while reducing glutamate, which acts as an excitatory neurotransmitter. Atypical antipsychotics can also work as antihistamines, which can create a sedative effect.

Effectiveness:

  • Whereas some drugs for mental illness can take up to several weeks to become effective, antipsychotics take effect almost immediately.
  • An average of 55-66% of patients see at least a 50% reduction in depressive symptoms within a 6 week period.
  • Half of patients enter remission after taking some atypical antipsychotics for depression either as monotherapy or part of combination therapy.
  • Most atypical antipsychotics have at least a 50% response rate when treating acute mania.
  • Atypical antipsychotics do not seem to induce depressive episodes.
  • Antipsychotics may reduce anxiety in some cases.

Common side effects:

  • Drowsiness
  • Dizziness
  • Restlessness
  • Weight gain
  • Dry mouth
  • Constipation
  • Nausea
  • Vomiting
  • Blurred vision
  • Low blood pressure
  • Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines)
  • Seizures
  • A low number of white blood cells, which fight infections
  • Loss of bone density

Withdrawal symptoms:

  • Dyskinesia
  • Headaches
  • Joint pain
  • Diarrhea
  • Nausea/vomiting
  • Sweating
  • Dizziness/light-headedness
  • Crying
  • Insomnia
  • Irritability
  • Mood swings
  • Panic attacks
  • Hallucinations
  • Psychosis
  • Suicidal ideation
  • Relapse

 

Always consult a physician before adding, discontinuing or changing any medication regimen. If you experience any side effects or signs of withdrawal, contact your doctor immediately.

 

 

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Image credit: thierry ehrmann