Text Size :
A A A

Medications and other Biological Treatments for Bipolar Disorder

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

There are various different kinds of medications available for Bipolar Disorder. For every person with this condition, choosing the right medication or combination of medications is a process that requires time and patience. The same medication can have different effects on different people and there is no way to know for sure just how a given person will respond to a particular medication until they try it.

As a result, even though there are general guidelines on how to use these medications, in practice this necessarily involves some trial and error. When done with the proper follow-up and monitoring of an experienced physician, this process as safe and, ultimately, necessary. The goal of this process is to find a combination of treatments that relieves all of the person's manic and depressive symptoms without causing too many side-effects.

Mood Stabilizers and Antipsychotics are the main treatments for Bipolar Disorder

The Mood Stabilizers and the Atypical Antipsychotics are the two principle groups of medications for treating Bipolar Disorder. All the medications in these two groups share the same purpose of trying to stabilize moods, that is, to ease both manic and depressive symptoms, help keep moods within a more healthy and regular range, and prevent relapses. Each of the medications differ in their unique properties, side-effects, and abilities to target either manic or depressive symptoms. The treatment guidelines provided on this site offer guidelines on when each one of them should be considered.

Despite their name, the Atypical Antipsychotics are often used even when a person has no psychotic symptoms at all, as they are very effective and commonly used in stabilizing moods regardless of the presence or absence of psychosis. Typical Antipsychotics can also be tried, especially in cases where Atypical Antipsychotics do not seem to be effective.

Controversy over using Antidepressants for Bipolar Depression

Antidepressants are a third group of medications that have been commonly used to treat the Depressive Episodes that frequently occur in Bipolar Disorder. However, there are now more and more findings suggesting that this strategy may have some important limitations.

Antidepressants can trigger manic symptoms, and for this reason they should never be used alone in Bipolar Disorder, but always in combination with a Mood Stabilizer or an Atypical Antipsychotic. Even when combined with these other medications, several studies have shown that antidepressants can make moods more unstable in Bipolar Disorder [ref, ref, ref; evidence to the contrary: ref, ref]. They can also increase the chances of having Rapid Cycling, which is a form of Bipolar Disorder that tends to be quite difficult to treat [ref, ref].

Moreover, there are also questions about the actual benefits of these medications for Bipolar Depression, for some studies have shown that they do not seem to offer much extra benefit for treating depressive symptoms beyond what the Mood Stabilizers and Atypical Antipsychotics can achieve on their own [ref, ref, ref].

Although antidepressants continue to be recommended as a first-line choice for treating Bipolar Depression [ref] - always in combination with a Mood Stabilizer or an Atypical Antipsychotic - this is probably most appropriate for cases of "pure" Depression that are not mixed with any manic symptoms. When manic symptoms are present, these medications should be avoided. Furthermore, antidepressants should be discontinued a few weeks after an episode of Bipolar Depression has resolved [ref]. Bupropion may be preferred to other antidepressants because it tends to cause lower rates of emergent manic symptoms [ref].

Electroconvulsive Therapy (ECT) for Bipolar Disorder

ECT is a very effective treatment for the different phases of Bipolar Disorder [ref]. It tends not to be used as a first-line treatment because it requires the use of general anesthesia, and also because of the stigma and the unfair negative perception in popular culture that has been attributed to it.  However, it is a very safe treatment, and overall its side effects are no greater than with medications.

Other Treatments for Bipolar Disorder

Ketamine is a medication that is showing promise as a treatment that can improve the symptoms of Bipolar Depression within a matter of hours after a single intravenous injection [ref]. However, after a few days the effects of this treatment usually disappear. This is not a treatment that can be used on a regular, long-term basis due to some important neurological side-effects that can develop. This treatment is not yet mainstream. Its role for the time being is mainly for helping to bring someone out of a Bipolar Depression quickly, and then letting other treatments take effect.

Omega-3 Fatty Acids are natural supplements that have been shown to be effective in relieving mood symptoms in Bipolar Disorder [ref, ref].  

Various other kinds of medications not discussed above have also been found to be helpful in certain cases. These are listed in the various treatment guidelines of Bipolar Disorder.

 

Psychotherapy

Manic, Hypomanic or Mixed Episode