Common Medications Prescribed

Treatments	How it is used	Precautions	Common Side Effects
Lithium	Most commonly used medication for bipolar and helps with mania and depression, regulating the mood swings. Can be used for ongoing treatment. Starts reducing severe manic symptoms in five to 14 days. Full effects may not be realized for weeks or months. Antipsychotics sometimes used with lithium in the first days of treatment to control manic symptoms and antidepressants may be used for the depression. Some people on lithium never have another episode. Others may have moderate mood swings that lessen as treatment continues, or have less frequent or less severe episodes.	Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, blurred vision, confusion, dizziness, muscle twitching, irregular heartbeat and seizures. Lithium should not be used during pregnancy.	May cause drowsiness, weakness, nausea, fatigue, hand tremor or increased thirst and urination. These side effects, except for hand tremor, usually go away. Weight gain may also occur. Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, blurred vision, confusion, dizziness, muscle twitching, irregular heartbeat and seizures.
Anticonvulsants
Valproic acid (Depakote®)	The anticonvulsant used most often as the main alternative therapy. Just as effective as lithium for non-rapid-cycling bipolar disorder and has been shown to be better than lithium in rapid-cycling bipolar disorder.	If pregnant, do not take this because of a risk of birth defects. Can cause liver problems. Can also cause life-threatening inflammation of the pancreas.	Although side effects are uncommon, they can occur: drowsiness, headache and indigestion.
lamotrigine (Lamictal®)	Approved by the FDA for the maintenance treatment of bipolar disorder to delay the time of mood to occurrence of mood episodes (depression, mania, hypomania and mixed episodes).	Possibility of a serious or even deadly rash: Three out of every 1,000 people taking Lamictal develop a rash. If a rash develops, call your doctor.	May cause headache, diarrhea, itching, problems seeing and dizziness
Other anticonvulsants
Carbamazepine (Tegretol®)(Carbatrol®)(Equetro®)	Some people who do not benefit from lithium or would prefer to avoid it have found relief from drugs used to treat seizures. The evidence for anticonvulsant effectiveness is stronger for acute mania than for long-term maintenance of bipolar disorder.	Carbamazepine may cause a decrease in the number of blood cells. Tell your doctor if you have ever had a decrease in the number of blood cells caused by another medication. If you experience any of the following symptoms, call your doctor immediately: sore throat, unusual bleeding or bruising, fever, or mouth sores	Can cause dizziness, drowsiness, feeling tired, tremor, weight gain and nausea.
gabapentin (Neurontin®)	Some people who do not benefit from lithium or would prefer to avoid it have found relief from drugs used to treat seizures. The evidence for anticonvulsant effectiveness is stronger for acute mania than for long-term maintenance of bipolar disorder.	Do not take if you are allergic to gabapentin, the main ingredient in Neurontin, or any other ingredient in Neurontin. Do not drive a car or operate heavy machinery until you are sure you can stay alert while taking this drug.	Can cause drowsiness, headache, tiredness, blurred vision, tremor, anxiety, and irregular eye movements.
topiramate (Topamax®)	Now marketed as a migraine medication. Some people who do not benefit from lithium or would prefer to avoid it have found relief from drugs used to treat seizures. The evidence for anticonvulsant effectiveness is stronger for acute mania than for long-term maintenance of bipolar disorder.	Serious risks include increased eye pressure (glaucoma), decreased sweating, increased body temperature, kidney stones, sleepiness, dizziness, confusion and trouble concentrating. Tell your doctor immediately if you have blurred vision or eye pain. Your doctor may also do simple blood tests to check for changes in electrolytes.	More common side effects are tingling in arms and legs, loss of appetite, nausea, diarrhea, taste change and weight loss. Your doctor may do simple blood tests to check for changes in electrolytes. Tell your doctor about other medications you take.
Antidepressants
paroxetine (Paxil®) fluvoxamine (Prozac®) fluozamine (Luvox®) sertraline (Zoloft®) citalopram (Celexa®) escitalopram (Lexapro®)	Used carefully and for short term because they can cause someone with bipolar to go into a manic episode. Selective serotonin reuptake inhibitors help with depression by regulating levels of serotonin, a neurotransmitter.	Can cause mania. See the alerts below.	Anxiety, diarrhea, drowsiness, headache, sweating, nausea, sexual problems and insomnia are possible side effects.
Benzodiazepines
lorazepam (Ativan®) clonazepam (Klonopin®) diazepam (Valium®) alprazolam (Xanex®)	Calms and sedates people until a mania or hypomania episode fades and mood-stabilizing agents can work.	Can be habit-forming and addictive. Tolerance may develop with long-term or excessive use, making the drug less effective. Do not stop taking these medications without talking to your doctor. Stopping suddenly can worsen your condition and cause withdrawal symptoms (anxiousness, sleeplessness and irritability).	Sedation is a common effect, and clumsiness, lightheadedness and slurred speech are other possible side effects.
Antipsychotics
quetiapine (Seroquel®) olanzapine (Zyprexa®) risperidone (Risperdal®) ziprasidone (Geodon®) aripiprazole (Abilify®)	Several atypical antipsychotics have been used in patients with bipolar disorder. They are especially helpful during acute episodes, but also may have longer-term mood stabilizing effects. Have been approved by the FDA for bipolar disorder. These drugs control mania while a mood stabilizer such as lithium or valproate starts to work.	Side effects can be severe - difficulty in speaking or swallowing, paralysis of the eyes, loss of balance control, muscle spasms, severe restlessness, stiffness of arms and legs, tremors in fingers and hands, twisting movements of body, and weakness of arms and legs. Geodon and Abilify should not be used in older adults with dementia.	May include dizziness, drowsiness, nausea, running nose, dry mouth, constipation, headache, dry skin, itchy eyes, loss of appetite, muscle spasms, restlessness, weight gain and elevated blood sugar and cholesterol levels.
Electroconvulsive therapy (ECT)
ECT	Has a high success rate for unipolar and bipolar depression. Doctors usually use ECT after drugs fail. ECT is done under anesthesia, and patients are given a muscle relaxant medication to prevent convulsions. The treatment involves a series of electrical pulses that move into the brain through electrodes on the patient's head. Doctors believe this electrical current might alter the electrochemical processes of the brain, consequently relieving depression.	ECT may only have short-term improvement with a high chance to relapse. Follow-up treatments may be needed. "Maintenance ECT" may be recommended by the doctor.	May cause short-term memory loss, but this tends to go away within one to two weeks after.

Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.

Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.

More on Bipolar Disorder

This article was reviewed and updated June 2007.