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Antipsychotics for the Treatment of Bipolar Disorder

Examples

First-generation, or typical, antipsychotic medicine

Generic Name Brand Name
haloperidol Haldol

Second-generation, or atypical, antipsychotic medicines

Generic Name Brand Name
aripiprazole Abilify
olanzapine Zyprexa
olanzapine and fluoxetine Symbyax
quetiapine Seroquel
risperidone Risperdal
ziprasidone Geodon

These medicines are available in liquid, tablet, or injectable form.

How It Works

These medicines balance certain chemicals in the brain (neurotransmitters). It is not clear exactly how these medicines work for the treatment of bipolar disorder. But they quickly improve manic episodes.

Why It Is Used

Each of these medicines has been approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder. Some medicines work better for some people than for others. Second-generation antipsychotic medicines may have fewer side effects than first-generation antipsychotic medicines. Be sure to talk with your doctor about how the medicine is working for you. Sometimes you might need to try more than one type of medicine before you find one that works best for you.

These medicines have all been found to be an effective treatment of manic episodes. Quetiapine has been approved by the FDA to treat both mania and depression. Other antipsychotic medicines, such as olanzapine, are also being studied for the treatment of depression in bipolar disorder. The single medicine combining olanzapine and fluoxetine (Symbyax) is also used to treat depressive episodes associated with bipolar disorder. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), which is used to balance certain brain chemicals (neurotransmitters) that are thought to cause depression.

How Well It Works

Drugs in this classification work quickly in the treatment of bipolar disorder, especially in older adults. These medicines have all been found to be an effective treatment of manic episodes. Some studies show the combination of an antipsychotic and a mood stabilizer may be more effective than a mood stabilizer alone.1

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

Neuroleptic malignant syndrome (NMS) is an extremely rare but serious side effect that has been reported by people who take antipsychotic medicines. NMS causes life-threatening problems with your body's ability to regulate its temperatures.

Call 911 or other emergency services right away if you have a fever and:

  • Muscle rigidity.
  • Fast or irregular heartbeat.
  • Rapid breathing.
  • Severe sweating.

Other side effects of antipsychotic medicines include:

Managing side effects

It may take several attempts to find the right dose and medicine to treat your bipolar symptoms. Effectiveness and side effects for each medicine vary from person to person.

Some side effects are minor. You can manage these through lifestyle changes such as exercise, relaxation techniques, and diet changes. Other side effects can be more serious and require changes to the dose or type of medicine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Before you take an antipsychotic medicine, be sure to tell your doctor if you have:

  • A heart condition.
  • A seizure disorder.
  • Problems with liver function.
  • Problems with blood pressure.
  • Diabetes or high blood sugar.
  • Constipation.
  • A history of breast cancer.
  • Problems with swallowing.
  • Problems with fainting.

These medicines should be started in low doses. Talk with your doctor about any other medicines you may be taking to make sure there are no negative drug interactions.

You may need regular liver tests, blood tests, and blood pressure monitoring while taking an antipsychotic medicine. Your doctor may also monitor your weight and blood sugar.

Avoid herbal stimulants (such as ma huang, ginseng, or kola) while taking an antipsychotic medicine.

Talk to your doctor or pharmacist about drinking grapefruit juice while taking an antipsychotic medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases the chances of having serious side effects.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Women who use this medicine during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Scherk H, et al. (2007). Second-generation antipsychotic agents in the treatment of acute mania: A systematic review and meta-analysis of randomized controlled trials. Archives of General Psychiatry, 64(4): 442–455.

Credits

By Healthwise Staff
Primary Medical Reviewer Patrice Burgess, MD - Family Medicine
Specialist Medical Reviewer Lisa S. Weinstock, MD - Psychiatry
Last Revised May 14, 2012

Last Revised: May 14, 2012

Author: Healthwise Staff

Medical Review: Patrice Burgess, MD - Family Medicine & Lisa S. Weinstock, MD - Psychiatry

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