Bipolar DisorderMedications for Bipolar Disorder
A patient reference guide from Tailor Made Psychiatry
About These Medications
Bipolar disorder is a complex condition involving episodes of depression, mania or hypomania, and periods of stability in between. Its causes are multifactorial — genetics, neurodevelopment, sleep, stress, and life circumstances all play a role. Medication is not the whole picture, but it is a central part of it: mood stabilizers and antipsychotics reduce the severity and frequency of episodes by modulating brain circuits involved in mood regulation.
Sleep regularity, avoiding alcohol and substances, stress management, and psychoeducation all contribute meaningfully to long-term stability alongside medication. Feeling well is not a reason to stop — it is usually a sign the medication is working.
Read the class information block before looking up your specific medication — it covers side effects and timelines that apply to all drugs in that group.
Mood Stabilizers
Mood stabilizers reduce the frequency and severity of mood episodes over time. They require consistent daily use to be effective — missing doses or stopping suddenly can trigger relapse.
Common class side effects
- Nausea or stomach upset — take with food
- Tremor — fine shakiness of the hands; common and often manageable
- Weight changes
- Sedation or cognitive dulling at higher levels
Stopping this medication: Never stop mood stabilizers suddenly. Abrupt discontinuation can trigger rebound mood episodes and, in some cases, withdrawal effects. Any changes should be planned gradually with your psychiatrist.
What to expect — Mood Stabilizers
Weeks 1–2Dose is being established and monitored. Blood tests may be required. Side effects most prominent early.
Weeks 2–4Acute symptoms (agitation, mood instability) begin to settle as therapeutic levels are reached.
Weeks 4–8Full stabilizing effect develops over weeks to months with consistent use.
Lithium — Lithium carbonate / Carbolith
Used for
Bipolar I and II — gold standard for long-term mood stabilization; protective against mania and suicidality
Distinct features
One of the most effective long-term treatments for bipolar disorder, with decades of evidence. Requires regular blood monitoring.
Common side effects
Fine hand tremor, increased thirst and urination, nausea (take with food), weight gain, mild cognitive dulling at higher levels.
Monitoring
Blood tests required: lithium level, kidney function, and thyroid (TSH) at regular intervals. Target level: 0.6–1.0 mmol/L for maintenance — check 12 hours after your last dose.
Watch for
Dehydration, vomiting, diarrhea, or starting new medications (especially ibuprofen/NSAIDs) can raise lithium to toxic levels. Know the signs of toxicity — listed in the safety section below.
Valproate / Divalproex — Epival
Used for
Bipolar I — especially mania, mixed episodes, rapid cycling
Distinct features
Can reduce agitation and acute mania relatively quickly. Requires regular blood level and liver monitoring.
Common side effects
Nausea, sedation, tremor, weight gain, hair thinning (biotin/zinc supplementation may help), stomach upset.
Important warning
This medication is teratogenic — it causes serious harm to a developing baby. If you are of childbearing age, reliable contraception is essential. Discuss this explicitly with your doctor.
Watch for
Liver toxicity (rare but serious); pancreatitis — seek immediate care for severe abdominal pain.
Lamotrigine — Lamictal
Used for
Long-term prevention of mood episodes — especially the depressive side — in bipolar I and II. Because it must be increased slowly over several weeks, it is not a fast-acting treatment, and it is not used for sudden mania.
Distinct features
Must be started and increased very slowly over 6–8 weeks to minimize the risk of a serious rash. Particularly effective at protecting against the depressive side of bipolar disorder.
Common side effects
Headache, dizziness, blurred vision, nausea, mild rash.
Drug interactions
Valproate significantly raises lamotrigine levels. Oral contraceptives lower lamotrigine levels. Inform your doctor of all medications.
Watch for
A serious skin reaction (Stevens-Johnson syndrome) is rare but possible — risk is highest if the dose is increased too quickly. Signs are listed in the safety section below.
Atypical Antipsychotics
Despite the name, atypical antipsychotics are widely used in bipolar disorder for both acute episodes and long-term maintenance — not just for psychosis. They have well-established mood-stabilizing properties.
Common class side effects
- Sedation — particularly early in treatment and at higher doses
- Dry mouth, constipation
- Dizziness on standing (orthostatic hypotension) — rise slowly from sitting or lying
- Weight gain and metabolic effects — varies significantly between agents
- Akathisia (inner restlessness) — an uncomfortable feeling of needing to move; report this promptly
Stopping this medication: These medications should not be stopped abruptly. Gradual tapering under medical guidance is recommended. Stopping suddenly may trigger mood episode relapse.
What to expect — Atypical Antipsychotics
Weeks 1–2Sedation and calming effect are often noticed quickly. Acute agitation or mania typically begins to settle within days to a week.
Weeks 2–4Mood stabilization continues to build. Sleep usually improves. Metabolic side effects (appetite, weight) may begin to emerge.
Weeks 4–8Full mood-stabilizing effect typically established. Ongoing monitoring of metabolic parameters recommended.
Quetiapine — Seroquel / Seroquel XR
Used for
Bipolar I and II — both mania and bipolar depression; maintenance; anxiety and sleep
Distinct features
One of the few medications with evidence for both sides of bipolar disorder. Sedation is often most prominent at lower doses.
Monitoring
Fasting glucose, lipids, weight, and blood pressure at baseline and regularly thereafter.
Watch for
Weight gain and blood sugar changes — monitor diet and activity.
Lurasidone — Latuda
Used for
Bipolar depression — first-line; less sedating than quetiapine
Distinct features
Favourable metabolic profile — less weight gain than most other agents. Must be taken with food (at least 350 calories) — absorption is significantly reduced without food.
Common side effects
Nausea, mild sedation, akathisia — report restlessness promptly.
Watch for
Akathisia is the most common reason people stop this medication — it is manageable if caught early.
Cariprazine — Vraylar
Used for
Bipolar I — both mania and bipolar depression
Distinct features
One of the newer options with evidence for both the manic and depressive sides of bipolar I. Favourable weight and metabolic profile compared with several older antipsychotics. Very long-acting — it builds up gradually over a few weeks, so the full effect takes time.
Common side effects
Restlessness/akathisia (the most common — report it; it is manageable), nausea, difficulty sleeping, mild tremor.
Watch for
Akathisia (inner restlessness, inability to sit still) — report promptly. Because it stays in the body a long time, changes after a dose adjustment may take 1–2 weeks to settle.
Aripiprazole — Abilify
Used for
Bipolar I maintenance; mania prevention
Distinct features
Activating rather than sedating. Less weight gain and metabolic impact than most other antipsychotics.
Common side effects
Akathisia (restlessness), nausea, headache, insomnia, tremor.
Watch for
Akathisia — report inner restlessness or inability to sit still promptly.
Olanzapine — Zyprexa
Used for
Acute mania; adjunct in bipolar depression; maintenance in severe cases
Distinct features
Rapid calming effect in acute mania. Higher metabolic burden than other agents.
Common side effects
Significant weight gain, elevated blood sugar and lipids, sedation, dry mouth.
Monitoring
Metabolic parameters required regularly — weight, blood sugar, lipids.
Watch for
Weight gain can be rapid and substantial. Discuss diet and monitoring plan with your doctor.
A Note on Antidepressants in Bipolar Disorder
Antidepressants (such as SSRIs) are used with caution in bipolar disorder and are generally not recommended as standalone treatment. Without a mood stabilizer on board, they can trigger mania, rapid cycling, or mixed states. If an antidepressant is prescribed, it should be in combination with a mood stabilizer and under close supervision.
Finding the Right Medication
It is common to need more than one try before finding the medication and dose that works best for you. This is a normal part of the process — not a sign of failure. If a medication is not helping after a full trial, or side effects are not manageable, there are other options. Keep your doctor informed about how you are responding so adjustments can be made.
When to Seek Help
Go to the emergency department or call 911 if you experience:
- Thoughts of suicide with a plan or intent — call 988 (Suicide Crisis Helpline) or go to the nearest emergency department
- Signs of a manic episode with loss of insight or safety risk
Lithium Toxicity — if you are on lithium, know these signs
- Coarse (severe) tremor — different from the mild fine tremor that is a normal side effect
- Confusion, disorientation, or drowsiness
- Slurred speech or unsteady walking
- Vomiting, severe nausea, or diarrhea
If you have any of these — especially after illness, dehydration, or starting a new medication — go to the emergency department. Do not wait.
Stevens-Johnson Syndrome (SJS) — if you are on lamotrigine, know these signs
- A spreading rash — particularly if it blisters or involves mucous membranes
- Sores in the mouth, eyes, or genitals
- Eye redness, pain, or discharge
- Fever alongside any of the above
SJS is rare but serious. Stop lamotrigine and go to the emergency department immediately if these signs develop.