From the Guidelines
The most common medications for bipolar disorder include lithium, valproate, and second-generation antipsychotics such as quetiapine, olanzapine, risperidone, and aripiprazole, with treatment typically beginning with a single medication and combinations used for inadequate response 1.
Medication Overview
The choice of medication depends on the phase of illness, side effect profiles, and patient history.
- Mood stabilizers:
- Lithium is considered the gold standard mood stabilizer, typically started at 300-600mg daily and adjusted based on blood levels (0.6-1.2 mEq/L) 1.
- Valproate (Depakote, 500-2000mg daily) and carbamazepine (Tegretol, 400-1600mg daily) are also commonly used.
- Second-generation antipsychotics:
- Quetiapine (Seroquel, 300-800mg daily), olanzapine (Zyprexa, 5-20mg daily), risperidone (Risperdal, 2-6mg daily), and aripiprazole (Abilify, 10-30mg daily) are widely used.
Treatment Guidelines
According to the WHO recommendations, lithium, valproate, or carbamazepine should be offered to individuals with bipolar mania, and haloperidol is recommended as a first-line antipsychotic, with second-generation antipsychotics considered as an alternative if availability and cost are not a constraint 1.
- Maintenance treatment with lithium or valproate should continue for at least 2 years after the last episode of bipolar disorder.
- Antidepressant medicines, always in combination with a mood stabilizer (lithium or valproate), may be considered in the treatment of moderate or severe depressive episodes of bipolar disorder.
Monitoring and Safety
Regular monitoring is essential, as lithium requires blood level and kidney function tests, valproate needs liver function tests, and antipsychotics require metabolic monitoring 1.
- These medications work by stabilizing neural pathways and neurotransmitter systems, particularly affecting glutamate, GABA, dopamine, and serotonin to prevent mood episodes.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications for Bipolar Disorder
The most common medications for bipolar disorder include:
- Mood stabilizers: lithium, valproate, and lamotrigine 2, 3, 4, 5, 6
- Anticonvulsants: valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin, topiramate, and clonazepam 3, 4, 6
- Atypical antipsychotics: quetiapine, olanzapine, risperidone, aripiprazole, asenapine, lurasidone, and cariprazine 2, 3, 4, 5, 6
- Antidepressants: fluoxetine, selective serotonin reuptake inhibitors, and bupropion, although their use is not recommended as monotherapy 2, 5
First-Line Treatment Options
First-line treatment options for bipolar disorder include:
- Lithium monotherapy 2, 4, 5, 6
- Lamotrigine monotherapy or as adjunctive treatment 2, 3, 4, 5, 6
- Valproate monotherapy or as adjunctive treatment 2, 3, 4, 5, 6
- Quetiapine monotherapy or as adjunctive treatment 2, 3, 5, 6
- Olanzapine monotherapy or as adjunctive treatment 2, 3, 4, 5, 6
Maintenance Treatment Options
Maintenance treatment options for bipolar disorder include: