Here’s Why Treating Bipolar Disorder Can Be So Complex


As with any medication, it’s a good idea to ask your doctor about side effects and what to look out for so you can flag a negative response if you experience one. For example, drinking alcohol while taking lithium can decrease its effectiveness or increase potential negative effects like sedation, according to the National Alliance on Mental Illness (NAMI).


Severe manic or depressive episodes can cause symptoms of psychosis, in which you may lose touch with reality and have delusions or hallucinations, according to the NIMH. Antipsychotic medications, which are often used to treat people with psychotic disorders1, such as schizophrenia, can help in that situation. Dr. Mondimore says these drugs have mood-stabilizing qualities, so they’re frequently prescribed to people with bipolar disorder as well.

There are two types of antipsychotics: first-generation (typical) and second-generation (atypical), the NIMH explains. Some common first-generation antipsychotics include chlorpromazine, haloperidol, perphenazine, and fluphenazine; second-generation drugs include olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone, cariprazine, and paliperidone.

Antipsychotics generally work by changing the levels of brain neurotransmitters, chemical messengers such as serotonin, which impact mood, according to Jamie Alan, Pharm.D., Ph.D., assistant professor of pharmacology and toxicology at Michigan State University. Both types of antipsychotics treat manic symptoms, but only second-generation antipsychotics are thought to work more broadly to target depression as well, the NIMH explains.

Generally, some symptoms like hallucinations subside within a few days of taking antipsychotics, but it can take up to six weeks to fully benefit from these drugs, according to the NIMH. Sometimes, antipsychotics are prescribed alongside other medications, such as those mood stabilizers we just discussed, to help you feel better faster. “The thought is that the antipsychotic can manage the episodes while the mood stabilizer has time to work,” Dr. Alan tells SELF. “The general consensus is that an antipsychotic and a mood stabilizer provide a greater benefit.”


Sometimes, people with bipolar disorder may take antidepressants if other medications don’t help completely resolve their low mood episodes. There are plenty of antidepressants out there, but the most common are selective serotonin reuptake inhibitors (SSRIs), which can affect mood by increasing the amount of serotonin in the brain2. (Other antidepressants also work by changing the levels of neurotransmitters, the Mayo Clinic explains.)

But antidepressants can sometimes trigger a manic episode in people with bipolar disorder, according to Dr. Alan. So it’s important that you pay attention to how you feel and talk to your doctor if you notice signs of mania (talking really quickly or having feelings of euphoria, for example), your other symptoms worsen, or you experience severe side effects like not being able to sleep. Some commonly prescribed antidepressants include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).

Anti-anxiety medications

Oftentimes, people with bipolar disorder may also develop symptoms of an anxiety disorder, such as generalized anxiety. With a generalized anxiety disorder, you may have trouble controlling your nervous thoughts, worry excessively about common events such as driving to work, and have trouble relaxing or sleeping, according to the NIMH.

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