Antipsychotic Medication for Bipolar Disorder

Antipsychotic medications are used as a short or long-term treatments for bipolar disorder to control psychotic symptoms such as hallucinations, delusions, or mania symptoms. These symptoms may occur during acute mania or severe depression. Some also treat bipolar depression, and several have demonstrated long-term value in preventing future episodes of mania or depression.

In people with bipolar disorder, antipsychotics are also used "off label" as sedatives, for insomnia, anxiety, and/or agitation. Often, they are taken with a mood-stabilizing drug and can decrease symptoms of mania until mood stabilizers take full effect.

Some antipsychotics seem to help stabilize moods on their own. As a result, they may be used alone as long-term treatment for people who don't tolerate or respond to lithium (Eskalith, Lithobid) and anticonvulsants.

Antipsychotic drugs help regulate the functioning of brain circuits that control thinking, mood, and perception. It is not clear exactly how these drugs work, but they usually improve manic episodes quickly.

The newer antipsychotics usually act quickly and can help you avoid the reckless and impulsive behaviors associated with mania. More normal thinking often is restored within a few weeks.

Antipsychotics used to treat bipolar disorder include:

• aripiprazole (Abilify)
• asenapine (Saphris)
• cariprazine (Vraylar)
• clozapine (Clozaril)
• lurasidone (Latuda)
• olanzapine (Zyprexa)
• quetiapine (Seroquel)
• risperidone (Risperdal)
• ziprasidone (Geodon)

Side Effects of Antipsychotic Drugs

Common side effects of antipsychotic medications include:

• Blurred vision
• Dry mouth
• Drowsiness
• Muscle spasms or tremors
• Weight gain

Note: Clozaril is not used often, despite its effectiveness for bipolar disorder. The drug can cause a rare, potentially fatal side effect that requires weekly or biweekly blood test monitoring. Also, Geodon is linked to a rare but potentially fatal skin reaction.

Older antipsychotic drugs are generally not used as a first-line treatment for bipolar disorder, and they are less established for treating depressive symptoms or preventing episodes during long-term use. However, they may be helpful if a person has troublesome side effects or doesn't respond to the newer drugs. Older antipsychotics include chlorpromazine (Thorazine), haloperidol (Haldol), and perphenazine (Trilafon). These drugs may cause a serious long-term side effect called tardive dyskinesia, a movement disorder characterized by repetitive, involuntary movement like lip smacking, protruding the tongue, or grimacing. Newer atypical antipsychotics also have the potential to cause this side effect, but have a relatively lower risk than the older conventional antipsychotics.

The medications deutetrabenazine (Austedo) and valbenazine (Ingrezza) have proven effective in treating adults with tardive dyskinesia.

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