Antipsychotic medications are used as short or long-term treatments for bipolar disorder to control psychotic symptoms such as hallucinations, delusions, or mania symptoms. These symptoms may show up during acute mania or severe depression episodes. Some also treat 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 agitation. Often, you take them with a mood-stabilizing drug to 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 a 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’s not clear exactly how these drugs work, but they usually improve manic episodes quickly.
The newer antipsychotics, sometimes called atypical antipsychotics, usually act quickly and can help you avoid the reckless and impulsive behaviors associated with mania. You’ll usually feel better within a few weeks.
Antipsychotics used to treat bipolar disorder include:
- Aripiprazole (Abilify)
- Asenapine (Saphris)
- Cariprazine (Vraylar)
- Clozapine (Clozaril)
- Lumateperone (Caplyta)
- Lurasidone (Latuda)
- Milsaperidone (Bysanti)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
Side Effects of Antipsychotic Drugs
Certain antipsychotic drugs cause significant weight gain and high cholesterol levels, and they may increase the risk of diabetes. People considering an antipsychotic for bipolar disorder should be screened for their risk of heart disease, stroke, and diabetes.
Common side effects of antipsychotic medications include:
- Blurred vision
- Dry mouth
- Drowsiness
- Muscle spasms or tremors
- Weight gain
Clozapine isn’t 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, ziprasidone 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’re less established for treating depressive symptoms or preventing episodes during long-term use. But they may be helpful if a you have side effects or don’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.
