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Let's Talk About Bipolar Disorder Medication

Learning that you have bipolar might feel frightening, but a diagnosis means you can now find some symptom relief—and be on your way to living better.

    Our Pro PanelBipolar Disorder Medication

    We went to some of the nation's top experts in bipolar disorder to bring you the most up-to-date information possible: 

    Po Wang, M.D. headshot

    Po Wang, M.D.Psychiatrist and Clinic Chief

    Bipolar Disorders Clinic at Stanford University Department of Psychiatry
    Linda Hubbard, L.M.F.T. headshot

    Linda Hubbard, L.M.F.T.Therapist

    Department of Behavioral Health, Psychiatry & Psychology at the Mayo Clinic
    Adam Rosenblatt, M.D.

    Adam Rosenblatt, M.D.Clinical Director of the Behavioral Health Unit and Geriatric Psychiatry

    University of Maryland Upper Chesapeake Health System

    Frequently Asked QuestionsBipolar Disorder Medication

    Will an antidepressant help when in the throes of a bipolar depressive episode?

    Studies have shown that, for reasons experts can’t fully explain, antidepressants are not very effective in treating bipolar depression. In fact, they can make things worse. Antidepressants taken alone (without a mood stabilizer) can sometimes trigger a manic episode. Experts also think that using antidepressants can increase the frequency of manic and depressive episodes over the long term.

    Are any bipolar medications safe for pregnant women?

    Not really. Lithium, Depakote, and Tegretol, three of the most common mood stabilizers prescribed for bipolar, must be discontinued during the first trimester to avoid the risk of birth defects, though they may be able to be used again later in the pregnancy. Electroconvulsive therapy (ECT) is usually the best treatment during pregnancy. Women thinking about getting pregnant should work closely with a psychiatrist and obstetrician to go over the various alternatives.

    Why does a doctor prescribe one drug over another?

    There’s no hard and fast rule. It bears repeating: Every single person with bipolar will react differently to the drugs prescribed, the combination of those drugs, and at what dosages they’re taken. Working closely with your doctor to experiment with a medication scheme that works for you is crucial. Another thing you and your doctor will want to take into consideration: Your insurance company may cover the cost of some drugs more fully than for others—copays can have as much to do with the prices set by pharmaceutical companies as they do with the effectiveness of the drugs themselves. Your doctor will bring into play her previous experience with the drugs: Did it work well with other patients? Did it have side effects? She can work with you to find what’s best physiologically and financially.

    If lithium is so effective for lessening the severity and frequency of mania and hypomania, why don’t doctors always try it first?

    Lithium can be difficult to use. It has what experts call a “narrow therapeutic window,” which means there’s a small difference between a dose that works and a dose that’s toxic, so it requires frequent blood tests. At toxic levels, it can damage your kidneys or your thyroid system, so people who already have conditions affecting those organs should not go on lithium. However, for most otherwise healthy people, it’s often worth trying lithium so long as you can maintain careful monitoring. If that’s not possible for you (because of schedule or cost or simple preference), your doctor will likely lead with other mood stabilizers.

    Leslie Pepper

    Leslie Pepper

    Leslie Pepper is a freelance writer specializing in health, nutrition, fitness, and wellness.