Antipsychotic medications can help a person with bipolar disorder stabilize their moods, reduce agitation, and improve overall quality of life. Types and dosage depend on your specific symptoms, while consistency and follow-ups can ensure optimal outcomes.
As a psychiatrist, I have two options for treating my patients: mood stabilizers, which are usually anticonvulsants, and antipsychotics.
Antipsychotics are a key treatment in managing bipolar I and II disorders. The use of antipsychotics can help regulate chemicals that influence our mood and behavior. They work by blocking dopamine receptors and modulating serotonin pathways. They play a role in managing acute manic and psychotic episodes. In particular, the atypical (second-generation) antipsychotics help treat depressive symptoms.
People living with bipolar disorder can work with their licensed psychiatric prescribers to create a comprehensive treatment plan that will reduce the frequency of mood changes, which can disrupt their daily lives.
Antipsychotics can be divided into two broad categories: typical (first generation) and atypical (second generation).
Typical antipsychotics are known to target and block dopamine receptors in the brain with the goal of reducing psychotic symptoms. A likely adverse effect of typical antipsychotics is involuntary body movements. Common typical antipsychotics are haloperidol, fluphenazine, and perphenazine.
Atypical antipsychotics play a role in serotonin modulation as well as targeting and blocking dopamine. Commonly prescribed atypical antipsychotics are aripiprazole, risperidone, quetiapine, and olanzapine. People better tolerate these types of antipsychotics for long-term use compared with typical antipsychotics. However, they may cause side effects, such as tardive dyskinesia (a movement disorder), akathisia (restlessness), and weight gain.
There is no single best antipsychotic medication for bipolar disorder, as there is no one-size-fits-all solution for everyone with this condition. The best choice depends on the type of bipolar episode (manic, depressive, or mixed), coexisting conditions, and how the individual responds to the medication.
There are medications doctors use to treat all types of episodes or treat just bipolar depression. If a person prefers a long-acting medication, they can have a monthly injection that can help with compliance. It’s important to work closely with a psychiatrist or licensed psychiatric prescriber to find the best medication for you.
The people who will benefit from atypical antipsychotics are those who experience severe manic or depressive episodes, mixed states (manic and depressive symptoms combined), or psychotic symptoms. Antipsychotics can be added to mood stabilizers such as valproic acid, lithium, and lamotrigine to treat those who have a partial response to their current treatment or need to quickly manage their bipolar symptoms.
It’s very important to have a thorough evaluation by a mental health professional to make sure you have the proper diagnosis and receive a prescription that will be most appropriate for you.
Most antipsychotics come in oral form, either as pills or liquids. Some antipsychotics are also oral disintegrating tablets that melt in your mouth, or you place them under the tongue for better absorption.
Doctors may also prescribe long-acting injectable antipsychotics for those who want less frequent dosing or find medication adherence challenging. Each medication has a standard initial starting dose. You will get a lower or higher dose based on how you metabolize medications. A doctor can also adjust the dosage based on symptom responses. For treatments to be effective, you must follow the regimen consistently.
The calming effects of antipsychotics, such as reduced agitation or anxiety, can occur within hours or days. Full mood stabilization may take several weeks of consistent adherence.
It’s very important to schedule routine follow-ups with your doctor to monitor your progress and be aware of adverse reactions. The process of finding the right dose may take some time, so it’s important for your doctor to set proper expectations with you. That way, you are less likely to quit within a few hours, days, or weeks of starting the medication.
The potential side effects of antipsychotic medications can be typical, metabolic, or even neurological. You may experience dry mouth, sedation, extreme drowsiness, or dizziness while taking an antipsychotic. The common metabolic side effects that a doctor must monitor are weight gain, increased blood sugar, and changes in cholesterol levels.
Potential neurological side effects include tremors, restlessness, and/or tardive dyskinesia. Not everyone taking these medications will encounter side effects. However, if you do have side effects, your doctor can help you manage them through regular monitoring and routine follow-up appointments.
Stopping antipsychotics should always involve the medical supervision of your psychiatrist, nurse practitioner, or physician assistant. Abruptly discontinuing your antipsychotics can risk withdrawal symptoms or relapse.
To safely stop an antipsychotic, your doctor can create a tapering plan to help you gradually reduce the dose of the medication and/or slowly switch to a different medication. This approach will be well-monitored, and it’s important for you to communicate with your doctor about your progress.
An antipsychotic medication is effective if you find your mood more stable, if incidents of agitation have reduced, and if there are improvements in your personal and occupational functioning. It’s very important for you and your doctor to regularly communicate about your symptoms since starting the medication. This will allow your doctor to track your progress and evaluate the medication’s effectiveness.
If the medication is not working, your doctor can adjust the dose, switch medications, or add another treatment to the plan. Finding the right treatment is a process that may take many trials. Don’t see yourself as a guinea pig — your doctor is trying to find the best treatment that helps reduce symptoms, limits the number of side effects, and allows you to have a better quality of life.
Dr. Ifeanyi Olele is a board certified psychiatrist and Fellow of the American Psychiatric Association, serving the Washington D.C. Metro area. He leads a private clinical practice and specializes in transcranial magnetic stimulation for treatment-resistant depression and OCD. Dr. Olele is passionate about advocating for mental health, mentoring, and supporting underserved communities.