To manage mood disorders like bipolar 1 disorder, doctors may prescribe a variety of medications. Some work to control your symptoms, called acute therapy. Other medications fall into the category of maintenance therapy and help to delay or prevent mood episodes. In most cases, bipolar 1 disorder requires ongoing, long-term care.

In this article, we’ll discuss six treatments for bipolar 1 disorder, how they work, and what side effects you may experience. Keep in mind though, there are several other treatments that are not listed here. The best treatment plan depends on how well a medication works, its potential side effects, and how it fits with any other medications you may be taking.

Be sure to reach out to your healthcare provider or a mental health professional with any questions or concerns about your treatment plan.

What Is Bipolar 1 Disorder?

Bipolar 1 disorder is a mental health condition marked by shifts between episodes of mania and depression. During a manic episode, you may feel unusually excited, irritable, or full of energy. These episodes last at least seven days. In some cases, manic episodes are intense enough that you need hospitalization.

Episodes of depression can also occur, and they typically last for at least two weeks. You may be in a depressive episode if you’re experiencing feelings of sadness or anxiety or you lose interest in activities you normally enjoy.

Having four or more episodes of mania or depression within one year is known as rapid cycling. Some people with bipolar 1 disorder also have depressive episodes with mixed features. This means they have both manic and depressive symptoms at the same time.

Once you’re diagnosed with bipolar 1 disorder, your doctor will work to find the best treatment plan for your needs. They’ll use one or more medications to manage your manic and depressive symptoms. Your treatment plan will also likely include:

• Psychotherapy (talk therapy), like cognitive behavioral therapy (CBT)
• Family-focused therapy, which helps loved ones understand bipolar 1 disorder and how to support you

Below, we explain six types of medications commonly used to treat bipolar 1 disorder and how they work.

1. Lithium

Lithium is a naturally occurring element and one of the most effective treatments for bipolar 1 disorder. In fact, it’s used as a first-line treatment based on how effective it’s been shown to be in studies. Lithium is used as a maintenance treatment to prevent mood episode relapses and has been shown to prevent suicide attempts.

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988.

If you take lithium, you’ll need regular blood tests to check your kidney and thyroid function, since high levels of lithium in the body can be harmful.

Many people experience little to no side effects from lithium therapy. Some side effects may show up when you start treatment but often fade over time.

Examples of lithium side effects include:

• Fatigue
• Unwanted weight gain
• Stomach cramps and nausea
• Thirst
• Headache
• Tremor (uncontrollable shaking)

MyDepressionTeam members have shared their experiences taking lithium. One asked, “Has anyone had side effects on lithium? I’m so tired, just sleeping the whole day, and my mouth is constantly dry.”

Another member replied, “I’ve been on lithium before and didn’t get any side effects. Just hang in and the side effects should go away.”

2. Anticonvulsants

Carbamazepine (Carbatrol, Tegretol) and valproic acid (Depakene, Depakote) help treat manic episodes in bipolar 1. These medications are mood stabilizers and anticonvulsants used to treat seizures. (Anticonvulsants are sometimes referred to by the broader term “anti-seizure medications.”) They work by calming overactive signaling in the brain.

The National Alliance on Mental Illness (NAMI) notes that anticonvulsants may be better for treating rapid cycling in bipolar 1 disorder.

Common side effects of anticonvulsant therapy include:

• Muscle aches or weakness
• Dizziness
• Diarrhea or constipation
• Fatigue
• Nausea or loss of appetite
• Skin rashes
• Weight gain

Lamotrigine

Lamotrigine (Lamictal) is a mood stabilizer and anticonvulsant medication used for seizures and bipolar disorder. According to NAMI, lamotrigine delays the time between mood episodes in people with bipolar 1 disorder. This means that you may go longer without experiencing a manic or depressive episode.

Lamotrigine is approved by the U.S. Food and Drug Administration (FDA) to treat bipolar 1 disorder and delays the time to occurrence of mood episodes, but it does not work well for acute episodes. Your doctor might prescribe lamotrigine alone or with other medications for long-term symptom control.

Side effects of lamotrigine can include:

• Nausea
• Mild skin rashes
• Headache
• Tiredness or drowsiness
• Dizziness

A rare but serious reaction called Stevens-Johnson syndrome has occurred in some people taking lamotrigine. This condition can be life-threatening. Call your doctor right away if you notice any of the following:

• Skin rash
• Blistering or peeling skin
• Hives
• Shortness of breath
• Sores around the mouth or eyes.

One MyDepressionTeam member shared their experience taking lamotrigine: “Added lamotrigine about a month ago. It seems to have helped some with my depression. Now, I’m having constant nausea and stomach pains. It’s probably a side effect of the lamotrigine.”

3. Antipsychotics

Antipsychotic medications are often used to treat mania and depression in bipolar 1 disorder. Doctors also use antipsychotics as maintenance treatment. Maintenance treatment is important for preventing or delaying mood episodes in bipolar 1 disorder.

The brain uses specialized chemical messengers — known as neurotransmitters — to send signals. People with bipolar 1 disorder have chemical imbalances that lead to mood episodes consisting of anxiety, agitation, or depression. Antipsychotic medications work by blocking receptors for the neurotransmitters serotonin and dopamine.

FDA-approved antipsychotics for treating mood disorders include:

• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Cariprazine (Vraylar)
• Lumateperone (Caplyta)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel XR)
• Risperidone (Risperdal)
• Ziprasidone (Geodon)

Common side effects of antipsychotics may include:

• Dry mouth
• Tremors or unusual body movements
• Increased appetite and weight gain
• Drowsiness or sluggishness
• Blurry vision
• Increased risk of high cholesterol or diabetes

Some antipsychotics are also called atypical antipsychotics, and they may be grouped with medications like lithium and anticonvulsants under the general term “mood stabilizers.” As the name suggests, mood stabilizers help stabilize (regulate) symptoms of mood episodes.

These medications can’t cure your mood swings, but they can offer significant relief from manic and depressive symptoms. Most people find these medications help to treat:

• Sleep problems
• Feelings of agitation
• Severe psychosis symptoms like hallucinations and delusions

These medications often take several weeks to start working. In some cases, your doctor may recommend combining an antipsychotic with another mood stabilizer for better symptom control.

4. Antidepressants

Antidepressants are medications used to treat different forms of depression. Doctors sometimes prescribe them along with a mood stabilizer or antipsychotic for bipolar disorder. However, studies suggest that antidepressants don’t offer extra benefits for treating bipolar 1 disorder compared to other treatments.

Examples of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta)
• Atypical antidepressants, such as bupropion (Wellbutrin SR and XL)

Mental health experts note that people with bipolar 1 disorder shouldn’t take an antidepressant on its own. Although antidepressants can be useful in treating depressive episodes, they actually make your risk of experiencing manic episodes higher. Still, there are some situations where certain antidepressants may be cautiously considered for use in bipolar depression, but always in combination with a mood stabilizer. Your doctor can help you weigh the risks and benefits of prescribing an antidepressant with your other bipolar 1 disorder treatments.

People with bipolar 1 disorder shouldn't take an antidepressant on its own — it can trigger mania in some people.

5. Combination Antipsychotic Medications

The FDA has approved two medications that combine an antipsychotic medication with a different class of medication.

Olanzapine and Samidorphan

Olanzapine and samidorphan (Lybalvi) treat bipolar 1 disorder in two ways:

• On its own as a short-term or maintenance therapy for manic or mixed episodes
• Together with lithium or valproate for manic or mixed episodes

In clinical studies, potential side effects of olanzapine and samidorphan included:

• Low blood pressure and fainting
• Changes in metabolism
• Constipation
• Difficulty controlling body temperature
• Low white blood cell count
• Tardive dyskinesia (uncontrollable body movements)

Olanzapine and Fluoxetine

Olanzapine and fluoxetine (Symbyax) is a combination for treating depressive episodes in people with bipolar 1 disorder. Studies show that this medication treats depression with bipolar disorder better than olanzapine or lamotrigine alone.

In clinical trials, researchers found that olanzapine and fluoxetine can cause:

• Dry mouth
• Increased appetite and weight gain
• Fatigue
• Drowsiness or sleepiness
• Increased risk of high cholesterol or diabetes.

6. Benzodiazepines

Benzodiazepines treat mania associated with bipolar 1 disorder. They work by calming the brain and nervous system, creating a sedative effect. Your doctor may prescribe a benzodiazepine to control manic symptoms when you first start treatment. This gives your other medications — like lithium — time to start working. Remember, it generally takes five to seven days for lithium to become effective.

Your doctor may prescribe a benzodiazepine to help control manic symptoms while waiting for other medications to start working.

Lorazepam (Ativan) is a benzodiazepine that’s given by mouth or as a shot into the muscle. Side effects you may experience include:

• Agitation
• Nausea
• Sedation (sleepiness)
• Depression
• Memory problems

Read more about specific medications in this list of treatments for bipolar, depression, and other mental health conditions.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and related conditions and their loved ones. On MyDepressionTeam, more than 150,000 members come together to ask questions, give advice, and share their stories with others who understand life with depression and bipolar disorder.

What treatments do you currently take or have you previously taken for bipolar 1 disorder? What side effects did you experience? Share your story in the comments below, or start a conversation by posting on your Activities page.