Medication for bipolar

The National Institute for Health and Care Excellence (NICE) uses evidence to guide the NHS on effective and safe care.

NICE recommends a tailored approach to medication for bipolar. This means working closely with your doctors to find the right combination of medications and doses that work for you.

Bipolar medication is not a ‘one size fits all’ solution. Changes in medication types and doses may be needed at different times, for example:

if you’re experiencing a bipolar episode
if you’re taken into hospital
if you’re planning a pregnancy
if you start to experience new or more severe side effects

Types of medication for bipolar

Many different medications are used to treat bipolar. The medication you take will depend on your symptoms, how severe they are, and the phase of the illness you are in.

Some medications are taken every day, while others are used only to manage certain symptoms at certain times.

For example, if you have trouble sleeping, your doctor may prescribe medication for a short time. This is sometimes known as ‘PRN’ medication (taken from the Latin ‘pro re nata', meaning ‘in the circumstances)

Mood stabilisers for bipolar

These medications work in various ways to stabilise your mood, helping to lift depression or calm you down if your mood is high. Examples include:

Carbamazepine
Lamotrigine
Lithium
Valproate (including sodium valproate, valproic acid, and semi-sodium valproate)

Mood stabilisers for bipolar
Antipsychotics for bipolar
Antidepressants for bipolar
Anti-anxiety tablets for bipolar
Night sedation for bipolar
Lithium for bipolar

Types of antipsychotics

Antipsychotic tablets

Most antipsychotics for bipolar are taken orally, by mouth – either swallowed as a pill or sometimes as a liquid.

Examples of antipsychotics taken orally include:

Aripiprazole
Olanzapine
Quetiapine
Risperidone

Antipsychotic injections

Some antipsychotic medications for bipolar are prescribed as a long-acting injection (known as a depot injection). They are usually recommended for people who find it difficult to take tablets regularly.

Sometimes, antipsychotics are given as injections in hospital as a short-term treatment for extreme anxiety.

Examples of antipsychotic injections include:

Aripiprazole
Haloperidol
Olanzapine
Paliperidone
Risperidone

Antidepressants for bipolar

Antidepressants can be prescribed to manage depressive episodes. But because they can sometimes trigger manic or hypomanic episodes in people with bipolar, it's crucial to work closely with your doctor to find the right medication and dose for your specific needs.

Regular monitoring and follow-up appointments are essential to ensure the medication is working effectively and to manage any side-effects.

Your doctor may also recommend combining antidepressants with mood stabilisers, or antipsychotic medications to help prevent mood swings and maintain stability.

Examples of antidepressants include:

Citalopram
Duloxetine
Escitalopram
Fluoxetine
Mirtazapine
Sertraline
Trazodone
Venlafaxine
Vortioxetine

Anti-anxiety tablets for bipolar

Anxiety is common in bipolar disorder, including generalised anxiety, panic attacks and social anxiety. These symptoms often happen before, during or after a mood episode.

Examples of anti-anxiety medication include:

Buspirone
Clonazepam
Diazepam
Lorazepam
Oxazepam
Pregabalin
Propranolol

Night sedation for bipolar

People with bipolar may experience sleep difficulties (insomnia) from time to time. Maintaining regular sleep patterns and avoiding stimulants like coffee in the afternoon and evening can help.

If sleep problems go on for more than a few days, talk to your doctor about the short-term use of sleeping tablets, also known as night sedation.

Examples of night sedatives include:

Melatonin
Promethazine
Temazepam
Zolpidem
Zopiclone

New guidelines around valproate for bipolar

Valproate is used to treat bipolar, other mental health conditions, and epilepsy. However, it carries a risk of birth defects and developmental disorders if taken during pregnancy.

The updated NICE guidelines say that sodium valproate should not be prescribed to anyone who could become pregnant unless no other suitable treatment is available and strict pregnancy prevention measures are in place.

Get your medication questions answered

NICE recommends yearly health checks for people who are taking bipolar medication to monitor their overall physical health.
Depending on your medication combination and doses, you may have tests for blood pressure, weight, kidney, liver, heart and thyroid function, blood sugar and cholesterol levels.
Typically, a psychiatrist will prescribe your first combination and dose of bipolar medication, often in hospital or after a GP referral.
They will also monitor any side effects you may have and make adjustments as needed.
Once you find the right combination of medications and your condition is stable, repeat prescriptions will normally be managed by your GP.
Unfortunately, people with bipolar are not entitled to free prescriptions unless there is another reason – you're older than 60 or getting certain benefits, for example.
If you pay for your prescriptions and need lots of prescriptions regularly, getting a pre-payment certificate (PPC) mean you can pay a fixed amount for either three months or a year.
This can be much cheaper than paying for individual prescriptions.
You can apply for a PPC on the NHS website here
Medication shortages can be stressful. If your usual medication isn’t available, speak to your GP or pharmacist. For example, during shortages, alternative medications may be suggested.
It’s important not to stop taking medication without advice from your psychiatrist or GP.
Most people with bipolar need medication to manage their symptoms effectively.
When the medication is working you may think you don’t need it any more. However, stopping medication can lead to symptoms coming back and you becoming unwell.
Always talk to your psychiatrist or GP before making changes to your treatment plan.
When you’re talking about medications with your doctor, don’t be afraid to ask questions about your specific prescription.
For example, you could ask:
- Are there any contraindications (reasons why the medication shouldn’t be prescribed)?
- What’s the best time of day to take it?
- Should I take it with food or on an empty stomach?
- What potential side-effects does it have?
- What side-effects should I let you know about?
- What will happen if I miss a dose and what should I do?
- Can I drive while I’m taking this medication?
- Is it safe for me to take this medication during pregnancy?
- Can I drink alcohol/smoke/vape on this medication?
- Are there any other medications I can’t take if I’m on this one?
- What tests will I need and how often?

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Bipolar UK’s group psychoeducation programme aims to help people living with bipolar to understand the condition better, and to empower you with tools and coping strategies to improve your quality of life.