Bipolar Disorder Medication: Key Evidence-Based Strategies and Side Effects Explained

This content has been updated from the previous article published on August 28, 2025.

Globally, about 37 million people are affected by bipolar disorder ( World Health Organization, 2025 ). Living well with bipolar disorder goes beyond just addressing symptoms as they arise. Types of bipolar disorder can look different from person to person, making individualized care especially important. One of the most effective tools in preventing relapse and maintaining emotional stability is the consistent and appropriate use of prescribed evidence-based medications.

This article explores current guidance on bipolar disorder medication, highlighting differences in treatments for mania versus depression, the role of maintenance therapy and what to consider about side effects.

Matching Bipolar Disorder Medications to Different Phases

Bipolar disorder often requires targeted treatment depending on whether an individual is experiencing mania or depression. 

Manic episodes may involve abnormally elevated or irritable mood, distractibility, racing thoughts or flights of ideas, increased drive and energy, increased or rapid speech, inflated self‑esteem or grandiosity, and excessive involvement in activities with a high potential for painful consequences accompanied by decreased need for sleep.

Depressive episodes typically include fatigue, low mood, and difficulty concentrating.

Using the right medication for a person’s specific symptoms is essential for safe, effective care.

FDA-Approved Treatments for Bipolar Mania:

  • Mood Stabilizers:

    • Lithium

    • Divalproex

    • Carbamazepine

  • Second-Generation Antipsychotics:

    • Risperidone

    • Olanzapine

    • Ziprasidone

    • Aripiprazole

    • Quetiapine

    • Asenapine

Medications for Bipolar Depression:

  • Lamotrigine

  • Cariprazine

  • Lurasidone

  • Lumateperone

  • Olanzapine + Fluoxetine (combination therapy)

Notably, quetiapine and olanzapine have efficacy in treating both manic and depressive symptoms.

Bipolar Disorder Medications for Maintenance

After stabilizing acute symptoms, maintenance therapy is important to prevent future episodes. Evidence-supported options include:

  • Lithium

  • Lamotrigine

  • Quetiapine

  • Olanzapine

  • Ziprasidone

  • Aripiprazole

  • Long-acting injectable risperidone: shown to help prevent relapse in some cases

Bipolar Disorder Medication Side Effects

Medications for bipolar disorder can cause side effects, which vary by class and individual. Discussing potential side effects with your provider can help you make informed choices and monitor your health. Some common side effects include:

  • Mood Stabilizers (e.g., lithium, divalproex, carbamazepine):

    • Tremor

    • Increased thirst and urination

    • Weight gain

    • Gastrointestinal upset

    • Thyroid or kidney effects

  • Second-Generation Antipsychotics (e.g., quetiapine, olanzapine, risperidone, aripiprazole, ziprasidone, lurasidone, asenapine):

    • Weight gain

    • Changes in cholesterol or blood sugar

    • Drowsiness or sedation

    • Muscle stiffness or movement side effects

    • Restlessness

  • Other Agents (e.g., lamotrigine, cariprazine, lumateperone):

    • Rash

    • Headache

    • Insomnia

    • Nausea

    • Dizziness

It’s important to weigh the benefits and risks of each medication for your specific situation. Only licensed providers can prescribe and monitor medications. Always consult your clinician if you have questions or notice any side effects.

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Do You Need More Than One Bipolar Disorder Medication?

Many people with bipolar disorder are prescribed more than one medication: a practice called polypharmacy. When clinically indicated, this can help treat complex symptom profiles, but every medication should target a specific need (mania, depression, or relapse prevention) to minimize unnecessary side effects and maximize benefit.

What Should People With Bipolar II Consider?

For individuals diagnosed with Bipolar II Disorder , depressive episodes and hypomania are more common than full mania. Quetiapine and lumateperone have shown effectiveness in symptom management ( Goldberg, 2023 ).

Key Takeaways for Bipolar Medication Management

Optimizing bipolar disorder medications is never one-size-fits-all. Understanding which medications are appropriate for each phase (mania or depression), partnering with a licensed clinician, and regularly reassessing your treatment plan can help promote long-term stability and well-being.

If you or someone you care about is living with bipolar disorder, seeking expert help and developing a personalized medication strategy can be an important step. Talk to a licensed psychiatric provider at LifeStance for support.

References

  1. Goldberg, J. F. (2023, February). In the red: Optimizing treatment for bipolar I disorder [Conference presentation slides]. NEI Saturday Morning Live. https://cdn.neiglobal.com/content/sml/2023/pdf/01-2023SML_Feb_BP1_Goldberg-EGB_Slides.pdf

  2. World Health Organization. (2025, September 8). Bipolar disorder. https://www.who.int/news-room/fact-sheets/detail/bipolar-disorder

Latest News From LifeStance Health

Key Takeaways Key Takeaways

  • Different medications are more effective for bipolar mania versus bipolar depression.

  • Seven medications are FDA-approved for long-term maintenance to prevent bipolar episodes.

  • Adherence to prescriptions and prescriber instructions is crucial for relapse prevention.

  • Polypharmacy is common, but it must be evidence-based and symptom-targeted.

Authored By 

Michelle Kotte

Reviewed By

Emily Econie, MS, PMHNP
Emily Econie is a Psychiatric Mental Health Nurse Practitioner in California who has been practicing since 2021. She has a Bachelor of Arts in Psychology and Master of Science in Homeland Security from San Diego State University and a Bachelor of Science in Nursing and Master of Science in Nursing/Nurse Practitioner from Azusa Pacific University. Emily has a diverse background working in a variety of environments including San Diego’s busiest Emergency Departments as well as the acute inpatient psychiatric setting. Most people are surprised to hear that nursing is not her first career. After working in law enforcement for several years, and frequently utilizing her skills as an Emergency Medical Technician, Emily was motivated to pursue a profession that focused on healthcare. Emily is most interested in helping people of all ages gain a better understanding of how the interaction between mind, body, and lifestyle choices, in conjunction with conventional treatment, can optimize individual functioning. It is important to Emily to practice what she preaches. So, her daily routine consists of waking up early, exercising and walking her dogs before work. In terms of hobbies, she loves riding horses and learning horsemanship. She also started learning to play the banjo about a year ago and enjoys learning new songs.

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