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

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

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.

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 ).

Take Our Quick & Easy Bipolar Questionnaire

Bipolar disorder can cause intense shifts in mood, energy, and activity levels — but you’re not alone. Take this assessment to identify symptoms commonly associated with bipolar disorder and understand if you may be suffering from a bipolar disorder.

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Questionnaire Disclaimer

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Important: Questionnaires like this are best completed in the presence of a qualified clinician who can appropriately interpret the scoring and results in the context of your overall health and history. Self-scoring may lead to misinterpretation and should not be used as the sole basis for any health decisions. This health survey is provided for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider regarding any personal health concerns. Completion of this survey does not establish a patient-clinician relationship. Responses are NOT monitored. If you are thinking of harming yourself or others please call toll-free 9-8-8 for the National Suicide & Crisis Lifeline (available 24/7), 9-1-1 or go to your nearest emergency room. By proceeding, you acknowledge this disclaimer and agree that this tool is for general awareness only. You assume all risks associated with its use. The survey administrators are not liable for reliance on its content.

This questionnaire is based on the Mood Disorder Questionnaire (MDQ), developed by Robert M. A. Hirschfeld, M.D., et al., in collaboration with the Depression and Bipolar Support Alliance (DBSA) and the University of Florida. Hirschfeld, R. M. A., Williams, J. B. W., Spitzer, R. L., et al. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. American Journal of Psychiatry, 157, 1873-1875. The MDQ is made available for clinical, educational, and informational use. © Robert M. A. Hirschfeld, M.D., et al.

For each of the following, answer “Yes” or “No.”

"*" indicates required fields

Step 1 of 16

6%

Part 1: Symptom Checklist

Question 1*

You felt so good or hyper that other people thought you were not your normal self, or you were so hyper that you got into trouble?

Yes	No

Question 2*

You were so irritable that you shouted at people or started fights or arguments?

Yes	No

Question 3*

You felt much more self-confident than usual?

Yes	No

Question 4*

You got much less sleep than usual and found you didn’t really miss it?

Yes	No

Question 5*

You were much more talkative or spoke much faster than usual?

Yes	No

Question 6*

Thoughts raced through your head or you couldn’t slow your mind down?

Yes	No

Question 7*

You were so easily distracted by things around you that you had trouble concentrating or staying on track?

Yes	No

Question 8*

You had much more energy than usual?

Yes	No

Question 9*

You were much more active or did many more things than usual?

Yes	No

Question 10*

You were much more social or outgoing than usual (e.g., telephoning friends in the middle of the night)?

Yes	No

Question 11*

You were more interested in sex than usual?

Yes	No

Question 12*

You did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?

Yes	No

Question 13*

Spending money got you or your family in trouble?

Yes	No

Part 2: Symptom Co-occurrence

Question 14*

If you checked “Yes” to more than one of the previous questions, have several of these ever happened during the same period of time?

Yes	No

Part 3: Functional Impact

Question 15*

How much of a problem did any of these cause you — like being unable to work, having family, money, or legal troubles, or getting into arguments or fights?

No problem	Minor problem	Moderate problem	Serious problem

Your Zip Code*

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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.