Medications for Bipolar Depression

Medication for the treatment of unipolar depression is often more successful than medication for bipolar depression because researchers know more about the depressed brain than the bipolar brain. Antidepressants that are clearly established as effective treatments for depression, often do not successfully treat bipolar depression, and in many instances can make it worse. The biggest concern is that antidepressants can cause mania, hypomania or induce rapid cycling.

Categories of Meds for Bipolar Depression

There are four main medication categories used to treat bipolar depression. Bipolar depression almost always requires more medication than unipolar depression in order to keep all of the symptoms under control without igniting mania.

Mood Stabilizers Like Lithium for Bipolar Depression

There are many mood stabilizers used in the treatment of bipolar depression. Some of the common mood stabilizers include:

• Lithium
• Valproate (Depakote)
• Carbamazepine (Tegretol)
• Lamotrigine (Lamictal)
• Oxcarbazepine (Trileptal)

In reality, only Lithium is a true mood stabilizer. The other medications are anticonvulsants that were created for epilepsy and were found to work on mood disorders. Valproate (Depakote), carbamazepine (Tegretol), and oxcarbazepine (Trileptal) work for mania, but only lamotrigine (Lamictal) and lithium has been shown to manage depression.¹

Learn more about Mood Stabilizers for Bipolar Disorder.

Antipsychotic Medication for Bipolar Depression

Antipsychotics were initially developed to handle the psychotic symptoms that accompany schizophrenia, but now have been found to work for a number of conditions. Taking an antipsychotic does not indicate the person is suffering from psychosis, but antipsychotic medications can be used to manage the psychosis that can come with depression, mania and mixed episodes.

Older generation antipsychotics like chlorpromazine (Thorazine) and haloperidol (Haldol) have fallen out of use in favor of the newer atypical antipsychotics. Atypical antipsychotics are thought to have fewer movement disorder side effects but may have additional risks in other areas. Atypical antipsychotics used in treatment include:

• Lurasidone HCI (Latuda)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Aripiprazole (Abilify)
• Ziprasidone (Geodon)
• Olanzapine-fluoxetine combination (Symbax)

Of these drugs, olanzapine, quetiapine, aripiprazole and olanzapine-fluoxetine have been found to be particularly useful in treating bipolar depression.

Learn more about Antipsychotic Medications for Bipolar Disorder.

Antidepressants for Bipolar Depression

The most familiar class of depression medications is antidepressants. While antidepressants are sometimes used as medications for bipolar depression, there is always the risk that an antidepressant will trigger mania / hypomania or create rapid cycling between bipolar highs and lows. Some doctors believe antidepressants may worsen long-term outcomes of bipolar disorder as well ² ("Are Antidepressants Safe and Effective in Bipolar Depression Treatment?").

If antidepressants are used to treat bipolar depression, they are combined with the use of a mood stabilizer or atypical antipsychotic medication to prevent the appearance of bipolar mania.

Tranquilizers

These are used to manage the anxiety that is very common with bipolar depression. They are also used as a sleep aid. Typical benzodiazepines and non-benzodiazepines used as medications for bipolar depression include:

• Lorazepam (Ativan)
• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Eszopiclone (Lunesta)
• Zolpidem (Ambien)

The last two medications are typically used as sleep medications. There is a risk of dependence with these drugs, but many use these drugs for anxiety and sleep without issue.

Bipolar Depression Medication Cocktails

Most people with bipolar depression who are successfully treated, often take several drugs simultaneously, sometimes called a medication cocktail. Results from a recent research project called the STEP-BD Project found 89% of those successfully treated for bipolar disorder required, on average, three medications from the above categories.

Bipolar Depression Approved Medications

All four of the above medication categories used to treat mood disorders are either approved by the Food and Drug Administration (FDA) for mood disorder treatment, or they are used in what's called an off-label use. Off-label use is an ethical and legal use of medications that have not specifically been sanctioned for use of a specific condition by the FDA.

FDA Approved Bipolar Depression Medications: At this time, there are three specifically approved medications for bipolar depression treatment:

• Lurasidone HCI (Latuda) - (Approved in 2013)
• Olanzapine-fluoxetine combination (Symbax) – Approved in 2004
• Quetiapine (Seroquel) – Approved in 2007

There are four medications approved for maintenance of bipolar disorder symptoms:

• Lithium – Approved 1974
• Lamotrigine (Lamictal) – Approved 2003
• Aripiprazole (Abilify) – Approved 2005
• Olanzapine (Zyprexa) – Approved 2004

Maintenance medications for bipolar maintain stability in bipolar disorder.

See also: "How Drinking Alcohol Affects Bipolar Depression Medications"

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