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The goal for treating bipolar disorder with medication is to find the right drug or combination of drugs for each symptom area. There are specific drugs for mania, depression, psychosis and anxiety, and there are some drugs that help with all these symptoms. A person may need only one drug, or they may need more than one. They may experience no side effects at all, or they may have to deal with many side effects. It can take a year or more to find the right combination of medications and the right doses that work for you. I tried over a dozen different medications, for example, before finding one that worked, and believe me it was worth the wait.

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You may already know the names of some of the most popular antidepressants such as Prozac (fluoxetine), Zoloft (sertraline), Wellbutrin (bupropion), Effexor (venlafaxine), Pristiq (desvenlafaxine), Celexa (citalopram), Cymbalta (duloxetine), Lexapro (escitalopram), etc. These drugs are extremely effective for depression treatment, but must be used with extreme caution in people with bipolar disorder, as they have a high risk of inducing mania. This simply can’t be stressed enough. Antidepressants can lead to increased rapid cycling and severe mania in people with bipolar disorder, and should never be used alone. They can be used, however, in conjunction with other mood stabilizers under careful doctor supervision with regular medication reviews. I know many people with bipolar disorder who use them successfully in this way. Common antidepressant side effects include agitation, weight loss or weight gain, headache, stomach upset, irritable bowel syndrome, sexual side effects, loss of appetite, leg-shaking, sleepiness, and most importantly, suicidal tendencies. It is essential that you and your health care professional look for signs of suicidal thoughts and behaviors if you start an antidepressant.

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While some of these potential side effects can be very strong, antipsychotics can be life saving medications that give a person the ability to work and function in society. If you have psychosis and/or full blown mania it is essential that you try multiple antipsychotics before giving up. It’s often possible to start with very low doses and then go up as needed. This is called microdosing. Many people eventually find the right anti psychotic with few side effects.

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Antipsychotics are used to treat psychosis, prevent mania and sometimes treat depression. Side effects of the SGAs include rapid weight gain, especially around the stomach, lethargy, restlessness (akathesia), dulled senses, tremors, impaired thinking, slow speech, shuffling the feet, and concentration problems. The main concern with the SGAs Clorazil, Zyprexa and Seroquel is that they can cause metabolic syndrome, a condition that relates to possible diabetes, heart disease and stroke. The antipsychotics with the lowest risk of metabolic syndrome are Abilify and Geodon. Risperdal is in the middle.

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