Finding the right medication for bipolar disorder can take time, but research shows that taking atypical antipsychotics can be very effective.

Managing symptoms of bipolar disorder typically means lifelong treatment. Treatment options can include lifestyle strategies, talk therapy, and learning to recognize signs of a depressive or manic episode.

Medication is one of the most effective methods incorporated into treatment plans for many people. Several medication options can be prescribed to treat bipolar disorder, such as:

  • mood stabilizers
  • antipsychotics
  • atypical antipsychotics

Some of these are approved by the Food and Drug Administration (FDA) to specifically treat bipolar disorder. Others have been FDA-approved for other mental health conditions that doctors can prescribe “off label” to treat bipolar disorder.

A doctor or mental health professional may recommend different medications depending on how you experience bipolar symptoms.

For example, you might take an atypical antipsychotic during a manic or depressive episode and a mood stabilizer during the time between episodes.

Atypical antipsychotics are a group of medications used to treat bipolar disorder. They are sometimes also called novel antipsychotic medications or second-generation antipsychotics.

They’re different from “typical” or “first-generation” antipsychotics because they cause fewer side effects, such as:

  • tremor
  • limb stiffness
  • restlessness
  • different facial movements

How they work

In addition to blocking dopamine signaling like the older first-generation antipsychotics, second-generation antipsychotics can also affect your serotonin levels.

Some 2020 research also shows that atypical antipsychotics may be less effective at raising prolactin levels than typical antipsychotics.

Elevated prolactin is a side effect and can be uncomfortable and could lead to issues with your physical health over time.

Atypical antipsychotics work to treat bipolar disorder by rebalancing imbalances in your brain’s neurocircuitry. In this case, a neurotransmitter like dopamine can become overactive, causing some people to experience:

  • thought disorder
  • hallucinations
  • delusions

These medications can help block dopamine receptors and reduce the severity of the symptoms.

Taking atypical antipsychotics

These medications are most often taken by tablet or pill. In an emergency, doctors can also give atypical antipsychotics by injection, usually through a long-acting injection every 2 or 4 weeks.

Mood stabilizers work to prevent episodes of mania and depression by reducing the chances of experiencing an episode and the severity of those episodes. This type of mood-stabilizing therapy is typically lifelong.

Still, a doctor or psychiatrist may sometimes prescribe antipsychotics during an acute manic episode or when treatment for bipolar is just starting.

A few examples of mood stabilizers include:

Although lithium is sometimes called the “gold standard” of bipolar treatment, it can take several weeks to have a full effect.

A treatment plan for bipolar disorder might include mood stabilizers and atypical antipsychotics in addition to therapy and self-care or lifestyle changes.

In the past, doctors and psychiatrists usually only prescribed antipsychotics for acute episodes and mood stabilizers for the “maintenance phase,” or the time between episodes.

Some 2013 research shows some people with bipolar disorder may benefit from atypical antipsychotics during the maintenance phase. Still, some evidence suggests that atypical antipsychotics may be less effective for preventing bipolar depressive episodes than manic episodes.

Overall, the effectiveness of antipsychotics for bipolar depression depends on the specific medication taken and how it affects your symptoms.

Your experience with bipolar disorder is unique to you. Like all mental health conditions, you may have to try several medications or strategies over time to find the right treatment plan that best supports you.

The FDA has approved several medications for treating bipolar disorder, and each of these medications is also approved for use during specific stages.

For example, one medication can be taken during a manic episode and the maintenance period but may not be recommended during a depressive episode.

Some doctors and mental health professionals may prescribe an FDA-approved drug for “off label” use, meaning that it is being used to treat something different than its initial approved use.

Common atypical antipsychotics approved for bipolar include:

  • aripiprazole (Abilify)
  • cariprazine (Vraylar)
  • lurasidone (Latuda)
  • olanzapine/fluoxetine combination (Symbyax)
  • risperidone (Risperdal)
  • quetiapine (Seroquel)
  • asenapine (Saphris)
  • ziprasidone (Geodon)
  • olanzapine (Zyprexa)

Other medications

A doctor may also recommend other medications for bipolar disorder, besides or in addition to atypical antipsychotics.

Lithium is a mood stabilizer and is considered a first-line treatment for bipolar disorder. It is often prescribed for manic episodes and maintenance therapy.

Other mood stabilizers approved for bipolar disorder fall into the class of anticonvulsant drugs, including:

A 2019 study of 21 participants found improvement in depressive symptoms in people with bipolar depression after using Rexulti, an atypical antipsychotic prescribed to treat schizophrenia. While additional research is needed, the study did offer some promising initial results.

Haloperidol (also known by its brand name, Haldol) is another medication that may treat bipolar disorder. It is a first-generation antipsychotic approved for the treatment of schizophrenia that can sometimes be prescribed off label for acute mania.

Like many medications, atypical antipsychotics for bipolar disorder can all have different side effects.

Talking with your doctor can be an important step if side effects become too difficult to manage or prevent you from continuing your treatment plan. Your doctor may have other available treatment options for you, like adjusting your dosage or prescribing a different medication.

It is possible to find a medication that helps improve your quality of life and manage bipolar disorder symptoms. For many people with this condition, the goal is to find the right balance between effective treatment and manageable side effects.

Some common side effects of second-generation antipsychotics can include:

Serious but less common side effects may include:

  • suicidal thoughts
  • facial tics or involuntary movement
  • heart inflammation or heart attack
  • cataracts

Suicide prevention

Remember that you’re not alone and resources are available to you. If you need to talk with someone right away, you can:

Not in the U.S.? You can find a helpline in your country with Befrienders Worldwide.

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Side effects of mood stabilizers

Mood stabilizers also come with potential side effects. For instance, lithium may cause you to experience:

  • tremors
  • appetite changes
  • dizziness
  • diarrhea
  • vomiting
  • nausea
  • dry mouth
  • thirst
  • increased urination
  • acne-like rash
  • hair loss or thinning hair

Bipolar disorder can be a condition that requires lifelong treatment for many people, and medication can be an important part of an effective treatment plan.

Atypical antipsychotics are often prescribed to help manage symptoms of bipolar disorder, sometimes in tandem with other medications like mood stabilizers.

Working with your doctor or psychiatrist to find the best medication for your treatment plan can take time. You may need to try several strategies or prescriptions before finding the right one for you.

Like many medications, atypical antipsychotics can come with side effects. Finding a balance between effective treatment and manageable side effects is often the goal for many people using medication to treat bipolar disorder. If side effects become troublesome, talking with your doctor can be helpful.

If you are ready to get help for bipolar disorder but don’t know where to begin, you can check out Psych Central’s guide to mental health help.