Medications and Supplements

Antipsychotic Medications for Treatment of Bipolar Disorder

Virginia J. Duffy PhD, NPP

Medication is the mainstay of treatment of Bipolar I disorder (not bipolar II). It is considered essential for treatment of acute symptoms, and often for long-term prevention of reoccurrence. There are two types of medication used to treat the symptoms of bipolar I disorder, antipsychotics and mood stabilizers.

Currently Antipsychotic Medications are becoming more frequently used to treat Bipolar I disorder. For now however, mood stabilizers are still the most commonly used medications. Mood stabilizer medications are more difficult to use, require more monitoring, and the research is less compelling on success.

In this article we will talk about antipsychotic medications for use in bipolar I disorder. You will find more about mood stabilizers elsewhere on this site.

Antipsychotic medications are "dopamine antagonists". This means they act in a way that prevents dopamine from getting into the cells. Dopamine is a neurotransmitter that allows messages to pass between cells in the brain. It is believed (a theory only) that an excess of dopamine in the brain can cause too many simultaneous messages that result in confusion and the symptoms of psychosis. This is a simple explanation of a complicated theory.

Currently there are two types of antipsychotics on the market, so-called “typical” antipsychotics and “atypical” antipsychotics.

Typical Antipsychotics

These were the first drugs to treat psychosis and schizophrenia. These were miracle drugs discovered in the 1950s. The use of these drugs allowed many patients with major mental illness to live in the community and have a more normal life.

• Chlorpromazine (Thorazine)

• Clozapine (Clozaril) (not a first choice)

• Flufenazine (Prolixin)

• Haloperidol (Haldol)

• Molindone (Moban)

• Trifluoperazine (Stelazine)

• Thioridazine HCl (Mellaril)

Atypical Antipsychotics

These are newer medications developed to avoid some of the side effects of the typical antipsychotics especially Tardive Dyskinesia (TD). These drugs are used almost exclusive in the US. They are no more effective then the typicals but do have less worrisome side effects. TD is said to be 10 times less with atypicals. Atypical antipsychotics may have more side effects then first thought. Recently there have been more concerns about the side effects of weight gain, metabolic syndrome and endocrine changes.

Atypical Medications Include:

• aripiprazole (Abilify) This is the newest atypical antipsychotic medication. Said to be different from the others in that it “balances” dopamine levels in the brain rather then decreasing them

• ziprasidone HCI (Geodon)

• risperidone (Risperdal)

• quetiapine fumarate (Seroquel)

• olanzapine (Zyprexa)

New medications are being introduced frequently as pharmaceutical companies struggle for the biggest market share. Studies show little difference in effectiveness between these drugs when used correctly. The side effects can be different however and often are the reason for the choice of a certain medication.

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