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Bipolar depression is the low mood typical in people with bipolar disorder. Medications can help manage symptoms, stabilize mood, and improve general well-being. Bipolar disorder is a lifelong mental health disorder. Many people with the condition will require continuous long-term treatment to manage symptoms. Symptoms include high and low moods, which are known as mania and depression. A psychiatrist will recommend medications alongside other interventional therapies to treat bipolar depression. This article discusses medications for bipolar disorder, their side effects, and other treatment options. What is the standard treatment for bipolar depression Share on PinterestFredy Sanchez/Getty ImagesMedications are typically the first-line treatment for bipolar depression. However, most treatment plans include a combination of medication, psychotherapy, and lifestyle modifications. A person’s symptoms and type of bipolar disorder will determine their treatment. A person will usually receive treatment for bipolar depression in an outpatient clinic setting. However, a person may be admitted to the hospital if their symptoms are severe and their risk of danger or self-harm is high. Medical and mental health professionals may prescribe medications such as mood stabilizers, antipsychotics, and antidepressants. Once a person’s mood stabilizes as a result of their medications, they can begin psychotherapy to learn how to manage their condition. This happens during the maintenance phase of treatment. Also during this time, doctors prescribe medications to prevent a relapse. People with bipolar depression may need more than one drug to manage their symptoms. For instance, they may take a mood-stabilizing drug along with an antipsychotic or antidepressant. Because people respond to medications differently, it can take a while for doctors to find the best medication or combination to treat each person’s symptoms. To determine the best treatment plan, doctors consider the following factors:the severity of a person’s symptomsany underlying health conditionsprevious or current medicationsthe safety and tolerance of the medication and other treatment optionsa person’s treatment preference Mood stabilizers Mood stabilizers are psychiatric medications that help regulate mood changes in people with bipolar depression. Minerals and anticonvulsants are types of mood stabilizers. The table below lists some common mood stabilizers and some of their possible side effects. Most medications have a long list of potential side effects, which a person should discuss with a doctor before taking the medication.Generic/brand nameIndicationsPossible side effectslithium (Eskalith, Eskalith CR, Lithobid)• bipolar disorder• vascular headaches• neutropenia• arrhythmia• confusion• nausea• diarrheavalproic acid (Depakene)• seizure disorder• bipolar disorder• migraine• headache• abdominal pain• drowsiness• dizzinessdivalproex sodium (Depakote)• bipolar disorder• mania• nausea and vomiting• drowsiness• diarrhea• indigestioncarbamazepine (Equetro)• bipolar I disorder• epilepsy• trigeminal neuralgia• dizziness• nausea and vomiting• drowsiness• involuntary muscle movements• rash• Stevens-Johnson syndromelamotrigine (Lamictal)• bipolar I depression• Lennox-Gastaut syndrome• nausea and vomiting• dry mouth• chest and back pain• edema• rash• Stevens-Johnson syndrometopiramate (Topamax)• bipolar disorder• epilepsy• migraine• parasthesia• changes in taste sensation• fatigue• cognitive problems Learn more about mood stabilizers for bipolar depression here. Antipsychotic medications Antipsychotic medications are a class of drugs that help manage the mania phase or severe depression typical of bipolar depression. Antipsychotics block dopamine receptors in the brain to reduce symptoms. Doctors often prescribe a class of antipsychotics known as atypical, or second-generation, antipsychotics rather than typical, or first-generation, antipsychotics. This may be because atypical antipsychotics cause fewer side effects. The table below lists some atypical antipsychotics that the Food and Drug Administration (FDA) has approved to treat bipolar depression, as well as their possible side effects. Most medications have a long list of potential side effects, which a person should discuss with a doctor before taking the medication.Generic/brand nameIndicationsPossible side effectsasenapine (Saphris, Secuado)• schizophrenia• bipolar depression• drowsiness• insomnia• restlessness• fatiguearipiprazole (Abilify)• bipolar I disorder• schizophrenia• Tourette’s syndrome• headache• nervousness• restlessness• dizzinesslurasidone (Latuda)• schizophrenia• bipolar depression• nausea• sedation• headache• akathisiaolanzapine (Zyprexa)• schizophrenia• bipolar I disorder• restlessness• unusual behavior• dizziness• difficulty sleepingquetiapine (Seroquel)• schizophrenia• bipolar I disorder• bipolar II disorder• acute manic episodes• drowsiness• orthostatic hypotension• dizzinessrisperidone (Risperdal)• schizophrenia• bipolar I disorder• nausea and vomiting• diarrhea• constipation• heartburnziprasidone (Geodon)• schizophrenia• bipolar mania• acute agitation• headache• restlessness• anxiety• lack of energy Antidepressants While there is controversy surrounding the efficacy of antidepressants, they can help manage the symptoms of bipolar depression. Doctors usually prescribe them off-label. This means that the FDA has not approved using antidepressants to treat bipolar depression. Doctors may prescribe an antidepressant along with a mood stabilizer to help reduce the chances of mania. Different classes of antidepressants balance specific neurotransmitters in the brain to improve a person’s mood. Serotonin and norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) are types of antidepressants. SNRIs SNRIs increase serotonin and norepinephrine levels in the brain by blocking serotonin and norepinephrine transporters. The table below lists examples of SNRIs and some possible side effects. Most medications have a long list of potential side effects, which a person should discuss with a doctor before taking the medication.Generic/brand namesIndicationsPossible side effectsdesvenlafaxine (Pristiq)• depression• bipolar disorder• abdominal pain• decreased appetite• headache• nauseaduloxetine (Cymbalta, Yentreve)• generalized anxiety disorder• depression• fibromyalgia• diabetic neuropathy• musculoskeletal pain• headache• drowsiness• fatigue• nauseavenlafaxine (Effexor)• depression• social anxiety disorder• cataplexy• headache• nausea• insomnia• dizzinesslevomilnacipran (Fetzima)• bipolar depression• nausea and vomiting• constipation• change in libido• excessive sweating SSRIs SSRIs treat bipolar depression by preventing the body from reabsorbing serotonin neurotransmitters to increase serotonin levels in the brain. High serotonin levels in the brain can improve a person’s mood. The table below lists examples of SSRIs and some possible side effects. Most medications have a long list of potential side effects, which a person should discuss with a doctor before taking the medication.Generic/brand namesIndicationsPossible side effectscitalopram (Celexa)• depression• drowsiness• insomnia• excessive sweating• nausea and vomitingescitalopram (Lexapro)• major depressive disorder• anxiety disorder• insomnia• excessive sweating• sexual dysfunction• nauseaparoxetine (Paxil)• depression• panic attack• obsessive compulsive disorder• post-traumatic stress disorder• drowsiness• dry mouth• loss of appetite• sleep disturbancesertraline (Zoloft)• major depressive disorder• panic disorder• obsessive-compulsive disorder• post-traumatic stress disorder• social anxiety disorder• premenstrual dysphoric disorder• fainting• lightheadedness• diarrhea• nausea Learn about the differences between SNRIs and SSRIs here. TCAs Doctors typically prescribe TCAs as second-line antidepressants after SSRIs to treat and manage major depressive disorders. The table below lists some FDA-approved TCAs and some possible side effects. Most medications have a long list of potential side effects, which a person should discuss with a doctor before taking the medication.Generic/brand namesIndicationsPossible side effectsamitriptyline (Elavil)major depressive disorder• weight gain• dry mouth• dizziness• constipationdesipramine (Norpramin)depression• nausea• drowsiness• weakness or tiredness• nightmaresimipramine (Tofranil, Tofranil-PM)depression• nausea• drowsiness• weakness or tiredness• excitement or anxietynortriptyline (Pamelor)depression• drowsiness• excessive sweating• dizziness• constipation MAOIs MAOIs block the enzyme monoamine oxidase from removing the brain’s neurotransmitters dopamine, serotonin, and norepinephrine. The table below lists some MAOIs and some possible side effects. Most medications have a long list of potential side effects, which a person should discuss with a doctor before taking the medication.Generic/brand namesIndicationsPossible side effectsphenelzine (Nardil)• treatment-resistant depression• panic disorder• social anxiety disorder• drowsiness • weakness• dizziness• dry mouthtranylcypromine (Parnate)• major depressive disorder• dry mouth• headache• diarrhea• difficulty urinating Benzodiazepines Benzodiazepines are fast-acting antianxiety medications that can offer immediate relief to people with bipolar depression. To reduce the risk of dependence and tolerance, doctors do not prescribe these drugs for long-term use. The table below lists examples of benzodiazepines and some potential side effects. Most medications have a long list of potential side effects, which a person should discuss with a doctor before taking the medication.Generic/brand namesIndicationsPossible side effectsalprazolam (Xanax)• panic disorder• anxiety disorder• drowsiness• dizziness• insomnia• memory problemsclonazepam (Klonopin)• panic disorder• epilepsy• nonconvulsive status epilepticus• lethargy• fatigue• impaired coordination• dizzinessdiazepam (Valium)anxiety disorder• sedation• fatigue• confusion• memory problemslorazepam (Ativan)anxiety disorder• sedation• dizziness• lethargy• impaired coordination Other treatments Bipolar medications may be most effective when people use them alongside other treatments, such as the following: Psychotherapy According to a 2017 set of clinical practice guidelines published in the Indian Journal of Psychiatry, psychotherapy can reduce the risk of relapse and improve health outcomes during the acute and maintenance treatment phases of bipolar depression. Psychotherapy involves one-on-one interaction with a therapist. Some examples of approaches to psychotherapy are:cognitive behavioral therapyinterpersonal and social rhythm therapyfamily-focused therapy Electroconvulsive therapy ECT A doctor may recommend ECT if a person’s bipolar depression is severe and does not respond to medication and psychotherapy. In this procedure, doctors will give a person general anesthesia before stimulating the brain with an electrical current. Researchers in a 2017 study evaluated the impact of ECT in 522 people with bipolar disorder. Two-thirds of the people had positive outcomes. The researchers concluded that ECT is safe and effective for treating all phases of severe, drug-resistant bipolar disorder. Lifestyle modifications Making healthy lifestyle choices may help prevent a relapse of bipolar depression. People can try the following approaches: eating a balanced dietavoiding drugs and alcoholexercising regularlygetting adequate resttaking medications according to their prescriptionattending medical and mental health appointments People should continue taking their medications even after their symptoms improve. Learn about natural remedies for bipolar disorder here. When to contact a doctor A person should contact a doctor if they are experiencing worsening symptoms or side effects when taking medication for bipolar disorder. The doctor may make occasional adjustments by changing a medication or reducing the dose to manage severe side effects. They will also monitor how a person’s symptoms improve with each adjustment. If a person does not see immediate changes after starting treatment for bipolar disorder, they do not need to worry. It may take a while for them to start seeing significant improvements. Outlook The National Institute of Mental Health notes that 2.8% of adults in the United States have a bipolar disorder diagnosis. This translates to 5 million people. And 82.9% of these people have a severe impairment. According to the United Kingdom’s National Health Service (NHS), without treatment, bipolar-related mania can last 3–6 months and depressive episodes can last 6–12 months. The NHS also states that symptoms usually improve within 3 months of treatment, which includes medication, psychotherapy, and lifestyle changes. Summary There is currently no cure for bipolar depression. However, treatment can help a person manage the condition. A person’s doctor will recommend a combination of medications, psychosocial interventions, and lifestyle changes for maximum effect. People with bipolar depression should work closely with a doctor and follow their recommended treatment plan to achieve the best outcome. 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