Bipolar Depression Medication: A Complete Guide

Bipolar disorder is a mood disorder that can affect the way you think, feel and behave. During a depressive episode, the symptoms of bipolar disorder can resemble clinical depression.

Because of the negative effects bipolar disorder can have on your moods and feelings, it may be referred to as “manic-depressive illness” or “bipolar depression.” 

Just like with major depression, the depressive symptoms of bipolar disorder can have a real negative impact on your quality of life. In some cases, they can be debilitating and affect your ability to function on a daily basis. 

The good news is that the depressive episodes caused by bipolar disorder are treatable using medication, talk therapy and changes to your habits and lifestyle.

Below, we’ve explained what bipolar depression is, as well as how it may affect your thoughts, feelings, moods and behavior. We’ve also discussed the options that are available for treating bipolar disorder, from medication to therapy and more. 

Bipolar depression is a term that’s used to refer to bipolar disorder, a mental disorder that can cause sudden, unusual changes in mood, focus and activity levels.

If you have bipolar disorder, you may notice that your mood changes rapidly, from moments of “high” feelings and elation to periods of sadness and worry. These periods of intense emotion and activity level are referred to as manic episodes and depressive episodes.

During a manic episode, you may feel extremely happy, satisfied and full of energy. You might also feel as if your mind is racing, that you don’t need to sleep, or that you can do many things at the same time. You may feel exceptionally capable, important and effective.

Some people feel irritable and touchy during manic episodes. In these periods, it’s common to talk quickly and engage in risky behaviors, such as spending money excessively.

Not all people with bipolar disorder experience severe manic episodes. When manic episodes involve less severe symptoms, they’re referred to as hypomanic episodes.

During a depressive episode, you may experience the opposite symptoms, such as feelings of tiredness, restlessness, sadness and worry. You may find it difficult to stay asleep or wake up, have a greater appetite and feel as if you’re unable to focus or complete simple tasks.

Some people experience anhedonia — an inability to experience pleasure — during depressive episodes. This can result in a weak sex drive, a lack of interest in activities and, in some cases, feelings of hopelessness, worthlessness and death. 

Many of the symptoms that may occur during depressive episodes are similar to the symptoms of major depressive disorder (MDD).

The mood episodes of bipolar disorder can last for several days to weeks or longer. During an episode, you'll typically have symptoms that occur on a daily basis and continue for most of the day. 

Mental health professionals have identified three types of bipolar disorder: 

• Bipolar I disorder. This type of bipolar disorder involves manic symptoms that occur for one week or longer, as well as depressive symptoms that usually occur for two weeks or longer. Some people with bipolar I disorder have severe, extreme manic symptoms that require medical care in a hospital.

• Bipolar II disorder. This type of bipolar disorder involves depressive episodes with less severe hypomanic episodes. People with bipolar II disorder do not experience the more severe manic symptoms that occur with bipolar I disorder.

• Cyclothymic disorder. This mild type of bipolar disorder involves manic and depressive episodes that are less severe than bipolar I or bipolar II disorder. These symptoms may occur over the course of several years.

Your healthcare provider may diagnose you with a certain type of bipolar disorder after talking to you about your symptoms, experiences and mental health history.

Bipolar disorder is a lifelong condition that can’t be cured. However, with active treatment, most people with bipolar disorder are able to reduce the severity of their symptoms and enjoy a high quality of life.

Several medications are used to treat bipolar disorder. Your healthcare provider may select one or several medications based on the severity of your symptoms, your health and your history of mental health treatments.

Lithium

Lithium is a mood-stabilizing drug that’s used to treat bipolar disorder. It belongs to a class of medications called antimanic agents and works by reducing abnormal activity in some parts of your brain to stabilize your feelings and behavior.

Your mental health provider may prescribe lithium to prevent manic episodes — periods in which you feel excited, irritated and stimulated — or to reduce their severity.

Research shows that lithium helps to reduce the severity of mania in 50 to 70 percent of people with bipolar disorder.

While lithium is effective, like many other medications, it may cause side effects. Common side effects of lithium include thirst, discomfort, nausea, increased urination and hand tremors.

Anticonvulsants

Anticonvulsants are medications that work by calming nerve activity. They were originally used to treat epilepsy, but are now often prescribed as mood stabilizers for bipolar disorder.

Common anticonvulsant medications for bipolar disorder include divalproex sodium (marketed as Depakote®), lamotrigine (Lamictal®) and others.

Like other bipolar disorder medications, anticonvulsants can cause side effects, including pain, nausea, insomnia, fatigue, rash, xerostomia (dry mouth) and rhinitis (inflammation and swelling of the nasal passages).

Antipsychotics

Antipsychotic medications are used to treat episodes of mania, mixed episodes and depressive phases that can occur as part of bipolar disorder. They’re often prescribed for use with mood stabilizers such as lithium and other medications.

Common antipsychotics for treating bipolar disorder include quetiapine (Seroquel®), asenapine (Saphris®), aripiprazole (Abilify®), lurasidone (Latuda®) and risperidone (Risperdal®).

Like other medications for bipolar disorder, antipsychotics can cause side effects. Common side effects of antipsychotic drugs include dry mouth, constipation, urinary retention, weight gain and sedation. 

Antidepressants

Many cases of bipolar disorder improve with the use of antidepressants — medications that work by increasing the levels of certain chemicals, called neurotransmitters, in your brain.

Common types of antidepressant medications for bipolar depression include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). 

By increasing the levels of serotonin, norepinephrine and other neurotransmitters in your brain, many antidepressants can reduce the severity of symptoms during episodes of depression.

However, antidepressants may increase your risk of developing manic symptoms. To reduce your risk of experiencing symptoms of mania, your mental health provider may also prescribe a mood stabilizing medication.

Like other medications, antidepressants can cause adverse effects, including some effects that may reduce your sex drive and/or sexual performance. 

Make sure to inform your healthcare provider if you develop side effects while using any type of antidepressant. Avoid stopping treatment or making changes to your use of medication without first talking to your mental health provider.

Benzodiazepines

Benzodiazepines are medications for managing anxiety. Your healthcare provider may suggest taking a benzodiazepine or similar anti-anxiety medication if your bipolar depression symptoms make it difficult for you to relax or fall asleep.

Common benzodiazepines include clonazepam (Klonopin®), alprazolam (Xanax®), lorazepam (Ativan®) and diazepam (Valium®).

Benzodiazepines can cause side effects and dependence, meaning they’re generally only used on a short-term basis.

Most medications for bipolar disorder are safe and effective when used as prescribed. However, it’s important to follow your healthcare provider’s instructions and inform them if you experience any side effects of unwanted symptoms while using your medication. 

If you’re prescribed medication for bipolar disorder, make sure to:

• Talk to your healthcare provider about risks and side effects. Some medications for bipolar depression may cause side effects. Talking to your healthcare provider ahead of time can help you to understand the risks and identify issues when they occur. If you experience side effects or health concerns while using medication, let your mental health provider know as soon as you can.

• Inform your healthcare provider about any other medications you use. Some types of medication can cause drug interactions if used with lithium, anticonvulsants and other bipolar disorder treatments.Make sure to inform your healthcare provider about any medications and/or supplements you currently take before using any medications for bipolar disorder.

• Let your healthcare provider know if you have a history of substance abuse. Some medications may not be suitable if you have a substance use disorder. Make sure to tell your healthcare provider if you’ve previously suffered from substance abuse issues.

• Use your medication consistently, even if it doesn’t work right away. Some types of medication, such as antidepressants, can take a few weeks to start working. Make sure to use your medication as prescribed, even if you don’t notice any effects right away.If you don’t notice any improvements after using your medication for four or more weeks, talk to your healthcare provider.

• Don’t stop using your medication without talking to your healthcare provider. It’s important to talk to your healthcare provider before stopping your medication or making any changes to your dosage. Stopping your medication abruptly could result in withdrawal symptoms and prevent you from maintaining a stable mood.

Although medication is important for treating bipolar disorder, effective treatment plans can also include non-pharmaceutical options such as therapy and lifestyle changes. 

If you’ve been diagnosed with bipolar depression, your healthcare provider may suggest taking part in therapy, making changes to your lifestyle or a combination of different approaches.  

Psychotherapy

Bipolar disorder often improves with psychotherapy, or talk therapy. Therapy involves talking to a licensed mental health provider about your thoughts, feelings and behavior, then working out effective ways to change your thinking and better cope with your symptoms.

Several forms of therapy are used to treat bipolar disorder and depression, including cognitive behavioral therapy (CBT), interpersonal therapy and social rhythm therapy (IPSRT).

Your mental health provider may recommend psychotherapy on its own or in combination with the use of medication. 

Therapy can produce real improvements, but results aren’t immediate. You might need to take part in therapy for several weeks or months before you begin to see improvements in how you think, feel and behave. 

We offer online counseling as part of our range of mental health services. You can learn more about how therapy works in our detailed guide to therapy for depression. 

Habits and Lifestyle Changes

Making small but meaningful changes to your habits and lifestyle can often improve your moods and make the symptoms of depression or bipolar disorder less severe. Try the following lifestyle changes to make managing bipolar depression easier.

Exercise Regularly

Exercise is one of the most effective habits for reducing the severity of depression. It’s linked to real improvements in mood, as well as increases in the production of feel-good nervous system chemicals called endorphins.

Although research is limited, some studies have produced findings that suggest regular exercise may also help to make the depressive symptoms of bipolar disorder easier to manage. 

It doesn’t take much exercise to produce noticeable benefits. In fact, the CDC recommends that adults aim for 150 minutes of moderate-intensity exercise per week, such as walking around the neighborhood or going for a bike ride, as well as two or more strength-based workouts.

Get Plenty of Deep Sleep

Sleep issues are common in people with bipolar disorder, and research suggests that they have a negative impact on quality of life and treatment outcomes.

Try to get at least seven hours of sleep per night. If you find it difficult to fall asleep, try setting a regular bedtime and removing any electronic devices, such as smartphones or computers, from your bedroom.

If you’re a regular coffee drinker, try to limit your caffeine intake, especially during the afternoon and evening. Not only can caffeine make sleeping more difficult, but it may also worsen some bipolar disorder symptoms. More research is needed to confirm this link.

Avoid Drugs and Alcohol

It’s important to avoid alcohol and illicit drugs while you’re treating bipolar depression, as these substances can intensify your symptoms and make staying in control of your thoughts, feelings and moods more difficult.

Some research suggests that alcohol can worsen the clinical course of bipolar disorder, making it a more challenging condition to treat.

Alcohol may also worsen the side effects of many medications used to treat bipolar depression, such as mood stabilizers and antidepressants. It may negatively interact with these types of medications, as well.

Avoid drinking alcohol or taking recreational drugs while treating bipolar depression. If you have an alcohol or substance use disorder, inform your healthcare provider before you take any type of medication to treat bipolar disorder. 

Other Treatments for Bipolar Disorder

In some cases, bipolar disorder may require other forms of treatment, such as electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS).

Electroconvulsive therapy involves the use of electric currents to stimulate the brain. It’s carried out under local anesthesia. You may need to take part in multiple sessions over the course of several weeks to experience noticeable improvements.

Transcranial magnetic stimulation involves the use of magnetic waves to activate certain parts of your brain. It’s a more targeted form of treatment than ECT. Research shows that TMS is often effective at treating depression, but research is limited on its effects for bipolar disorder.

Bipolar disorder is a serious mental illness that can make many aspects of your daily life more challenging. Luckily, it’s usually possible to control your symptoms with the right medication.

If you think you might have bipolar disorder that involves depressive episodes, one of the most important steps that you can take is reaching out for professional help. 

You can do this by asking your primary care provider for a mental health referral, scheduling an appointment with a psychiatrist in your city, or by connecting with a licensed psychiatry provider from home using our online psychiatry services. 

If you have bipolar disorder, you’ll receive a personalized treatment plan, ongoing follow-up care and, if appropriate, a prescription for medication to manage your symptoms. 

Interested in learning more about mental health? Our free mental health resources share proven strategies for dealing with depression, anxiety, stress and other common problems.