Typically, treatment entails a combination of at least one mood-stabilizing drug and/or atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote or generically as divalproex). Lithium carbonate can be remarkably effective in reducing mania, although doctors still do not know precisely how it works. Lithium may also prevent recurrence of depression, but its value seems greater against mania than depression; therefore, it is often given in conjunction with other medicines known to have greater value for depression symptoms, sometimes including antidepressants.
Valproic acid is a mood stabilizer that is helpful in treating the manic or mixed phases of bipolar disorder, along with carbamazepine (Equetro), another antiepileptic drug. These drugs may be used alone or in combination with lithium to control symptoms. In addition, newer drugs are coming into the picture when traditional medications are insufficient. Lamotrigine, another antiepileptic drug, has been shown to have value for preventing depression and, to a lesser degree, manias or hypomanias.
Other antiepileptic drugs, such as gabapentin, oxcarbazepine, or topiramate, are regarded as experimental treatments that sometimes have value for symptoms of bipolar disorder or other conditions that often occur with it.
Haloperidol or other newer antipsychotic medications, such as olanzapine or risperidone, are often given to patients who fail to respond to lithium or divalproex. They also may be given to treat acute symptoms of mania – particularly psychosis – before lithium or divalproex can take full effect, which may be from one to several weeks. Another antipsychotic, Latuda, is approved for use in bipolar I depression as is the combination of olanzapine plus fluoxetine (called Symbyax). The antipsychotic quetiapine is approved to treat bipolar I or II depression. Preliminary studies also suggest that the atypical antipsychotic cariprazine (Vraylar) also may have value for treating bipolar depression