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Here you can read about medication for treatment of bipolar disorder – lithium, medication for psychoses and medication for epilepsy.

About bipolar disorder

If you have a bipolar disorder, you may experience unnaturally large energy fluctuations and mood swings. You may have repeated periods of illness with mania, hypomania, depression and/or mixed state. You can read more about this on our page on bipolar disorder in adults.

It is usually painful to experience a depression or mixed state. A mania or hypomania can sometimes be painful, but it can also trigger a feeling of euphoria.

Although mania or hypomania can sometimes cause euphoria, most people prefer that hypomania and mania are prevented and treated. There are two reasons for this: Firstly, a mania is generally followed by a depression which lasts much longer than the mania itself. Secondly, you often do things in a manic state that you regret afterwards.

This may, for example, be that you quarrel with your family, or that you do spontaneous, ill-considered things, such as incurring large debt or sending strange messages.

The purpose of treating your bipolar disorder is to prevent periods of illness, thereby increasing your quality of life.

Treatment with medication will significantly reduce your risk of periods of illness. You may nevertheless experience having a mania, depression or mixed state. Here, however, the treatment can still help alleviate and shorten the period of illness.

To reduce the risk of new periods of illness, it is important that you receive psychoeducation (education about your disorder) in addition to medication.

NB: Medication for depression

If you have bipolar disorder, you should only take medication for depression

(antidepressants) together with mood stabilising medication (mood stabilisers). Taking medication for depression on its own may trigger a mania.

Medication for bipolar disorders

Medication for bipolar disorder – mood stabilisers – can prevent and treat depression, mania and mixed states in most patients. There are many different types of medication that can be used individually or in combination.

The individual types of medication stabilise the activity in different signalling systems in the brain. Some types of medication are better at preventing depression than mania – and vice versa. Because the medication works in different ways, there are also different side effects.

Your treatment will be adapted based on the course of your illness and your wishes. Your doctor can tell you about the pros and cons of different types of medication. This will better enable you to decide which treatment you want.

One cannot say for sure in advance which medication will help you best. Nor is it possible to know exactly what side effects you may experience. Therefore, you may need to try several types of medication before you and your doctor find the medication that is best for you.

There are three overall types of mood stabilisers:

Lithium
Medication for epilepsy (antiepileptics)
Medication for psychoses (antipsychotics)

Combination of different types of medication

In some cases, it may be a good idea to combine the different types of medication. This may be relevant if treatment with one type of medication does not help you well enough.

Lithium

Lithium has preventive and curative effects on both depression and mania.

Lithium in excessive doses may damage the kidneys. It is therefore very important that you receive the right lithium dose. When you start treatment, you will therefore have regular blood samples taken during the first four weeks. Once you and your doctor have found the right dosage for you, it is still necessary to monitor your treatment with a blood test about 1-4 times a year to check that your kidneys continue to tolerate the amount of lithium. Your metabolism will also be checked because, in some cases, it may be affected by the treatment. If this happens, you can be given a metabolic hormone supplement together with lithium.

Please note

It is important that you are always getting the right dose, as lithium can be dangerous when administered in excessive doses. Always contact your doctor if you experience symptoms such as lethargy, muscle twitching (for example unsteady walking) and slurred speech.

Read more about what to pay attention to on sundhed.dk (in danish).

Side effects

Not everyone gets side effects from treatment with lithium, but many experience mild side effects. The most common side effects are a slight tremor of the hands, increased thirst or a tendency to loose stools. Some gain a little weight or get more blemished skin. In some cases, troublesome side effects can be treated with medication.

Remember fluids

When you are being treated with lithium, make sure to drink fluids regularly.

If you forget to drink fluids, the concentration of lithium in your blood becomes too high. Always contact your doctor if you have a high fever or sweat a lot (for example due to high temperatures/heat waves). This may be of importance to your lithium dose.

Painkillers

Be aware that some painkillers (for example ipren/ibuprofen) may affect your lithium dose.

Medication for epilepsy (antiepileptics)

Antiepileptics are medicinal products that have been used to treat epilepsy for many years. Today, we know that medication for epilepsy can also help prevent and treat bipolar disorder.

There are several types of medication which have different advantages and disadvantages. Some are best at preventing and treating manias or mixed states, while others are best at preventing and treating depressions. Some types of medication work almost immediately, while others need to be increased slowly to the effective dose over many weeks.

The most frequently used medicinal products are lamotrigine and valproate.

Lamotrigine:

Has few side effects, but should be increased slowly to the effective dose over 6 to 10 weeks.
If you are being treated with lamotrigine, there is a very small risk that you may develop a very rare, but serious, skin disorder called Toxic epidermal necrolysis. Therefore, contact your doctor if you develop a rash after starting treatment with lamotrigine.

Valproate:

Works already after a few days, but has more frequent side effects such as tiredness (fatigue).
If you are being treated with valproate, there is a small risk that you may develop hepatitis. Contact your doctor if you experience symptoms of hepatitis such as: lethargy, nausea, vomiting, diarrhoea, abdominal pain (pain in the stomach region), possibly jaundice. A symptom may also be that the medication does not work as desired.
You will have regular blood samples taken to check your liver values. In the first year after you have started treatment with valproate, you will have blood samples taken four times a year.

Medication for psychoses (antipsychotics)

Antipsychotics were originally developed to treat psychoses, but they can also be used to prevent and treat fluctuations in bipolar disorder. Some types of medication can be used to treat manias, others are used for depression and mixed states, while others have an effect on anxiety and sleep problems.

Your doctor and you will jointly decide which medication and dose are right for you.

The various antipsychotics may have different side effects. Some may cause stiffness in the muscles or tremors (which may be treated with medication against side effects). Others may cause increased appetite or changes in the body’s metabolism of sugars and fats.

The side effects will often depend on the dose. While a relatively small dose may have a preventive effect, a higher dose will often be needed to treat acute mania or a mixed state. Therefore, you can sometimes choose to accept certain side effects for a limited period in order to recover faster from, for example, a mania.

How to take the medication?

Lithium and antiepileptics are only available as tablets to be taken once or twice a day.
Antipsychotics are available as regular tablets. Some are also available as melting tablets that dissolve when you place them on your tongue. A few medicinal products are available as a drinkable solution.
Several types of antipsychotics are also available as ‘extended release medication’, that is a long-acting injection given every two to eight weeks.
Extended release medication may be a good idea if you want to avoid taking medication on a daily basis or if you have difficulty remembering to take your tablets.

Your doctor will initially suggest one of the medications with the fewest side effects and the best documented effect on precisely your most frequent type of disorder period (mania, depression or mixed state).

However, it is impossible to predict which medication works best for you. It may therefore often be necessary to change medication several times. Special considerations may also apply; for example if you have other chronic diseases or are very worried about specific side effects.

Finally, it is crucial whether you prefer to receive your medication as tablets every day or as an injection at an interval of weeks. The different types of medication can also be combined to achieve a more effective treatment.

The dose you need may vary over time. It is therefore important that you attend regular check-ups with your doctor.

When you are being treated with mood stabilisers, your doctor will ask you if the medication has worked as intended and if you have had any side effects. Your doctor will make sure to adjust your dose and renew your prescriptions on an ongoing basis. If you are taking several medicinal products at the same time, your doctor will make sure that they work together.

Your doctor will order and monitor blood tests on an ongoing basis to ensure that your dose is correct and that you can tolerate the medication. Depending on the type of medication with which you are being treated, you will have blood samples taken every three to twelve months.

In some cases, it may also be necessary to check your weight and waist circumference or to do an electrocardiogram (ECG) to check your heart rhythm.

Taking mood stabilisers is generally not harmful – not even over an extended period. However, if you are being treated with lithium, it is important that you remember to have regular blood tests to detect any side effects early on.

Mood stabilisers do not pose a risk of abuse or dependence. You will not experience withdrawal symptoms if you suddenly stop taking the medication, but you may risk acute depression or mania if you stop taking it overnight.

No adverse effects on brain tissue have been described in connection with prolonged use of mood stabilisers.

Medication and pregnancy

Some types of medication should not be taken during pregnancy. Talk to your therapist if you are planning to get pregnant.

Please note: Valproate

Taking valproate during pregnancy can seriously harm your unborn child. Therefore, talk to your doctor immediately if you are considering having a child. Always use effective contraception when taking valproate. And do not stop using contraception until you have talked to your doctor. Never stop taking valproate until you have agreed this with your doctor, as your disorder may otherwise get worse.

Podcast

Tip: In the podcast ‘Mødregruppen’, Nanna, who has a bipolar disorder, talks about her pregnancy, including her use of medication. The podcast was produced by the psychiatric services in Central Denmark Region.

#2: Mødregruppen (podbean.com) - in danish

For how long will you be on medication?

It is recommended that you continue to take your medication to prevent new periods of illness. The preventive treatment will last for several years and may be for life.

Some patients have a great desire to be free of medication Always discuss this with your doctor – together you can weigh the pros and cons of your treatment to clarify whether your treatment is working as it should, or whether it should be changed or completely stopped.

Over time, many people find a treatment that they are so satisfied with that they continue with it for many years or perhaps throughout their lives.

More information

Bipolar disorder in adults including advice for people living with a bipolar disorder and advice for relatives of an adult with bipolar disorder.

This page was updated in April 2024.

Approved by: Birthe Jensen, Head Nurse, Regional Psychiatry Horsens, and Maike Andreasen, Consultant, Department of Depression and Anxiety Disorders, Aarhus University Hospital – Psychiatry.

Mood stabilising medication