Bipolar disorder medication: what’s prescribed and when?

Medication is often a key part of treating bipolar disorder, helping to stabilise mood and manage the highs of mania or hypomania, as well as the lows of depression. While starting medication can feel like a big step, it’s important to know that you won’t have to navigate it alone – support is available throughout the process.

Everyone’s treatment journey is different and finding the right medication can take time. However, with the right support, many people find that medication helps them feel more balanced, more settled and better able to manage their day-to-day life.

What types of medication are used to treat bipolar disorder?

There are several types of medication that can help manage bipolar disorder, each working in a slightly different way.

The right option for you, at any one time, will depend on your current symptoms, how you've responded to treatment in the past, and any physical health needs. Because bipolar disorder can change over time, your treatment plan will be tailored to your needs and reviewed regularly to make sure it continues to support your wellbeing.

Mood stabilisers

Mood stabilisers are used to help prevent extreme mood swings and reduce the risk of future episodes.

Lithium is the most well-known mood stabiliser and has been used for many years to manage both mania and depression.

• Used in: Manic episodes, depressive episodes, mixed episodes and long-term maintenance
• Purpose: Helps keep mood steady and reduces the risk of future episodes
• How long it takes to work: May take 1 to 2 weeks to start noticing an effect, with full benefits seen after several weeks
• Common side effects: Thirst, increased urination, weight gain, tremors or mild nausea. These often settle with time or dose adjustment
• Personalised care: the dose of lithium is precisely adjusted to your needs. It’s monitored with regular blood tests and the dose is adjusted accordingly. This minimises side effects and maximises the therapeutic benefit

Anticonvulsants

Originally developed to treat epilepsy, some anticonvulsants also work as mood stabilisers and can be useful for people who don’t respond well to lithium.

• Used in: Manic episodes, depressive episodes, mixed episodes and long-term maintenance
• Purpose: Help to reduce mood swings and stabilise long-term mood patterns
• How long they take to work: Usually take a few days to a few weeks to start having an effect
• Common side effects: Drowsiness, dizziness, weight changes, skin rashes or nausea. Side effects vary depending on the specific anticonvulsant being used. Most people do not get any adverse effects

Common examples include lamotrigine and carbamazepine.

Antipsychotics

These may be prescribed during manic or mixed episodes, especially if your symptoms include agitation, racing thoughts or psychosis. Some antipsychotics are also used long-term to help keep mood stable.

• Used in: Manic episodes, mixed episodes, depressive episodes (in some cases), and long-term maintenance
• Purpose: Help calm manic symptoms and, in some cases, support mood stabilisation longer term
• How long they take to work: Can begin working within a few days, especially for agitation
• Common side effects: Drowsiness, weight gain, restlessness, and changes to blood sugar or cholesterol levels

Common examples include olanzapine, quetiapine, risperidone, and aripiprazole.

Antidepressants

These can be helpful during depressive episodes but are usually given alongside a mood stabiliser to lower the risk of triggering a manic episode.

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and sertraline, are generally the preferred type of antidepressant for people with bipolar disorder.

• Used in: Depressive episodes (always alongside a mood stabiliser)
• Purpose: Help lift low mood during depressive phases
• How long they take to work: Typically 2 to 4 weeks to start noticing improvements
• Common side effects: Nausea, headaches, sleep changes, increased anxiety initially or sexual side effects

Benzodiazepines

These are sometimes prescribed short-term to ease anxiety, agitation or sleep problems during an episode. They aren’t used long-term because of the risk of dependence.

• Used in: Manic episodes, mixed episodes, or acute distress during any episode
• Purpose: Provide quick relief from distressing symptoms
• How long they take to work: Fast-acting – often within an hour
• Considerations: Not suitable for long-term use due to the risk of dependence
• Common side effects: Drowsiness, dizziness, poor concentration or unsteadiness

Examples include diazepam and lorazepam.

Each person’s medication needs are different, and it may take time to find the right combination for you. With regular reviews and the right adjustments over time, many people find a medication plan that becomes a key part of their bipolar disorder treatment.

How do doctors decide which medication to prescribe?

Your psychiatrist will take the time to understand your individual needs and circumstances before recommending any medication to you. The goal is to find the safest and most effective option to help manage your symptoms and support your wellbeing.

Some of the key things your doctor will consider include:

• The type of episode you’re currently experiencing – different medications are used for mania, hypomania, depression or mixed episodes
• Your history of mood episodes – how often they occur, how severe they’ve been and how they’ve responded to treatment in the past
• Previous bipolar disorder medications – whether you’ve taken any before, how well they worked, and what, if any, side effects you had
• Your physical health – conditions affecting your liver, kidneys or thyroid can influence which medications are safe and appropriate
• Pregnancy – some medications carry risks during pregnancy, so your doctor will carefully weigh up the benefits and risks if you’re pregnant or planning to be
• Your lifestyle – this includes how likely you are to take medication regularly and attend monitoring appointments

When should I start taking medication for bipolar disorder?

Medication is often recommended early in the treatment of bipolar disorder – sometimes soon after diagnosis – especially if your symptoms are severe, distressing or disrupting your everyday life. Starting medication early can help bring your mood under control and reduce the likelihood of future episodes.

However, everyone’s journey is different. Some people may choose to delay starting medication, while others might stop and restart it later, depending on how their symptoms change over time.

You may want to speak to your doctor about starting medication if you’re:

• Finding it hard to manage your mood swings, especially if they’re affecting your relationships, work or daily routine
• Feeling overwhelmed by depressive or manic symptoms
• Struggling with sleep, agitation, racing thoughts or low energy for long periods
• Worrying about your safety or decision-making during an episode
• Experiencing symptoms that are becoming more frequent, severe or unpredictable

Even if you’re unsure whether medication is the right step, having an open conversation with your GP or a psychiatrist can help you understand your options and make a decision that feels right for you.

Taking medication for bipolar disorder

Bipolar disorder is a long-term condition, but with the right treatment and support, you can live a stable and fulfilling life. Medication doesn’t ‘cure’ bipolar disorder – instead, it helps to manage symptoms and reduce their impact over time.

For many people, medication plays an important role in:

• Reducing the severity and frequency of mood episodes
• Helping you feel more in control of your emotions
• Supporting better sleep, more consistent energy levels, and healthier relationships

You’ll usually need ongoing treatment to maintain stability. This often includes a combination of medication, talking therapy and practical lifestyle support tailored to your needs.

Regular check-ins with your psychiatrist are an important part of staying well. They can help monitor how you’re feeling, adjust your treatment if needed, and make sure you feel supported as life changes.

If you’re looking for support, Priory can help. Our expert psychiatrists, therapists and mental health professionals have years of experience in supporting people with bipolar disorder. We offer a range of flexible treatment options – from outpatient appointments and therapy, to more structured inpatient programmes – so you can find care that fits your life.

Wherever you are in your journey, we’re here to help you move forward.