Deciding which medication to add depends on the severity and type of symptoms, your history of response to medications, and your preference, says Zimbrean. “For instance, a patient who is improving on lithium, but continues to be anxious and have trouble sleeping, may benefit from adding a low dose of [a second generation atypical antipsychotic].”
Atypical antipsychotics treat bipolar symptoms by blocking signals from brain messengers like dopamine and serotonin. Depending on which messenger the drug targets most, some work better for manic and mixed episodes, while others treat depressive episodes best.
If you need adjunctive therapy, your provider may recommend adding one of these atypical antipsychotics.
- Aripiprazole (Abilify) treats acute manic and mixed episodes.
- Asenapine (Saphris) treats acute manic and mixed episodes. It’s placed under the tongue, which allows it to reach the bloodstream more effectively than if swallowed.
- Cariprazine (Vraylar) treats acute manic, mixed, and depressive episodes.
- Lurasidone (Latuda) treats bipolar depression.
- Olanzapine (Zyprexa) treats acute manic and mixed episodes, and when added to lithium, can work faster than other adjuncts.
- Quetiapine (Seroquel) treats acute manic, mixed, and depressive episodes.
- Risperidone (Risperdal) treats acute manic and mixed episodes.
- Ziprasidone (Geodon) treats bipolar mania and is also used as maintenance therapy.
Many atypical antipsychotics have similar side effects, which may include:
- Drowsiness
- Dizziness
- Nausea, vomiting, or diarrhea
- Weight gain
- High cholesterol
- Changes in heart rhythm
- Insulin resistance and an increased risk of developing diabetes
- Abnormal blood test results (for example, changes in blood counts or liver enzymes)
- Involuntary movements, restlessness, tremors, or jerking motions
Some have more specific side effects. For example, asenapine can cause mouth numbness, and ziprasidone can cause a skin rash.
Atypical antipsychotics may be discouraged for some people with liver disease, glaucoma, or a weak immune system. These medications also increase the risk of stroke and death in older adults with dementia. If these medications are being used for depression, there is a risk of suicidal and hostile ideation in young adults and children.
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