Managing the Side Effects of Bipolar Disorder Medication

Lithium

Lithium is one of the most commonly prescribed mood stabilizers and is considered one of the go-to options for treating bipolar disorder. Lithium is often very effective and is considered the only mood stabilizer that significantly reduces the chance of suicidal ideation. But it can be associated with some unpleasant side effects, including:

• restlessness
• dry mouth, increased thirst, and frequent urination
• digestive issues, such as nausea
• trembling of the hands

Some people may experience less common side effects, such as:

• tiredness
• vomiting and diarrhea
• blurred vision
• impaired memory and difficulty concentrating
• skin changes, such as dry skin or acne
• muscle weakness

Lithium also requires regular bloodwork while taking it because it can cause thyroid or kidney problems.

Anticonvulsants

Some anticonvulsants, which are commonly used to treat seizure disorders, are also useful mood stabilizers. They can be particularly helpful for managing the mood symptoms of bipolar disorder. Some examples include divalproex (or valproic acid), carbamazepine, and lamotrigine.

Side effects depend on the particular anticonvulsant but commonly include:

• drowsiness
• dizziness and poor coordination
• nausea, vomiting, or mild cramps
• blurred vision
• confusion
• muscle tremors
• skin sensitivity, including sensitivity to the sun, and rashes
• headache

Less common side effects associated with these types of medications include:

• mild hair loss
• weight gain
• bruising or bleeding
• liver problems
• menstrual cycle changes

Divalproex is typically associated with fewer side effects than the other anticonvulsants. In rare cases, carbamazepine can cause low blood cell counts, which may lead to mouth sores and fever or flu-like symptoms. Lamotrigine can cause a severe rash in rare cases.

Second-generation antipsychotics

Second-generation antipsychotics are also known as atypical antipsychotics. They are often paired with other medications used to treat bipolar disorder, including mood stabilizers. Second-generation antipsychotics are typically preferred over first-generation antipsychotics. Older first-generation antipsychotics are associated with a chance of involuntary movements.

The use of second-generation antipsychotics may be associated with an increased chance of metabolic side effects. These may include:

• weight gain
• diabetes
• elevated cholesterol and triglycerides

Antipsychotics, in general, may also cause:

• heart arrythmias
• low blood pressure when standing
• sedation
• sexual dysfunction

If you experience any of these side effects, it’s important to let your healthcare team know and discuss your options. If the side effects are too much but your treatment is otherwise working, your doctor may suggest some adjustments to your treatment plan before changing medications. They may:

• adjust the dose
• change when and how you take your medication
• prescribe another medication to help manage the side effects

For example, if you experience nausea when taking your medication, your doctor may suggest you take your dose with food. If your medication causes drowsiness, taking it before bedtime may minimize the effects on your daily routine.

Other lifestyle interventions, such as getting regular exercise and eating a heart-healthy diet, can be useful to help prevent and minimize the effects of weight gain from medications.

A change of medication may be the best option for some people. Based on the types of side effects you are experiencing, your doctor may suggest switching to a different medication.

It’s important to talk with your healthcare team before discontinuing any medication, even if you feel that your bipolar disorder is well controlled. Abruptly stopping your medication can cause your bipolar disorder symptoms to worsen.

Certain antidepressants can trigger mood episodes in some people with bipolar disorder if they are taken alone. They are typically used in combination with antipsychotics.

You’ll want to tell your doctor about all the medications you take. Also, if you want to discontinue any medications included in your treatment plan, you’ll want to first consult with your healthcare team.

The safest bipolar disorder medication is one that controls the symptoms of the condition and causes the fewest or most tolerable side effects. Because there’s no one-size-fits-all approach to bipolar disorder treatment, a plan may look different for everyone.

For most people, lithium is highly effective at controlling mood and can even lower suicidal ideation. Also, your doctor will want to monitor your well-being regularly to ensure no concerns regarding thyroid or kidney function.

People at high risk for heart disease or diabetes may want to avoid antipsychotics, which may cause a metabolic disturbance. Others may find they’re helpful at controlling their symptoms.

You’ll want to work with your healthcare team at finding the safest option that controls your symptoms and minimizes unpleasant side effects.

Not taking bipolar disorder medication can have serious effects, too. Even if your condition is well controlled, stopping your medication can cause symptoms to return.

People with bipolar disorder are also at increased risk for:

• other mental health concerns (anxiety, substance use, or eating disorders)
• thyroid disease
• migraine
• heart and vascular disease
• diabetes
• obesity

In addition to stabilizing your mood, bipolar disorder medications can help reduce the chance of these health concerns, including heart disease and stroke.

The side effects of bipolar disorder medications can be unpleasant, but there are options that can help you manage them. You’ll want to talk with your healthcare team before deciding to stop any medication. They’ll offer ways to adjust your current treatment plan to reduce the effects of your medications.

Finding the right medication for you may take some time and a little bit of trial and error. You and your healthcare team can work together to find the treatment plan that works best for you.