Medications For Bipolar

Presentation from Royal Edinburgh Hospital pharmacists on different medication treatments for bipolar disorder

April Meeting: Medications For Bipolar

This month, we were joined by lead clinical pharmacist Paul Maguiness and specialist pharmacists Jennifer Falconer and Morven Forsyth from the Royal Edinburgh Hospital to discuss bipolar medication. Their presentation explored the different medication types for bipolar treatment and how they are used for episodes of acute mania, episodes of acute depression, and relapse prevention. Read the highlights from the presentation below or view their full presentation slides.

Types of Medications

Antipsychotics (Second Generation)	Quetiapine – mania, depression and preventing relapse ​ Olanzapine – mania, depression, preventing relapse ​ Risperidone, Aripiprazole – mania, preventing relapse, effective in acute illness ​ Lurasidone – bipolar depression (unlicensed) ​ Cariprazine – mania, depression (unlicensed)
Mood Stabilizers	Lithium Valproate Lamotrigine Carbamazepine
Antidepressants	SSRIs (Selective Serotonin Reuptake Inhibitors) - Sertraline, Citalopram, Fluoxetine SNRIs (Serotonin–Noradrenaline Reuptake Inhibitors) - Venlafaxine, Duloxetine TCAs (Tricyclic Antidepressants) - Amitriptyline, Nortriptyline, Imipramine MAOIs (Monoamine Oxidase Inhibitors) - Phenelzine, Moclobemide NaSSAs (Noradrenergic and Specific Serotonergic Antidepressants) - Mirtazapine​ SARIs (Serotonin Antagonist and Reuptake Inhibitors) - Trazodone Others - Vortioxetine, Bupropion, Agomelatine

Recommended Medication Treatment

Acute Manic Episode	Antipsychotics Mood stabilizers (Lithium, Valproate) Benzodiazepines
Acute Depressive Episode	Antipsychotics Mood stabilizers Antidepressants
Relapse Prevention/Maintainance	Antipsychotics Valproate Carbamazepine Antidepressants

Key takeaways

• Antipsychotics are the 1st line of treatment for mania

• Lithium is 1st line of treatment for long term prevention

• Valproate is considered a better treatment option for mania

• Antidepressants have a risk of increasing mania/hypomania

• Medication treatment requires physical health monitoring

Additional information and resources

Take a look at the NHS handy chart for more on bipolar medications. You can also visit our Resources page to find more information about topics related to bipolar.

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