Antipsychotics for Bipolar Disorder

Antipsychotic medications work by balancing chemicals in the brain (neurotransmitters) that, when unbalanced, can cause mental disorders. It is not clear exactly how these medications work for the treatment of bipolar disorder. However, they do quickly improve manic episodes. At present, olanzapine is the only antipsychotic medication that has been formally approved for treatment of bipolar disorder; however, others are commonly prescribed.


Olanzapine acts as a mood stabilizer to manage the manic phase of bipolar disorder. Olanzapine is easy to take, and it has been shown to be safe and effective for the treatment of mania due to bipolar disorder. It is usually effective at easing manic symptoms after only one week of treatment.

Side effects of Olanzapine can include:

  • Drowsiness
  • Low blood pressure that can make a person feel dizzy when they stand up
  • Allergic reaction to the medication (skin rash)
  • Headaches
  • Sleepiness


Risperidone has not yet been formally approved for treatment of bipolar disorder, although it may be prescribed. Risperidone can help restore more normal thinking and a more normal mood. Preliminary studies show it to be helpful for those people with bipolar who experience "breakthrough" episodes of depression and mania (mood disruption that occurs while taking maintenance medications to control these episodes). Risperidone may also be effective in the treatment of mania in young people, although research continues in this area.

Risperidone is often used in individuals who are resistant to treatment with other medications. It is associated with decreased side effects compared with other available drugs. It is often used successfully to treat symptoms of psychosis.

Side effects of Risperidone can include:

  • Sleepiness
  • Weight gain
  • Breast tenderness
  • Allergic reaction (skin rash)
  • Headaches
  • Constipation
  • Decreased sexual desire and function
  • Increased heart palpitations

Before taking olanzapine or risperidone, tell your physician if you have:

  • A seizure disorder
  • Problems with liver function
  • Blood pressure or constipation
  • A history of breast cancer
  • Problems with swallowing

Other things to be aware of when evaluating these medications.

This type of medication should not be taken if you are pregnant or have had a condition called neuroleptic malignant syndrome.

  • These medications should be started in low doses in older adults. Talk with your doctor about any other medications you may be taking to make sure there are no negative drug interactions.
  • You may want to consider having liver function tests performed periodically while taking an atypical antipsychotic medication. Your blood pressure should also be monitored.
  • Avoid herbal stimulants (such as Ma-huang, ginseng, or kola) and grapefruit (which may make the medication toxic) while taking an antipsychotic medication.