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Mood Stabilizer Overview/Topic Index | First-Generation Antipsychotic drugs (FGAs) & Atypical Antipsychotic drugs (AAPs) as Mood Stabilizers

1.  Crazymeds Used as Mood Stabilizers

Until the early 2000s practically everything prescribed in the US to treat bipolar disorder was an off-label prescription. At that time all the doctors had was lithium, Thorazine, and Depakote with FDA approval to treat mania; Thorazine and Depakote began as meds for something else, while lithium, just prior to its use as a mood stabilizer, was no longer considered a medication1. There were a whole bunch of antidepressants, with new ones being approved all the time, to very carefully treat the depressive episodes. However, some doctors refused to prescribe antidepressants at all. I liked to joke that if a med was in the PDR it was used by somebody, somewhere, at some time, to treat bipolar.

Ten years later there are even more options with FDA approval to treat bipolar disorder. Most of them are atypical antipsychotics (AAPs), and it’s likely that all meds in the new future approved to treat bipolar disorder will also be AAPs. There are still lots of Antiepileptic Drugs (AEDs) that are used, with or without the FDA’s official blessing, and more being approved all the time. Almost any AED will be used to treat bipolar sooner or later2.



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2.  List of Mood Stabilizers/Bipolar Agents/Antimanic Agents Approved by the FDA:

2.1  Antiepileptic Drugs (AEDs)/Anticonvulsants (ACs)

Antiepileptic drugs (AEDs), also known as anticonvulsants (ACs), with FDA approval to treat bipolar disorder:

2.2  Antipsychotics

Antipsychotics with FDA approval to treat bipolar disorder:

  • Abilify (aripiprazole)
  • Geodon/Zeldox (ziprasidone HCl) - but not Geodon IM (ziprasidone mesylate)
  • lithium
  • Risperdal (risperidone)
  • Saphris (asenapine)
  • Seroquel (quetiapine)
  • Thorazine (chlorpromazine)
  • Zyprexa (olanzapine) - including Zyprexa IM
  • Invega (paliperidone) - Not bipolar per se, however the oral version (but not Invega Sustenna, the once-a-month injection) is the first, and so far only, drug with FDA approval to treat the bastard love child of bipolar and schizophrenia: schizoaffective disorder.4
  • Symbyax (olanzapine & fluoxetine) - Technically classified as an antidepressant, this combination of the second-generation AP Zyprexa and the barely-selective SSRI Prozac was the first medication approved to treat bipolar depression, as well as the first medication approved to treat bipolar disorder and nothing else5.
  • Solian (amisulpride) is an SGA/AAP unavailable in the US, but approved elsewhere to treat bipolar disorder.


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3.  List of Drugs Often Prescribed Off-label as Mood Stabilizers / Bipolar Agents / Antimanic Agents

3.1  Antiepileptic Drugs (AEDs) / Anticonvulsants (ACs)

Antiepileptic drugs frequently prescribed off-label to treat bipolar disorder:

  • Depakene (valproic acid)
  • Tegretol (carbamazepine) - only Equetro is approved to treat bipolar in the US. Tegretol and generic carbamazepine are approved to treat it in Canada.
  • Topamax (topiramate)
  • Trileptal (oxcarbazepine)
  • Benzodiazepines
    • Ativan (lorazepam)
    • Klonopin (clonazepam)
    • Valium (diazepam)
    • Xanax (alprazolam)
  • Unless it’s one of the AEDs with side effects so bad that you’d use them only if nothing else works ( Sabril, Felbatol), it gets prescribed off-label to treat bipolar disorder.
  • Any newly-approved AED will get thrown at bipolar, assuming it’s not like Sabril or Felbatol. Don’t get your hopes up about any new AEDs going through the clinical trials for FDA approval to treat bipolar disorder. While the money is in bipolar disorder for SGAs/AAPs, as far as AEDs are concerned the money is in pain: headaches, fibromyalgia, and assorted forms of neuropathy and neuropathic pain.

3.2  Antipsychotics

Antipsychotics frequently prescribed off-label to treat bipolar disorder:

  • Haldol (haloperidol) - although it has a type of quasi-approval in that the PI sheet is littered with references to its use as an antimanic agent and the FDA didn’t tell Sandoz to remove them.
  • Although most First-Generation Antipsychotics (FGAs) were used for bipolar disorder at one time or another, you probably want to stick with Thorazine or Haldol.
  • Fanapt (iloperidone)
  • Clozaril (clozapine)
  • As with AEDs, any newly approved SGA/AAP that doesn’t have FDA approval for bipolar will get thrown at it anyway.

3.3  Miscellaneous Medications

Assorted other medications prescribed off-label to treat bipolar disorder:

  • Calcium Channel Blockers as Antimanics / Mood Stabilizers
    • verapamil - the most popular, and the only one with any results.
    • nimodipine - the data are contradictory as to whether it works or not.
    • isradipine - expensive and a pain in the ass to take.
  • Parkinson’s Disease / Restless Leg Syndrome Meds (dopamine agonists) as Antidepressants
    • Mirapex (pramipexole) - the most popular dopamine agonist prescribed off-label for depression.
    • Requip (ropinirole) - a close second. Bipolar depression responds fairly well to dopamine agonists.
    • Other dopamine agonists - second line meds for PD & RLS that are also used to treat the side effects of APs.
  • Stimulants as antidepressants and to treat ADD/ADHD that usually accompanies bipolar and/or bipolar is often misdiagnosed as. If you don’t believe me about bipolar disorder being misdiagnosed as ADD/ADHD (or vice versa), compare this test with this test. If it weren’t for the names could you tell the difference?


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| First-Generation Antipsychotic drugs (FGAs) & Atypical Antipsychotic drugs (AAPs) as Mood Stabilizers



1 Although lithium carbonate and lithium citrate had been used to treat gout, hypertension, and even epilepsy (lithium causes seizures - I know that all too well - and is used to induce them in critters when testing various things), by the 1940s lithium carbonate was considered to have no medicinal value and lithium citrate was a third-line sedative.

2 Almost being the key word. Drugs like Sabril (vigabatrin) and adrenocorticotropic hormone (ACTH), which are used to treat forms of epilepsy so bad, and respond to little else, that side effects like partial to (rarely, but possible) total blindness, or a $23,000 a vial (approximately one month's worth) price tag really do suck less than something like West syndrome.

3 Whatever the fuck enteric-release is.

4 Although Clozaril (clozapine) has the extremely specific approval for "Reducing the Risk of Recurrent Suicidal Behavior in Patients with Schizophrenia or Schizoaffective Disorder."

5 See above about lithium.



Drugs Used to Treat Bipolar Disorder is copyright 2012 Jerod Poore
Page created by: Jerod Poore. Date created: 26 January 2011 Last edited by: JerodPoore on: 2015–05–08





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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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