Why Your Doctor May Prescribe More Than One Medication for Bipolar Disorder

If your healthcare provider has prescribed more than one medication to help you manage bipolar disorder, you might have a few questions: Why isn’t one medication enough? And does needing multiple medications mean your condition is more severe?

Not necessarily.

Psychiatrist Edward Kilbane, MD, explains why a combination of medications is sometimes the best way to help manage the manic and depressive symptoms that bipolar disorder can cause.

Why might you need more than one medication?

“Some people with bipolar disorder need to take several medications on a regular basis,” Dr. Kilbane says. “That’s what we call polypharmacy.”

But your healthcare provider’s goal isn’t piling on more meds for the sake of it. It’s to identify the right tools for the symptoms you’re experiencing, so you can live as symptom-free as possible.

Research shows that about 33% of people with bipolar disorder take more than three medications to manage the condition. Here’s a look at when and why multiple medications might be needed.

Targeting different symptoms

Because bipolar disorder can affect both ends of the mood spectrum, healthcare providers often need more than one strategy to manage symptoms. And that may mean more than one medication.

“Bipolar disorder has two poles — depression and mania or hypomania,” Dr. Kilbane explains. “Some medications work better for mania, and some work better for bipolar depression. Others help with long-term mood maintenance.”

Addressing different timeframes

Two types of medications often prescribed for bipolar disorder help target different symptoms and different phases of the condition:

• Mood stabilizers are often prescribed for long-term management of the highs and lows.
• Atypical antipsychotics often help manage an acute episode of bipolar depression or mania and keep mood stable. They can also help with symptoms of psychosis, if you’re experiencing them.

“We tend to start with a mood stabilizer, like lithium salt or an antiseizure medication,” Dr. Kilbane says. “If needed, we may then add an atypical antipsychotic, especially if someone is experiencing symptoms like psychosis.”

Managing severe symptoms and risk

Everybody experiences bipolar disorder differently. Symptoms can be mild, moderate or severe. But you’re more likely to be prescribed multiple medications for bipolar disorder if you have a history of:

• Severe depression: “Most people with bipolar disorder have many more depressive episodes than manic episodes throughout their lifetime,” Dr. Kilbane notes. If your depression is severe or unrelenting, a medication combo may help.
• Suicide attempts: “Amongst mood disorders, bipolar disorder brings the highest suicide risk,” Dr. Kilbane shares. “Many people spend significant periods of time in depressive episodes, and suicidal ideation is a major symptom of depression — though it can also occur during mania or mixed episodes.” Lithium can be especially helpful in targeting suicidal ideation.
• Symptoms of psychosis: Bipolar disorder can affect your ability to tell the difference between what’s real and what’s not. These symptoms of psychosis may occur during a depressive episode, a manic episode or a mixed episode.

Lessening side effects

The medications you take to manage bipolar disorder can sometimes cause unwanted side effects. For example, antipsychotic medications may raise your blood sugar or cause weight gain. And both antipsychotics and mood stabilizers can cause daytime sleepiness.

Not everyone experiences negative side effects of their bipolar medications. But if you do, your provider will want to weigh possible solutions, such as adjusting a dose or switching to a different medication.

“There are also times when we might recommend adding another medication to help prevent or lessen a side effect that you’re experiencing,” Dr. Kilbane explains.

Managing related conditions

No single medication can do it all. If you have other mental health conditions, like an anxiety disorder, you may need additional medications to help manage severe or overlapping symptoms.

And in fact, bipolar disorder may raise your risk of certain conditions. A review of studies found that nearly 39% of people with bipolar disorder had at least one other psychiatric condition, especially:

• Anxiety disorders
• Substance use disorder (SUD)
• Attention-deficit/hyperactivity disorder (ADHD)
• Impulse control disorders

People with bipolar disorder may also have a higher risk of developing other conditions, like heart disease, migraines and obesity.

You may need other types of treatment, too

Even when you’re taking medication to manage your bipolar disorder, your healthcare provider may recommend other types of treatment, as well — all with the goal of helping you feel like the best version of yourself.

“There are multiple tools we can turn to as we address your symptoms, and pharmacological tools are just one of them,” Dr. Kilbane clarifies. “Other common tools include psychotherapy and lifestyle habits, like keeping a consistent routine and getting enough sleep.”

And there are others, too. Ask your healthcare provider whether additional therapies for bipolar disorder might fit into your treatment plan.

Final thoughts

Bipolar disorder is a chronic condition that requires lifelong management. If you want to better understand any aspect of your treatment plan, don’t hesitate to talk to your healthcare provider. They can explain why they’ve made certain recommendations and tell you what to expect from each of your medications.

It’s also important not to stop any of your prescribed medications without your doctor’s go-ahead. If your symptoms change over time, or if you’re experiencing unintended side effects, let them know.

“You can always come to us to say, ‘Hey, I've been very depressed,’ or ‘I'm concerned that I'm getting more manic,’” Dr. Kilbane encourages. “Your provider can help make the appropriate adjustments to get you back on track.”