Mood Stabilizers vs. Antipsychotics for Bipolar Disorder: What’s the Difference?

If you've been diagnosed with bipolar disorder, your treatment plan may include a mood stabilizer, an antipsychotic medication or both.

But what does that mean, exactly? What do these medications do, and why might they be prescribed together?

Psychiatrist Edward Kilbane, MD, gives an overview of the differences between mood stabilizers and antipsychotics — including why both can be important parts of treatment for bipolar disorder.

Are mood stabilizers and antipsychotics the same thing?

Mood stabilizers and antipsychotic medications are not the same. They’re two separate categories of medications that are used to treat certain aspects of bipolar disorder.

• Mood stabilizers are designed to do exactly what their name says: stabilize your mood over time. “They help even out the extreme emotional highs and lows — the mania and depression — that bipolar disorder can bring,” Dr. Kilbane says.
• Antipsychotic medications can work quickly to help treat acute mania and depression. They affect some of the neurotransmitters in your brain and change the balance of certain chemicals.

Your treatment may involve one or more medications, along with other treatments, like talk therapy.

“Once you’ve received a diagnosis, there are some very effective treatments that we can turn to,” Dr. Kilbane says. “And it’s important to note that, for most people, the treatments we have work quite well.”

Dr. Kilbane takes a deeper look at these two categories of medications.

Mood stabilizers

Mood stabilizers are medications that help prevent or lessen the extreme highs and lows that bipolar disorder can bring. They do that by affecting the brain chemicals involved in mood regulation, which can help:

• Ease symptoms of mania and hypomania and depression
• Reduce mood swings
• Lessen the likelihood of future episodes

While these medications can be very helpful in the long term, they don't work immediately. It may take several weeks before you notice their full effects.

“Mood stabilizers are the mainstay of treatment for bipolar disorder,” Dr. Kilbane says. “They’re the medications we tend to start with.”

When it comes to bipolar disorder management, lithium and certain antiseizure medications (originally developed to treat epilepsy) are the most commonly used mood stabilizers. Some are more helpful for mania, some for bipolar depression and others for maintenance.

Atypical antipsychotics

The term “antipsychotic” may feel upsetting or surprising, especially if you've never had hallucinations or other symptoms associated with psychosis. But antipsychotic medications can be effective treatments for bipolar mania, depression and mood stabilization.

“Also, people with bipolar I disorder may experience symptoms of psychosis when they’re sick, and these medications can help with hallucinations or paranoid thoughts,” Dr. Kilbane explains.

A newer category of medications called second-generation (atypical) antipsychotics can be especially helpful. They work by changing the way certain neurotransmitters, including dopamine and serotonin, affect your brain.

And they work relatively quickly, which makes them especially helpful when you’re experiencing an episode of bipolar mania or depression.

“These medications were initially approved to treat schizophrenia, but they’re now used to treat a range of mental health conditions, including bipolar disorder,” he adds.

Are they ever used together?

Mood stabilizers and antipsychotic medications are sometimes prescribed together. But it all depends on your symptoms.

Your provider may recommend combined treatment if you:

• Have severe symptoms, like psychosis
• Experience “mixed states” (manic and depressive symptoms at the same time)
• Need additional support for long-term mood stability

“There’s often room to try different therapies at the same time,” Dr. Kilbane notes.

What about antidepressants?

Many people who have bipolar disorder experience depressive episodes. So, you might wonder: Shouldn’t antidepressant medications be part of treatment, too?

“You would think that an antidepressant would be a good idea,” Dr. Kilbane acknowledges. “But the evidence actually isn’t great for antidepressants in bipolar disorder.”

In fact, there’s evidence that antidepressants’ effects on serotonin can actually contribute to manic episodes in people with bipolar disorder. Instead, he explains that mood stabilizers can help fill in the gaps to achieve what you’d expect antidepressants to do.

“A lot of the mood stabilizers we use are approved not just for bipolar disorder, but also for bipolar disorder in a depressive episode,” Dr. Kilbane shares. “They have some inherent antidepressant effects to them.”

That doesn’t mean antidepressants are never used in bipolar disorder. The decision depends on your individual symptoms and treatment plan.

Final thoughts

For most people, treatments for bipolar disorder are very effective. But mania and depression can sometimes be hard to treat, especially if your symptoms change over time.

It’s important to work with your healthcare provider on an ongoing basis so they know what’s working, what isn’t and whether your treatment plan needs to change.

“Bipolar disorder is a chronic condition, and it has fluctuations,” Dr. Kilbane recognizes. “So, it’s a matter of finding a provider that you connect with and identifying a medication — or a combination of them — that works for you.”