The most widely prescribed medication for both bipolar I and bipolar II disorder is lithium. Approved by the FDA in 1970, lithium has long been considered a first-line treatment for managing manic, depressive, and mixed episodes, as well as for maintenance therapy to prevent mood swings.
However, over the past two decades, there has been a significant shift in prescribing patterns. The use of second-generation (atypical) antipsychotics has increased substantially. By 2016, more than half of outpatient visits for bipolar disorder included a prescription for these medications, up from just 12% in 1997.
Conversely, lithium prescriptions decreased from 30.4% to 17.6% during the same period. Commonly prescribed second-generation antipsychotics for bipolar disorder include:
These antipsychotics are often used alone or in combination with mood stabilizers like lithium or anticonvulsants, depending on the individual's symptoms and treatment response.
In summary, while lithium remains a foundational treatment for bipolar disorder, second-generation antipsychotics have become increasingly prevalent in clinical practice.
The choice of medication is highly individualized, taking into account the specific type of bipolar disorder, symptom severity, side effect profiles, and patient preferences.
