What Is the Most Prescribed Drug for Bipolar Disorder?

October 7, 2025 •

4 min read

An estimated 2.8% of U.S. adults experienced bipolar disorder in the past year, with 82.9% of these cases classified as having serious impairment [1.7.1]. The answer to 'What is the most prescribed drug for bipolar?' is complex, as treatment involves several classes of highly effective medications.

Quick Summary

A detailed look at the medications used for bipolar disorder. The most common treatments include mood stabilizers like lithium and atypical antipsychotics such as quetiapine, with the best choice depending on individual symptoms.

Key Points

No Single Answer: There isn't one 'most prescribed' drug; treatment is individualized based on symptoms and bipolar disorder type [1.2.1].
Key Medication Classes: The primary drug classes are mood stabilizers (like lithium and lamotrigine) and atypical antipsychotics (like quetiapine and aripiprazole) [1.2.2].
Rise of Antipsychotics: Atypical antipsychotics are now frequently prescribed first-line agents for treating both manic and depressive episodes [1.5.2].
Lithium's Enduring Role: Lithium is a highly effective 'gold standard' mood stabilizer, particularly for treating mania and reducing suicide risk [1.2.4, 1.2.6].
Lamotrigine for Depression: The mood stabilizer lamotrigine (Lamictal) is a preferred option for maintenance therapy to prevent depressive episodes [1.2.1, 1.9.1].
Combination Therapy: Many individuals require more than one medication (e.g., a mood stabilizer plus an antipsychotic) to manage their symptoms effectively [1.4.1].
Personalized Journey: Finding the right medication regimen is a collaborative process between the patient and their healthcare provider [1.2.1].

Understanding Bipolar Disorder and Treatment Goals

Bipolar disorder is a mental health condition characterized by dramatic shifts in a person's mood, energy, and ability to think clearly [1.7.4]. These shifts involve high and low moods, known as mania and depression. The primary goal of pharmacological treatment is to stabilize these moods, manage acute episodes of mania or depression, and prevent their recurrence over the long term [1.5.4]. Because the illness presents differently in each person—with varying severity and frequency of episodes—there is no single 'best' medication. Treatment is highly personalized and often requires adjustments over time [1.2.1].

What Is the Most Prescribed Drug for Bipolar? A Complex Answer

There is no single medication that stands out as the most prescribed for all individuals with bipolar disorder [1.2.1]. However, treatment guidelines and prescription data point to a few key players. Historically, Lithium has been considered the "gold standard" mood stabilizer since its approval in 1970 and remains a first-choice option, especially for treating mania and preventing relapse [1.2.1, 1.2.6].

In modern practice, atypical antipsychotics are now very commonly prescribed, sometimes more frequently than traditional mood stabilizers. For example, a 2023 study noted that quetiapine was prescribed to 54–65% of patients on an antipsychotic [1.4.1]. This class of drugs is versatile, with certain agents approved to treat mania, bipolar depression, or for maintenance therapy [1.2.2]. Medications like quetiapine (Seroquel), aripiprazole (Abilify), and olanzapine (Zyprexa) are frequently used [1.2.1]. Studies show that mood stabilizers and antipsychotics are the most important drug classes for patients, often used in combination [1.4.1].

One large-scale study of initial treatment regimens found that mood stabilizers were the most common class used (43.8%), followed closely by antidepressants (42.3%) and atypical antipsychotics (31.7%) [1.3.2]. The most common single-drug regimen was lamotrigine (9.6%) [1.3.5]. This highlights that prescription patterns depend heavily on the specific type of bipolar disorder and whether the patient is experiencing a manic or depressive episode.

Key Medication Classes for Bipolar Disorder

Treatment for bipolar disorder falls into several categories, often used in combination to achieve the best results [1.2.4].

Mood Stabilizers: The Foundation of Treatment

This class is central to managing bipolar disorder. They work to control mood swings and prevent both manic and depressive episodes [1.2.4].

Lithium (Lithobid): Considered a first-line agent for long-term prophylaxis and acute mania [1.2.5]. It is also the only long-term medication for bipolar disorder that has been shown to decrease the risk of suicide [1.2.4]. However, it requires careful monitoring of blood levels to avoid toxicity and can have side effects like tremor, thirst, and potential kidney or thyroid problems [1.2.2, 1.6.2].
Anticonvulsants: Certain anti-seizure medications have proven mood-stabilizing properties and are widely used [1.2.1].
- Lamotrigine (Lamictal): Particularly effective for the maintenance treatment of bipolar I disorder and preventing depressive episodes [1.5.2, 1.9.2]. It is often a preferred medication for bipolar depression [1.2.1]. Gradual dose increases are necessary to minimize the risk of a serious rash [1.9.1].
- Divalproex Sodium (Depakote): Effective in treating and preventing mania and is often a first choice for mixed episodes or rapid cycling [1.5.2, 1.6.4]. Common side effects include drowsiness and weight gain [1.6.4].

Atypical Antipsychotics: A Modern Mainstay

Also known as second-generation antipsychotics, these medications are used to treat acute mania and, in some cases, bipolar depression. They are often prescribed alone or with a mood stabilizer [1.2.3].

Quetiapine (Seroquel): FDA-approved for treating acute mania, bipolar depression, and as a maintenance therapy [1.5.2, 1.5.6]. Side effects often include drowsiness and weight gain [1.2.1].
Aripiprazole (Abilify): Indicated for acute and maintenance treatment of manic or mixed episodes, either alone or with lithium or valproate [1.2.5]. Common side effects can include restlessness and nausea [1.2.1].
Lurasidone (Latuda): Approved to treat bipolar depression, both as a monotherapy and in combination with lithium or valproate [1.2.3].
Olanzapine (Zyprexa): Effective for acute mania and maintenance, but it is associated with significant weight gain and metabolic side effects [1.5.2]. A combination drug, Symbyax (olanzapine/fluoxetine), is specifically approved for bipolar depression [1.2.3].

Antidepressants: A Cautious Approach

Antidepressants are sometimes used to treat the depressive phase of bipolar disorder, but their use is controversial. They are almost always prescribed alongside a mood stabilizer or antipsychotic because, when used alone, they carry a risk of inducing a manic or hypomanic episode [1.2.1, 1.3.6]. Symbyax, a combination of an antidepressant (fluoxetine) and an antipsychotic (olanzapine), is the only FDA-approved antidepressant formulation for bipolar depression [1.2.4].

Comparison of Common Bipolar Medications


Medication	Class	Primarily Treats	Common Side Effects
Lithium (Lithobid)	Mood Stabilizer	Mania, Maintenance	Tremor, increased thirst, weight gain, kidney/thyroid issues [1.6.2].
Lamotrigine (Lamictal)	Mood Stabilizer (Anticonvulsant)	Bipolar Depression, Maintenance	Dizziness, headache, nausea, serious rash (rare) [1.2.1, 1.9.5].
Quetiapine (Seroquel)	Atypical Antipsychotic	Mania, Bipolar Depression, Maintenance	Drowsiness, weight gain, dry mouth, metabolic changes [1.2.1, 1.6.2].
Aripiprazole (Abilify)	Atypical Antipsychotic	Mania, Maintenance	Restlessness (akathisia), nausea, insomnia, dizziness [1.2.1, 1.2.5].
Lurasidone (Latuda)	Atypical Antipsychotic	Bipolar Depression	Nausea, restlessness, drowsiness, movement disorders [1.2.3, 1.2.5].
Divalproex Sodium (Depakote)	Mood Stabilizer (Anticonvulsant)	Mania, Mixed Episodes	Drowsiness, weight gain, dizziness, nausea, tremor [1.6.4].

Conclusion

While the question "What is the most prescribed drug for bipolar?" is common, it has no simple answer. Treatment is not one-size-fits-all. Lithium remains a foundational mood stabilizer, especially for mania, while anticonvulsants like lamotrigine are key for preventing depressive relapse [1.2.5, 1.9.2]. The most significant shift in recent years has been the rise of atypical antipsychotics like quetiapine, which are now first-line treatments for all phases of the illness—mania, depression, and maintenance [1.5.6]. Often, patients achieve stability through a combination of these medications, tailored by a psychiatrist to their specific needs and side effect tolerance [1.4.1]. The best treatment is a personalized, collaborative journey between patient and provider.

For more information on bipolar disorder, you can visit the National Institute of Mental Health (NIMH).

Frequently Asked Questions

First-line treatments for acute mania include mood stabilizers like lithium or divalproex, or an atypical antipsychotic [1.5.2]. For bipolar depression, first-line options include quetiapine, lurasidone, or the olanzapine-fluoxetine combination [1.2.2, 1.5.2].

Yes, monotherapy (using a single drug) can be effective for some people, especially in less severe cases [1.5.3]. However, combination therapy, using two or more medications, is very common and often more effective for managing complex symptoms [1.4.1].

Bipolar disorder is considered a lifelong illness, and most people require continuous, long-term maintenance treatment to prevent the recurrence of mood episodes [1.5.4, 1.9.5].

A mood stabilizer, like lithium or lamotrigine, works to prevent both high (manic) and low (depressive) mood swings [1.2.4]. An antidepressant specifically targets depression, but if used alone in someone with bipolar disorder, it can risk triggering a manic episode [1.2.1].

Lithium was the first medication specifically approved for bipolar disorder and remains a highly effective 'gold standard' for treating acute mania and preventing mood episode recurrence. It is also uniquely proven to reduce the risk of suicide in people with bipolar disorder [1.2.4, 1.2.6].

Common side effects vary by medication but frequently include drowsiness, weight gain, nausea, and tremor. Atypical antipsychotics are often associated with metabolic changes, while lithium can affect thyroid and kidney function with long-term use [1.6.2, 1.6.4].

They excel in different areas. Lithium is generally superior for treating and preventing mania, while lamotrigine is more effective at preventing depressive episodes [1.9.2]. The choice depends on which type of episode the patient is more prone to.