Best antipsychotics (in conjunction with lithium) for bipolar 1

I have bipolar 1 and have been on lithium for about 2 years. During those years I have had both a full manic episode and then a depressive episode later.

I have tried Seroquel with some drowsiness side effects and since then have been on Seroquel XR which has given me worse drowsiness.

What are the best options in terms of antipsychotics?

(P.S. I have tried one antiepilieptic drug and had a bad reaction so I am not comfortable with trying another one.)

Hi TicTacGo,

I highly recommend taking this question to a psychiatrist rather than asking our opinions, because everyone is different and may have different experiences with medications.

@scaredandconfused - I will be seeing her this week; I am just looking for the opinions of others, which are always taken with the knowledge that the users on this forum are not doctors.

zyprexa works well for me. I know others suffer side effects from it. Your Pdoc will recommend what is best.

i think it really depends on the effect you need and how well you tolerate tranquilizers/antipsychotics. if seroquel was too sedating, then you'll probably want something high potency.

perphenazine compares well to many "atypicals" in long term treatment of Schizophrenia. Here in the US, family doctors would often use perphenazine at low doses in bipolar people, until prescribing habits shifted towards depakote and then the "atypicals."

loxapine might be atypical-ish, in terms of tolerability...if one keeps the dose low enough.

amoxapine is chemically related to loxapine. its not available everywhere in the world, but its still somewhat popular in the us for psychotic depression. its a tca that does double duty as a tranquilizer. when it works, it often works faster than other available drugs.

abilify...maybe? as with any tranquilizer, keep an eye on the dose, especially with lithium on board. akathisia is a big problem (in large studies...), but ive never had akathisia with it (I dealt with akathisia from other "atypicals," though...).

zyprexa is very effective. in large studies w/ people diagnosed as Schizophrenic, zyprexa comes in 2nd to clozapine. metabolic problems are a big issue. eps, td, akathisia, etc. still occur, just not as frequently as with the older drugs. sedation, emotional numbing, etc. seem to come with the territory. some people take metformin with the zyprexa to mitigate weight gain and metabolic problems.

i would personally skip risperidone. prolactin elevation, more td than other "atypicals," weight gain, sedation, more eps than many other "atypicals."

here in the us, there are 2 new abilify-ish options: rexulti and vraylar. i dont know if they're available in your country or what their trade names are, if they're marketed there. they're d2 partial agonists. i think both are now approved for schizophrenia and are being used in depression in bipolar, also.

i had an acquaintance who did well on navane. that's another older tranquilizer/antipsychotic. she tolerated it well, it got the job done, no major eps or other problems.

some people do well on geodon. im scared of it, personally, but some people swear by it. 2x daily dosing, tends to be sedating for a while. there was a black box in the us for heart complications, so...that's an issue.

the flupentixol you're taking at a low dose could potentially be increased, to a point. from what little ive read about flupentixol, it doesnt' cause too many problems and can help with anxiety, agitation, and depression....if one watches the dose. go too high, its basically thorazine.

ok. hope this helps. good luck.

@still_crazy - I am taking your advice in consideration and making notes to take with to my next appointment.

I'm on monthly injections of invega sustenna, works great. No side effects

My pdoc prescribed Latuda today for me. But my insurance won't cover it and a 30 day supply is over $1,000.
Latuda has a low side effects profile.

I'm bipolar with psychotic features. I did not do well on Seroquel or Abilify so I didn't take an AP for about a year. Now the music and voices have returned. My doctor said I may need to go IP.

My insurance refused to pay for mine for about 6 months. My doctor kept sending in appeals until we got it covered. It's still quite expensive but nothing like the price without insurance. Just be prepared to pay the highest copay your insurance has. Until we got it approved I took samples.

Schizoaffective, PTSD, Anxiety

UPDATE:

We are going to try Risperdal and see what happens. I'm hopefully gonna do alright on this one.

Good luck on the risperdal.