Considering Lexapro for Bipolar Disorder Treatment? Read This

You may have heard of using the SSRI Lexapro to treat anxiety and depression –– but is it beneficial for people with bipolar disorder, too? Read on to learn more.

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Bipolar disorder, also known as bipolar depression, is a mood disorder marked by intense highs (manic episodes) and lows (depressive episodes). The symptoms of this disorder can make day-to-day functioning really difficult. Not to mention, quality of life can take a hit. 

Psychiatric medication is an effective way to manage bipolar disorder symptoms, whether you have bipolar I, bipolar II, or cyclothymia. Lexapro is a commonly prescribed psychiatric medication –– but should it be prescribed for bipolar disorder? Read on to learn more about whether or not you should take Lexapro for bipolar disorder, as well as other treatment options for this mood disorder.

Introduction to Lexapro for bipolar disorder

First, it’s important to understand what Lexapro is. Lexapro, the brand name for escitalopram, is an antidepressant medication that acts on serotonin, a chemical messenger in your brain that is partially responsible for mood. 

As a selective serotonin reuptake inhibitor (SSRI), Lexapro blocks the reuptake of serotonin, which means it increases the amount of available serotonin in your brain. By increasing serotonin levels, selective serotonin reuptake inhibitors like Lexapro can help reduce symptoms of depression and anxiety.

Lexapro is FDA-approved for the treatment of:

• Major depressive disorder (MDD) in adults and children 12 years old and up 
• Generalized anxiety disorder (GAD) in adults and children 7 years old and up

Should you take Lexapro for bipolar disorder?

So we know that Lexapro can help depression and anxiety symptoms, but what about bipolar disorder symptoms? Generally speaking, psychiatrists do not prescribe Lexapro, especially on its own, to people with bipolar depression. “Lexapro is not FDA-approved for bipolar disorder,” says Dr. Eli Muhrer, Charlie Health’s Medical Director. “Without a mood stabilizer, it can trigger mania and/or worsen mood instability in those with bipolar disorders.”

This can be potentially dangerous since manic episodes can result in impulsive, reckless behaviors. Not to mention, mania can also result in psychosis, including hallucinations or delusions. 

On top of potentially triggering a manic episode, using any SSRI for bipolar disorder treatment can also increase the risk of rapid cycling, which means having more frequent mood episodes –– whether manic episodes or depressive episodes. 

However, there are cases where a psychiatrist might prescribe Lexapro –– but only if mood is stabilized first via medication, Dr. Muhrer says. For example, if someone has a co-occurring anxiety disorder alongside bipolar, a doctor may prescribe Lexapro after the bipolar mood symptoms are stabilized with medication, says Dr. Muhrer.

Still, you have to be cautious. “It should be started slowly and under the close care of a psychiatric provider to assess for any worsening mood instability and/or manic symptoms,” he adds. 

What are better medication options for bipolar disorder?

If you have bipolar disorder, other medications are better, safer options to improve your mental health and manage symptoms, as opposed to SSRIs.

Dr. Muhrer says mood stabilizers and atypical antipsychotics are considered first-line treatments for bipolar disorder –– however, they do require close monitoring. In some cases, providers may recommend taking a mood stabilizer and an antipsychotic medication together. 

1. Mood stabilizers for bipolar disorder

Mood stabilizers help to level out mood. For example, if you’re experiencing an acute manic episode, a mood stabilizer can help you return to baseline. Additionally, mood stabilizers can be used for maintenance treatment, which means they can prevent mood episodes from happening in the first place.

Examples of mood stabilizers are:

• Lithium
• Depakote (valproic acid)
• Lamictal (lamotrigine)
• Tegretol (carbamazepine)

2. Atypical antipsychotics for bipolar disorder

Although antipsychotics are typically associated with treating psychosis, they are also useful for treating bipolar disorder symptoms. 

Examples of atypical antipsychotics are:

• Abilify (aripiprazole)
• Latuda (lurasidone)
• Seroquel (quetiapine)
• Symbyax (olanzapine and fluoxetine) 
• Vraylar (cariprazine)

How to choose the right bipolar medication for you 

Ultimately, your psychiatrist will determine which mood stabilizer or atypical antipsychotic is the best fit for you. They will consider your symptoms, overall mental health, and whether you have bipolar I, bipolar II, or cyclothymia. Depending on your bipolar subtype, certain medications may be a better choice than others.

Your psychiatrist will also take any co-occurring mental health conditions into account. Bipolar disorder commonly occurs alongside:

• Anxiety disorders
• Attention-deficit hyperactivity disorder (ADHD)
• Eating disorders
• Substance use disorder
  

After getting a comprehensive view of your whole mental health, your provider can determine if adding on another medication, such as an SSRI like Lexapro, would make sense as a part of your treatment plan. Your provider will explain the benefits and risks of the medication, including common side effects. Make sure to take the medication exactly as prescribed by your doctor. 

Therapy for bipolar disorder treatment

In addition to psychiatric medications, therapy plays a key role in bipolar depression treatment. For many people with bipolar disorder, a combination of psychiatric medication (like a mood stabilizer or antipsychotic) and therapy brings the most effective, long-lasting relief. 

“While medications help stabilize mood and reduce the intensity of manic and depressive episodes, therapy provides tools for managing the daily challenges, emotional regulation, and lifestyle adjustments necessary for long-term stability,” Dr. Muhrer explains. 

He says that if you have bipolar disorder, therapy can help you:

• Develop healthy coping strategies
• Improve sleep hygiene 
• Prevent relapse into mood episodes
• Build structure and routine
• Foster healthy relationships and communication
• Address co-occurring conditions, such as anxiety disorders

Some therapy modalities that are commonly used for bipolar disorder treatment are: 

1. Cognitive-behavioral therapy (CBT)

CBT helps you identify unhealthy, negative thought patterns that may contribute to your bipolar symptoms. For example, you might uncover unhelpful thought patterns you have while you’re in a depressive episode and learn how to challenge these thoughts to create healthier ones. More helpful thought patterns can lead to healthier behaviors, improving mental health.

2. Dialectical behavior therapy (DBT)

DBT is a skills-based therapy rooted in mindfulness and acceptance, focusing on regulating emotions and improving relationships. The four key pillars of DBT are mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. 

3. Group psychoeducation

Psychoeducation refers to learning about your mental health condition so you can better understand it. In a group setting, you’ll learn more about what bipolar disorder is and how to manage mania and depressive episodes. You’ll also get to connect with other people who are in the same shoes as you. 

4. Family-focused therapy

This form of family therapy involves bipolar disorder psychoeducation and building healthy communication skills within the family. Family members will learn how to best support their loved one with bipolar disorder, including helping them stick to their treatment plan.  

5. Interpersonal and social rhythm therapy (IPSRT)

This unique therapy focuses on your interpersonal relationships and daily schedule. It helps you improve your relationships by teaching healthy conflict resolution, communication skills, and healthy boundaries. It will also help you optimize your daily routine, creating stability in your life.  

How Charlie Health can help

If you or a loved one are struggling with bipolar disorder, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for individuals and families dealing with serious mental health conditions, including bipolar I, bipolar II, and cyclothymia. 

Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. We also offer medication management as needed. With the right support team and a well-rounded treatment plan, managing your bipolar disorder is possible. Fill out the form below or give us a call to start healing today.