How Do Antimanic Agents Work?

Antimanic agents are medications used as mood stabilizers in psychiatric conditions such as bipolar disorder and schizophrenia. In addition, some antimanic agents control abnormal electrical activity in the brain and are used to treat neurological conditions such as epilepsy and trigeminal neuralgia.

Antimanic agents control mania, an extremely euphoric and excited mood associated with psychiatric disorders. Antimanic agents also control involuntary muscle contractions or pain caused by the abnormal firing of nerve cells (neurons). Antimanic agents work by regulating the chemical balance and activity, and electrical activity in the brain.

Antimanic agents help reduce manic excitement by acting on several neurotransmitters such as dopamine, serotonin and norepinephrine, which are chemical messengers that neurons release to communicate with each other and stimulate activity. 

Antimanic agents primarily block D2 dopamine receptors and 5-HT2A serotonin receptors, which are protein molecules that initiate excitatory action when stimulated by these neurotransmitters. Some antimanic agents stimulate H1 histamine receptors in the central nervous system, producing sedation and calming effects. 

Antimanic agents prevent abnormal electrical impulses by stabilizing the sodium channels in neurons and reducing their electrical conductivity.

• Antimanic agents may be administered as:
• Oral tablets, capsules, solutions or suspensions
• Intramuscular or subcutaneous injections

Antimanic agents are used to treat the following conditions:

FDA-approved:

• Schizophrenia
• Bipolar I disorder mania
• Major depressive disorder
• Autism
• Tourette syndrome (a nervous system disorder involving repetitive movements or unwanted sounds)
• Epilepsy
• Trigeminal neuralgia
• Bipolar I disorder (manic or mixed episodes)
• Bipolar I disorder maintenance
• Agitation associated with schizophrenia and bipolar I mania
• Bipolar depression

Off-label uses:

• Restless legs syndrome
• Postherpetic neuralgia
• Chemotherapy associated nausea or vomiting
• Stuttering
• Alcohol dependence
• Insomnia
• Psychosis or agitation related to Alzheimer dementia
• Posttraumatic stress disorder (PTSD)

Orphan designation:

• N-glycanase 1 deficiency

Side effects of antimanic agents may include the following:

• Weight gain
• Headache
• Agitation
• Insomnia
• Anxiety
• Nausea
• Vomiting
• Akathisia (restlessness)
• Lightheadedness
• Increased appetite
• Constipation
• Dyspepsia (indigestion)
• Abdominal discomfort/pain
• Diarrhea
• Gastritis
• Anorexia (loss of appetite)
• Ataxia (impaired coordination, balance and speech)
• Dizziness
• Fatigue
• Somnolence (drowsiness)
• Lethargy
• Sedation
• Confusion
• Increased waist circumference
• Increased diastolic blood pressure
• Tachycardia (rapid heartbeat)
• Abnormal ECG
• Orthostatic hypotension (blood pressure drop when standing up from sitting or lying down)
• Syncope (fainting)
• Hypotension (low blood pressure)
• Bradycardia (slow heartbeat)
• Palpitations
• Atrial fibrillation
• Chest pain
• Myocardial infarction (heart attack)
• Congestive heart failure (CHF)
• Aggravation of hypertension/hypotension
• Aggravation of coronary artery disease
• Atrioventricular block
• Bundle branch block (block of electrical impulse pathway to the heart)
• Arrhythmia (irregular heartbeat)
• Cardiomyopathy (heart muscle disease)
• Myocarditis (inflammation of heart muscle)
• Sudden cardiac death
• Cerebrovascular disease
• Transient ischemic attack (stroke caused by reduced blood supply to the brain)
• Hypertriglyceridemia (high triglycerides in the blood)
• Hypercholesterolemia (high cholesterol in the blood)
• Hyperprolactinemia (increase in blood prolactin levels)
• Hyperglycemia (increase in blood glucose levels)
• Increased HbA1c values
• Increase in blood insulin levels
• Diabetic ketoacidosis and coma
• Increased creatinine phosphokinase
• Elevated levels of liver enzymes ALT and AST
• Liver injury
• Jaundice
• Hepatitis
• Pancreatitis
• Hepatosplenomegaly (enlargement of liver and spleen)
• Liver failure
• Extrapyramidal symptoms (drug-induced movement disorders)
• Asthenia (weakness)
• Falls
• Accidental injury
• Xerostomia (dry mouth) with sore and inflamed mouth and lips
• Dryness of the pharynx
• Rhinitis (inflammation of the nasal passage)
• Nasopharyngitis (inflammation of the nasal passage and pharynx)
• Rhinorrhea (runny nose)
• Cough
• Blurred vision
• Parkinsonism
• Tremor
• Pituitary adenoma (benign tumor in the pituitary gland)
• Drooling
• Dysgeusia (taste disorders)
• Hyperacusis (sensitivity to sounds)
• Tinnitus (ringing in ears)
• Ear pain
• Back pain
• Neck pain
• Connective tissue and bone disorders
• Musculoskeletal stiffness
• Pain in extremities
• Muscle spasms
• Muscle rigidity
• Muscle weakness
• Myalgia (muscle pain)
• Arthralgia (joint pain)
• Dyskinesia (involuntary muscle movements)
• Enuresis (urinary incontinence)
• Nocturnal enuresis (bedwetting)
• Urinary frequency
• Urinary retention
• Dysuria (painful urination)
• Azotemia (increased blood urea nitrogen [BUN] and creatinine)
• Renal failure
• Ileus (temporary lack of intestinal muscle contraction)
• Intestinal obstruction
• Colon ischemia (reduced blood supply to the colon)
• Fecaloma (impacted stool)
• Fecal incontinence
• Decreased thyroid function
• Hypersensitivity reactions such as:
  • Rash
  • Pruritus (itching)
  • Urticaria (hives)
  • Angioedema (swelling in the tissue under the skin or mucous membranes)
  • Laryngospasm and oropharyngeal spasm (throat spasms)
  • Photosensitivity
  • Erythema multiforme (round lesions like bullseye)
  • Erythematous nodosum (painful bumps under the skin)
  • Exfoliative dermatitis (redness and peeling of the skin)
  • Generalized exanthematous pustulosis (pustular eruptions)
  • Onychomadesis (separation of nail from nail bed)
  • Drug rash with eosinophilia and systemic symptoms (DRESS)
  • Anaphylaxis (severe allergic reaction)
  • Stevens-Johnson syndrome (a rare medical emergency with flu-like symptoms and a painful rash)
  • Toxic epidermal necrolysis (a severe skin condition with widespread redness, skin cell death and exfoliation which can lead to sepsis)
• Aggravation of lupus erythematosus (an autoimmune disorder)
• Infections
• Alopecia (hair loss)
• Diaphoresis (excessive sweating)
• Excessive salivation
• Excessive thirst
• Injection site pain and reactions
• Facial edema
• Pitting edema
• Decrease in weight
• Blood disorders such as:
  • Neutropenia (low levels of neutrophil, a type of immune cell)
  • Increase or decrease in levels of leukocytes
  • Agranulocytosis (low granulocytes, immune cells with granules)
  • Anemia (low red blood cell count)
  • Aplastic anemia (anemia due to reduced red cell production)
  • Pancytopenia (decrease in all types of blood cells)
  • Eosinophilia (high level of eosinophils, a type of immune cell)
  • Thrombocytopenia (decrease in platelet count)
  • Thrombotic thrombocytopenic purpura (a rare disorder characterized by clotting in small blood vessels, resulting in a low platelet count)
  • Porphyria (a group of disorders that can cause nerve or skin problems) 
• Bone marrow depression
• Hemorrhage
• Epistaxis (nasal bleeding)
• Vasculitis (inflammation of blood vessels)
• Thrombophlebitis (inflammation of veins with blood clot)
• Thromboembolism (obstruction of a blood vessel by a blood clot)
• Deep vein thrombosis (DVT)
• Pulmonary embolism
• Adenopathy (swelling of glands)
• Lymphadenopathy (swelling of lymph nodes)
• Hyperpyrexia (high temperature)
• Dyspnea (shortness of breath)
• Pneumonia/pneumonitis (lung inflammation)
• Sleep apnea (interrupted breathing during sleep)
• Gynecomastia (breast tissue growth in males) in children
• Sexual dysfunction
• Precocious puberty
• Menstrual disorders
• Vaginal discharge
• Impotence
• Retrograde ejaculation
• Priapism (persistent and painful erection)
• Aggressive reaction
• Talkativeness
• Depression with agitation
• Amnesia (loss of memory)
• Schizophrenia
• Altered mental status
• Blunted affect (reduced ability to express emotions) 
• Delirium
• Nightmares
• Autonomic instability (dysfunction of the autonomic nervous system)
• Depressed level of consciousness
• Peripheral neuritis (damage to peripheral nerves)
• Paresthesia (abnormal skin sensations)
• Dysphagia (swallowing difficulties)
• Hiccups
• Hypothermia (drop in body temperature)
• Oculogyric crisis (prolonged upward deviation of the eyes)
• Punctate (marked by tiny holes or dots) cortical lens opacities
• Increased ocular pressure
• Transient diplopia (double vision)
• Visual hallucinations
• Nystagmus (involuntary eye movement)
• Conjunctivitis (inflammation of the conjunctiva, the membrane over the whites of the eye and inner surface of eyelids)
• Teary eyes
• Eye discharge and margin crusting
• Eye and eyelid swelling
• Dry eyes
• Ocular hyperemia (redness of eyes)
• Light sensitivity
• Reduced visual acuity
• Glaucoma (a condition that damages the optic nerve)
• Neuroleptic malignant syndrome (a rare life-threatening drug reaction)
• Tardive dyskinesia (a neurological disorder that causes involuntary repetitive movements)
• Stuttering and other speech disorders
• Restless legs syndrome
• Rhabdomyolysis (breakdown of skeletal muscle cells)
• Seizure
• Status epilepticus (a medical emergency, when a seizure lasts longer than five minutes)
• Suicidal ideation and attempt
• Pathological gambling
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH, a disorder which causes water retention)
• Hyponatremia (reduced sodium levels in the blood)
• Reduced calcium in the blood leading to osteoporosis
• Immune hypersensitivity reaction
• Hypogammaglobulinemia (immune system disorder that prevents antibody production)
• Drug withdrawal syndrome

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of antimanic drugs include:

• Abilify
• Abilify Maintena
• Abilify MyCite
• aripiprazole
• Aristada
• Aristada Initio
• carbamazepine
• Carbamazepine Chewtabs
• Carbatrol
• Epitol
• Equetro
• olanzapine
• olanzapine/samidorphan
• Perseris
• quetiapine
• Risperdal
• Risperdal Consta
• risperidone
• Seroquel
• Seroquel XR
• Tegretol
• Tegretol XR
• Teril
• Zyprexa
• Zyprexa Relprevv
• Zyprexa Zydis