Caveat here that I’m neither a doctor nor a psychopharmacologist, but I am a psychotherapist with many years of inpatient experience on treatment teams with psychiatrists. Antipsychotics seem to most often be used as an adjunct treatment with a mood stabilizer when someone is experiencing severe mania or severe depression with psychosis. When someone’s symptoms are too severe, a mood stabilizer alone may either take much longer (like weeks) to stabilize someone, or it won’t stabilize them at all.

After stabilizing their most acute symptoms, we would always work with our patients to define a short term goal to work with their outpatient doc in tapering off the antipsychotic while continuing with a maintenance dose of mood stabilizer, because the goal should always be to be on as little medication as possible while maintaining stability.

The most common antipsychotic prescribed for bipolar is zyprexa, aka olanzipine, but the evidence seems to show that it’s no more efficacious than lithium or depakote as far as its usage as a maintenance med, but it comes with a serious risk of weight gain, metabolic syndromes, and EPS, where the side effect profiles for the mood stabilizers are much more tolerable on average. Where olanzipine shines though is in treating that acute phase of severe mania or depression in the short term.

Everyone is different and everyone’s body responds differently to different meds, but personally if I had severe bipolar disorder, I would try my damnedest to avoid relying on an antipsychotic as a maintenance med.

I don’t know the science and medicine, but Seroquel helps me sleep at night (I am bi-polar). When I was in my 20s, a much larger dose did nothing for me. Many years later, we tried it again because physiology changes. Now it works. Too much and it’s hard to wake up in the morning.

I still liked taking a strong dose of Halcyon better. I could pop up in the morning feeling fantastic. But my current doc won’t let me have it except when I need to wake up and drive in the morning because it’s “habit-forming.” The Seroquel leaves me a little hazy for a while, so when we were two days in office after the pan rescinded, that’d be a Halcyon sleep. Luckily, my current gig is a ten minute walk from home.

Bipolar involves dysregulation of dopamine. Schizophrenia also involves dopamine but in a different way.

Second generation antipsychotic medications are not only dopamine antagonists but also potent serotonin antagonists. Regulating serotonin uptake can help stabilize mood, both with depression and elevated states. So possibly more to do with their effects on serotonin receptors than dopamine receptors. (Not a doctor but nothing I said can’t be confirmed with a quick google scholar search)

For me it helps with brain fog and memory and also the other psychiatric disorder I have, trichotillomania, which is very hard to treat. They also have anti manic activity in the second generation antipsychotics.