Not really sure where this list came from, but I have a lot to add! Pharmacy background (not a doctor) here (in the US so YMMV) and Bipolar 2 with anxiety features and ADHD. I am only speaking from my educational background and this is most certainly not medical advice.
Typically these days AEDs are first line along with antipsychotics if the patient is distressed. Personally I take Lamictal and used to keep an emergency stash of antipsychotics but I don’t metabolize them well. Lithium seems to be a last resort kind of thing because of the small therapeutic range. It’s hard to ensure continuous blood level monitoring, but from what I hear from other pts is good things.
Drugs affecting serotonin should be used with extreme caution. These primarily include SSRIs SNRIs but also some drugs you might not expect. Trazodone indicated for sleep, buspirone indicated for anxiety, Zolfran indicated for nausea are a few on the top off my head but is not an exhaustive list. The fastest I have ever achieved hypomania was buspirone in about 2 weeks. In comparison it took about 4 months for Zoloft.
Benzodiazepines are the black sheep in pharmaceuticals in my opinion. The therapeutic range is huge so the odds of overdose are near 0. Primarily for anxiety, some of these drugs have a very mild mood stabilization effect. They also help reduce excess movement tardive diskenesia from long term antipsychotic use. Personally, I have never had to increase my dose and have been on a regular low dose schedule for about 4 years, but they can be addictive.
Beta blockers- Propranolol is unique in that it’s not selective as to which beta receptors it affects. Long story short, can prevent adrenaline rushes and in turn prevent anxiety attacks.
Stimulants are typically not advised but I’m sure a lot of people on here have comorbid adhd and can understand the value. Data on this is a bit polarized (pun intended). My opinion that is purely anecdotal to my experiences trying to find the right treatment is that providers only seem to care about preventing mania and rarely seem concerned about all the other facets of mental health once the BD is slapped on my chart. I’m lucky after 15 years to have found a provider who treats me as a whole person and sees that if I cannot manage my hyperactivity and regulate my emotions, then I say or do things impulsively that end up growing into larger mood episodes.
Sorry for editorializing this so much. I find chemistry fascinating
I half-heartedly tried therapy. First visit I told her one topic was off limits. Second, she pushed and I reminded her it was off limits. Third time, she spent most of the visit trying to get me to talk about it. $70 a week to talk about things I'm super busy trying to repress... pass lmao