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Your doctor will figure out what medication to prescribe based on various factors, such as: the kind of episode you’re experiencing, and the severity of that episode; how quickly you need the medication to work; whether you have any co occurring psychiatric or medical disorders; any previous responses with medication; the safety and tolerability of the medications; and personal preference.If none of those treatments work, the next option is one of these medications (which are considered “second line” because of their safety and tolerability risks): olanzapine, carbamazepine, ziprasidone, and haloperidol. Another option is the combination therapy of olanzapine with lithium or divalproex.Lithium and divalproex also are commonly combined in clinical practice. For instance, lithium or divalproex plus an atypical antipsychotic is helpful if you need a faster response, and have more severe episodes.

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