Verapamil for Mania in Bipolar Disorder

The Scarce Science Behind This Calcium Channel Blocker

A woman with bipolar disorder.
A woman with bipolar disorder.. Peter Dazeley/Getty Images

Verapamil, a type of calcium channel blocker, was studied years ago as a therapy for manic episodes in people with bipolar disorder. That being said, the scientific data behind it is scarce and controversial, meaning some studies have found a benefit and others have not. Regardless, it's not a typical or standard medication used by psychiatrists in treating bipolar disorder.

Let's examine the scientific history behind using verapamil and other calcium channel blockers in bipolar disorder.

What are Calcium Channel Blockers?

Calcium channel blockers affect the movement of calcium into cells of the heart and blood vessels, relaxing the blood vessels and increasing the supply of blood and oxygen to the heart. They are generally used to treat high blood pressure, arrhythmia (irregular heartbeats) and angina pectoris (heart-related chest pain).

The main calcium channel blocking agents that have been examined as potential therapies for bipolar disorder, especially with manic episodes include:

  • Verapamil - brand names Calan, Isoptin SR
  • Nimodipine - brand name Nimotop
  • Diltiazem - brand names Cardizem, Cartia XT, Dilacor XR, Tiazac


Regarding it potential benefit, one 2002 study in Biological Psychiatry examined 11 women with either mania or mixed symptoms of depression and mania. Of these 11 women, 9 of them showed a positive response or improvement in their mania after being treated with verapamil.

In a 2008 study in Bipolar Disorders, verapamil alone did not improve manic episodes, but when combined with lithium, it did. That being said, the study was still small, with only 10 patients taking the combination of verapamil and lithium.

The author did note too that any person taking a combination of verapamil and lithium needs to be monitored closely, as there is a possibility of serious side effects like:

  • worsening of lithium side effects
  • choreoathetosis — involuntary movements
  • slow heart rate with possible heart attack
  • problems with coordination


One 2002 case study in the American Journal of Obstetrics and Gynecology reported on the successful use of nimodipine in a woman who was pregnant. She was unable to tolerate a more traditional mood stabilizer, lithium.

Also, according to an older study in Bipolar Disorders, nimodipine may be useful for people with bipolar disorder who do not respond to traditional medications, especially those with ultra-rapid-cycling and brief recurrent depressive episodes.


In a small 2000 study in the Journal of Psychiatry and Neuroscience, of 8 patients with treatment-resistant bipolar disorder, there was a decrease in both their manic and depressive episodes after taking diltiazem. That being said, there were some problems with the design of the study. For instance, the patients were taking other medications other than diltiazem, and it was small.

What Does This All Mean?

It's important to understand that calcium channel blockers are not typical medications for mania — as evidenced by the fact that there are few studies on them.

With that, it's unclear at this time what the future role of calcium channel blockers will be in treating the mania of bipolar disorder. It may be that it's used in combination with other mood stabilizers when a person is not responding to the mood stabilizer alone or other combinations of medications.


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Goodnick PJ The use of nimodipine in the treatment of mood disorders. Bipolar Disord. 2000 Sep;2(3 Pt 1):165-73.

Mallinger AG et al. Verapamil augmentatin of lithium treatment improves outcomes in mania unresponsive to lithium alone: preliminary findings and a discussion of therapeutic mechanisms. Bipolar Disord. 2008 Dec;10(8):856-66.

Silverstone PH & L. Birkett. Diltiazem as augmentation therapy in patients with treatment-resistant bipolar disorder: a retrospective study. J Psychiatry Neurosci. 2000 May;25(3):276-80.

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Yingling DR, Utter G, Vengalil S, & Mason B. Calcium channel blocker, nimodipine, for the treatment of bipolar disorder during pregnancy. Am J Obstet Gynecol. 2002 Dec;187(6):1711-2.

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