What is the evidence for the use of second-generation antipsychotic long-acting injectables as maintenance treatment in bipolar disorder?

BACKGROUND: In recent years, the use of second-generation antipsychotics long-acting injectable in the maintenance treatment of bipolar disorder has sparked interest in improving adherence and reducing the risk of relapse.

AIMS: This report aims to review the available evidence concerning the use of second-generation antipsychotics depot in bipolar disorder and specify the typology of patients that could be eligible for this formulation.

METHODS: A systematic review of the literature was conducted using Pubmed and EMBASE.

RESULTS: Data available for the clinician assessing the interests of second-generation antipsychotics depot in long-term treatment of bipolar disorder are limited to risperidone. It seems particularly relevant for bipolar patients with poor adherence or early in the course of illness and can be used as monotherapy with manic polarity. It should always be considered for use in combination with at least one other mood stabilizer in patients with depressive polarity. As for other medications, the benefit/risk ratio for a long-acting should be evaluated individually.

CONCLUSIONS: If using a depot formulation could be considered for all patients in order to approach a perfect compliance, patients with certain clinical profiles could be an argument for prioritizing the use of long-acting injectable as maintenance treatment. Additional studies are needed with other second-generation antipsychotics depot in bipolar patients to generalize their use in the maintenance treatment of bipolar disorder but the future golden standard of studies with long-acting formulations remains to be defined.