Antipsychotic long-acting injections: mind the gap

Emerging treatments in the management of bipolar disorder - focus on risperidone long acting injection

Bipolar disorder is a life-long psychiatric illness characterized by a high frequency of relapses and substantial societal costs. Almost half of the patients are prescribed second generation antipsychotics for treatment of manic states, or as the maintenance therapy. Risperidone long acting injection (RLAI) as a monotherapy or as adjunctive therapy to lithium or valproate for the maintenance treatment of bipolar I disorder was approved by Food and Drug Administration (FDA) in United States in May 2009. In this review we will consider the aspects of pharmacology, pharmacokinetics, metabolism, safety and tolerability, and clinical trials focusing on the efficacy of RLAI in bipolar disorder. The patients' perspective and attitudes to long-acting injections will also be discussed.

How much more effective do depot antipsychotics have to be compared to oral antipsychotics before they are prescribed?

Antipsychotic depots are less frequently prescribed than oral compounds. In an experimental study involving N=106 psychiatrists we studied how much more effective with respect to relapse prevention depot antipsychotics have to be compared to oral antipsychotics before they are chosen for prescription. Most psychiatrists have to judge depot as clearly superior with respect to relapse prevention before they recommend it to patients. If psychiatrists judge depot as unpleasant for the patients and do not see much need for checking their patients' compliance they are less likely to prescribe depot. Other psychiatrist-related factors (e.g. age, gender, and work experience) did not influence attitudes toward depot.