One of the hurdles for people living with bipolar disorder I is sticking to a treatment plan. When you skip doses of your medicine, it increases your chances of mood episodes that can harm your mental health. One way to combat this problem is through extended-release injectable antipsychotic medications.
The goal of bipolar I treatment is to balance or “smooth out” your moods so that you have fewer swings that can lead to depression or mania. Antipsychotic drugs are often a good option for people whose symptoms aren’t quite under control with other medications, such as mood stabilizers. You may add antipsychotics to your mood stabilizer or take them instead of a mood stabilizer.
When you take these medications in pill or liquid form by mouth, you typically need to remember to take them once a day. But there are new extended-release injectable options you only get once every two weeks to two months. These shots can make it easier to stay the course with your treatment and reduce your risk of relapse and hospitalization.
How Extended-Release Injections Work
Doctors aren’t sure exactly how extended-release injectables work to reduce bipolar I symptoms. But they do know that antipsychotic drugs interact with the parts of your brain that deal with thinking, mood, and perception.
Newer antipsychotics, including extended-release injectables for bipolar I, are sometimes called atypical antipsychotics. They tend to act quickly and can help you avoid the impulsive, risky behaviors that can come with mania. Your thinking calms down from its manic state and stabilizes within a few weeks after starting them.
Studies show that these medications work better against episodes of mania than depression in bipolar I.
Aripiprazole extended-release injection (Abilify Maintena) is the first FDA-approved extended-release injectable for bipolar I maintenance. It's given to adults once per month.
Risperidone long-acting injection (Risperdal Consta) can be given every two weeks to adults for the maintenance phase of bipolar I.
How You Take Them
All extended-release injections for bipolar I are meant to go into a muscle. Your doctor will give you these drugs either in your arm or your bottom.
As for aripiprazole, if you’ve never had this medicine before, whether as a shot or a pill, your body will need time to adjust to it. You’ll need to take it in tablet form every day for up to two weeks before you get your first shot. You’ll continue to take these tablets for two more weeks after receiving your first shot, too.
With risperidone, you’ll take daily tablets for the first three weeks after you get the first shot.
Your doctor will help you decide which extended-release injectable is best for you. It will depend on your specific symptoms, medical history, and other things.
Side Effects
Like all medications, extended-release injectables come with some risks. For starters, they can cause pain, swelling, and redness around the spot where you get the shot. They also bring all the same possible side effects as they do in pill form. The specific side effects you could have depend on the type and dosage of your injectable. Some of the more common ones include:
- Weight gain
- Headache
- Extreme tiredness
- Stomach pain
- Constipation
- Vomiting
- Dry mouth
- Back, muscle, or joint pain
- A hard time falling asleep or staying asleep
- Dizziness, feeling unsteady, or having trouble keeping your balance. This can happen often right after taking the medication, or especially when standing up from a lying down position.
- Involuntary movement of your muscles, a condition called tardive dyskinesia
Most side effects only last while you’re taking the drug. But involuntary muscle movements can continue after you go off the medication and be permanent.
One very rare and life-threatening complication is called neuroleptic malignant syndrome, which causes fever, muscle stiffness, and delirium – extreme confusion and loss of your sense of reality. You’re at higher risk of this side effect if you have to take high doses of the medicine early in your treatment. If you have these symptoms, you need to call 911 and get to the hospital right away.
If your side effects are bad enough that they outweigh the benefits of the medication, your doctor can adjust your dose, prescribe other medications to help control some of the side effects, or possibly change you to another medication.
Show Sources
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SOURCES:
Mayo Clinic: “Bipolar Disorder.”
Archives of Neuropsychiatry: “Long Acting Injectable Antipsychotics in the Treatment of Schizophrenia and Bipolar Disorder.”
MedlinePlus: “Aripiprazole Injection.”
SMI Adviser: “What should clinicians know about risperidone or Risperdal Consta (‘Consta’) (risperidone microspheres LAI)?” “What extended-release injectable (LAI) antipsychotic medications are available in the U.S.?”
Haddad, P. and Fleischhacker, W., Oxford Academic, Antipsychotic extended-release injections, 2013.
Centre for Addiction and Mental Health: “Antipsychotic Medications.”
