Medication Adherence and the Use of Long-Acting Antipsychotics in Bipolar Disorder

Abstract

Adherence to treatment is a major determinant of outcome in bipolar disorder. Poor insight, attitudes towards treatment, and poor understanding of medications and the illness can all lead to reduced adherence. Nonadherence and partial adherence both also appear to play a significant role in relapse. Thirty to forty percent of patients with bipolar disorder who attempt to be adherent to treatment are actually only partially adherent. Clinicians frequently address the problem of poor adherence by adding an antipsychotic medication to the mood stabilizer regimen. The availability of a long-acting atypical antipsychotic raises the possibility of using this agent to prevent bipolar relapse. The literature on the use of depot antipsychotics in bipolar illness is reviewed, based on a search of PubMed and Ovid Medline. No randomized, controlled trials of depot antipsychotics in bipolar illness have been performed. However, several case series and naturalistic trials that have used first generation agents suggest that depot antipsychotics are effective in reducing relapse in bipolar illness. Depot antipsychotics, including long-acting first and second generation agents, can be important adjuncts in the long-term management of bipolar illness. Controlled trials with these agents in bipolar disorder are warranted.