The concurrent use of two long-acting injectables in the maintenance treatment of bipolar disorder.

Abstract

Bipolar disorder is a serious condition that can cause significant impairment in patients' lives. As such, it is important to ensure good treatment and management of the condition. However, adherence to pharmacological treatment is a significant problem, and risks of non-adherence include hospitalization and suicide. Both antipsychotic medications and mood stabilisers are recommended for the maintenance treatment of bipolar disorder. According to the Canadian Network for Mood and Anxiety Treatment (CANMAT) 2018 guidelines, psychoeducation should be provided initially to reduce non-adherence to medication. If this is ineffective, long-acting injectable (LAI) antipsychotics should be considered (1). The CANMAT guidelines also state that most patients with bipolar disorder will require short or long-term combination treatment to address acute or subsyndromal symptoms and to reduce rates of recurrence. To our knowledge, this is the first case presentation that examines the combination of two antipsychotic LAIs for maintenance treatment of bipolar disorder. We describe two patients with bipolar disorder, with a history of multiple relapses due to non-adherence to oral medications, who were maintained on both Paliperidone 150mg and Aripiprazole 400mg LAIs once every 4 weeks.