What are once-monthly mental health injections?
Once-monthly shots for mental health are a type of long-acting injectable (LAI) antipsychotic medication. These are not a single product but rather a category of medicines prescribed to individuals with specific mental health disorders, such as schizophrenia and bipolar I disorder. Unlike daily oral medications, LAIs are administered by a healthcare professional into a muscle, where the medicine is slowly released into the body over several weeks. This sustained release ensures consistent therapeutic levels of medication are maintained, helping to manage symptoms effectively between doses.
Key once-monthly injectable antipsychotics
Two of the most well-known once-monthly options are:
- Abilify Maintena (aripiprazole): FDA-approved for the treatment of schizophrenia and for maintenance monotherapy of bipolar I disorder in adults. It is administered via an intramuscular injection into the buttocks or deltoid muscle.
- Invega Sustenna (paliperidone palmitate): An atypical antipsychotic indicated for the treatment of schizophrenia and schizoaffective disorder in adults. A typical dosing schedule involves two initial doses a week apart, followed by monthly maintenance injections.
Other long-acting formulations exist with different dosing intervals. For instance, some risperidone extended-release injections can be administered once a month, while longer-lasting versions of paliperidone are available for administration every 3 or 6 months after stabilization on the monthly version.
How do these long-acting injectables work?
LAIs utilize an extended-release formulation to deliver a steady supply of medication into the bloodstream over time. When a healthcare provider administers the injection, the medication forms a small, harmless depot in the muscle. Over the next month, the active pharmaceutical ingredient is slowly released, maintaining a consistent therapeutic level in the patient's system. This contrasts sharply with oral medications, where daily dosing can lead to peaks and troughs in medication levels, potentially causing more side effects or less consistent symptom control. The slow and consistent release from LAIs promotes greater medication stability and adherence.
Benefits of a once-a-month shot
For individuals with certain mental health conditions, particularly those struggling with medication adherence, once-monthly injections offer several significant advantages:
- Improved Adherence: Missing daily oral doses is a common problem that can lead to relapse. A monthly injection removes the burden of remembering to take medication every day, ensuring patients receive consistent treatment.
- Greater Stability: The slow, steady release of medication helps prevent the fluctuations in drug concentration that occur with daily dosing. This can lead to more stable symptom control and a reduced risk of relapse.
- Increased Independence: By providing reliable, long-lasting symptom control, these injections can help individuals live more independently and improve their overall quality of life.
- Enhanced Monitoring: Regular monthly visits with a healthcare provider for the injection provide a consistent opportunity to monitor symptoms, side effects, and overall progress.
Important considerations and side effects
While effective, once-monthly injections have important considerations. Potential side effects are generally similar to their oral counterparts and should be discussed with a healthcare provider. A significant safety consideration is a boxed warning concerning the increased risk of death in elderly patients with dementia-related psychosis who use antipsychotics.
Common side effects for medications like Abilify Maintena and Invega Sustenna can include:
- Injection site pain, redness, or swelling
- Weight gain
- Restlessness or agitation (akathisia)
- Drowsiness or sedation
- Dizziness
- Metabolic changes, such as changes in blood sugar or cholesterol levels
- Involuntary movements (tardive dyskinesia), though this risk is generally lower with atypical antipsychotics
It is crucial to be aware of these potential side effects and to discuss them openly with your healthcare team. The benefits of improved adherence and consistent symptom control must be weighed against these risks on an individual basis.
Comparison of Once-Monthly Injectables
| Feature | Abilify Maintena (Aripiprazole) | Invega Sustenna (Paliperidone Palmitate) |
|---|---|---|
| Indicated Conditions | Schizophrenia, Bipolar I Disorder | Schizophrenia, Schizoaffective Disorder |
| Active Ingredient | Aripiprazole | Paliperidone |
| Injection Site | Deltoid (upper arm) or gluteal (buttock) muscle | Deltoid or gluteal muscle |
| Initiation Requirement | Oral aripiprazole must be taken for 2 weeks prior and continued for 2 weeks after the first injection | Tolerability to oral paliperidone or risperidone established first. Two initial injections administered one week apart. |
| Maintenance Schedule | Once monthly | Once monthly |
| Common Side Effects | Injection site pain, weight gain, restlessness, sedation, constipation | Injection site pain, headache, weight gain, restlessness, sedation |
Conclusion: Making an informed decision
The once-a-month shot for mental health, delivered via long-acting injectable antipsychotics, offers a reliable and convenient treatment option for individuals managing conditions like schizophrenia and bipolar I disorder. Medications like Abilify Maintena and Invega Sustenna address a key challenge in mental healthcare: consistent adherence. By providing a steady, continuous dose of medication, these injections help maintain stable symptom control, reduce the risk of relapse, and improve long-term outcomes. However, the decision to use a monthly injectable is a personal one, made in collaboration with a healthcare provider, after carefully considering the benefits, potential side effects, and individual circumstances. For those who find daily pill regimens challenging, a monthly shot can be a transformative step toward better mental health management. For more information on treatment options and mental health resources, you can visit the National Alliance on Mental Illness (NAMI) website.
