What is the injection for mood stabilizers? A Comprehensive Overview

October 7, 2025 •

5 min read

According to one clinical trial, long-acting injectable (LAI) antipsychotics significantly delayed time to mood episode relapse in patients with bipolar I disorder compared to placebo. For individuals managing chronic mood conditions, understanding what is the injection for mood stabilizers? is a critical step towards more consistent and effective treatment, particularly for managing bipolar disorder.

Quick Summary

Injectable mood stabilizers, known as long-acting injectables (LAIs), are medications that release slowly over weeks or months. Used primarily for bipolar disorder, they can improve medication consistency, prevent relapse, and reduce hospitalizations, especially for those struggling with daily pill regimens.

Key Points

Long-acting injectables (LAIs) are available for mood stabilization: Medications like aripiprazole and risperidone come in injectable forms that act as mood stabilizers, particularly for bipolar disorder.
LAIs provide steady medication release: The injection creates a depot in the muscle, ensuring a slow and consistent release of the drug over weeks or months, avoiding the peaks and troughs of daily oral doses.
Improved medication adherence is a key benefit: For individuals who struggle to remember or take daily pills consistently, LAIs guarantee medication delivery and significantly improve adherence.
Injectables can reduce relapse and hospitalization: Studies show that consistent use of LAIs can lower the risk of mood relapses and reduce the need for repeat hospitalizations in bipolar disorder patients.
Healthcare providers manage the injection schedule: The injections are administered by a professional, removing the burden of self-administration and allowing for regular monitoring of the patient's condition.
Consideration of side effects is crucial: While offering benefits, LAIs also carry risks such as injection site reactions, weight gain, metabolic changes, and movement disorders, which must be discussed with a doctor.

Understanding Injectable Mood Stabilizers

For many individuals with bipolar disorder, maintaining a consistent medication schedule can be challenging due to the very nature of the illness, which involves fluctuating mood states that can impair judgment. Long-acting injectable (LAI) formulations offer a reliable alternative to daily oral pills, providing a steady and continuous dose of medication over an extended period. These injectables are often second-generation antipsychotics, which also function as mood stabilizers. They are administered by a healthcare professional, typically into a large muscle like the arm or buttocks.

How Long-Acting Injections Work

Long-acting injectables work by creating a 'depot' of the medication within the muscle where it is injected. This depot slowly releases the active drug into the bloodstream over weeks or months, ensuring a consistent therapeutic level of medication. Unlike oral medications that cause peaks and troughs in drug concentration, LAIs maintain a more stable level, which can lead to better symptom control and potentially fewer side effects. This mechanism bypasses the potential for missed or delayed daily doses, which is a major factor contributing to relapse in bipolar disorder.

Common Injectable Medications Used as Mood Stabilizers

Several long-acting injectable antipsychotics are used to manage bipolar disorder, often in combination with other mood stabilizers or as monotherapy for maintenance treatment. The specific choice depends on the patient's condition, history, and tolerability.

Aripiprazole (Abilify Maintena, Abilify Asimtufii, Aristada)

Aripiprazole is an atypical antipsychotic available in long-acting injectable form and is FDA-approved for the treatment and maintenance of bipolar I disorder. It is a partial dopamine and serotonin receptor agonist.

Abilify Maintena: Administered monthly via intramuscular injection.
Abilify Asimtufii: Administered less frequently than monthly, offering a different dosing schedule.
Aristada: Administered periodically via intramuscular injection after an initiation dose.

Risperidone (Risperdal Consta)

Risperidone is a second-generation antipsychotic with mood-stabilizing properties. Risperdal Consta is an intramuscular injectable form approved for the maintenance treatment of bipolar I disorder. It is typically administered periodically. Real-world studies have shown it can reduce hospitalization rates in bipolar I patients.

Paliperidone (Invega Sustenna, Invega Trinza, Invega Hafyera)

Paliperidone is the active metabolite of risperidone and is also available in long-acting injectable formulations.

Invega Sustenna: A once-monthly injection.
Invega Trinza: Administered periodically after a series of monthly injections of Invega Sustenna.
Invega Hafyera: A less frequent injection for individuals who have been adequately treated with Invega Sustenna or Invega Trinza.

Olanzapine (Zyprexa Relprevv)

Olanzapine pamoate is a long-acting injectable antipsychotic used for the maintenance treatment of schizophrenia, and also for managing acute agitation associated with bipolar I disorder. It is typically administered periodically. Zyprexa Relprevv requires a three-hour post-injection observation period due to the risk of Post-Injection Delirium/Sedation Syndrome (PDSS).

Oral vs. Injectable Mood Stabilizers: A Comparison


Feature	Oral Medications	Injectable (LAI) Medications
Administration	Daily, by patient	Periodic (e.g., monthly, quarterly), by healthcare professional
Adherence	Requires consistent daily effort; prone to lapses, especially during episodes.	Guarantees medication delivery for the full duration of the injection cycle.
Drug Levels	Fluctuating peaks and troughs, which can contribute to side effects and symptom instability.	Stable, steady therapeutic levels over weeks or months, leading to greater consistency.
Convenience	Daily routine can be a burden for some individuals with cognitive or motivational challenges.	Fewer appointments, removing the daily burden of remembering medication.
Relapse Prevention	Effective when taken consistently, but high non-adherence rates correlate with higher relapse risk.	Strong evidence for reducing relapse and rehospitalization rates, particularly in patients with a history of poor adherence.
Flexibility	Easier and faster to adjust dose or discontinue if a serious side effect occurs.	Dose adjustments take longer due to the extended-release nature of the medication.

Who is a Candidate for Injectable Treatment?

Injectable mood stabilizers are not suitable for everyone, but they can be a transformative option for certain individuals. Your healthcare provider will assess your needs and history to determine if an LAI is right for you. Common candidates include:

Individuals with a history of poor medication adherence. A significant percentage of individuals with bipolar disorder struggle with taking their medication consistently, and LAIs provide a reliable solution to this challenge.
Patients with frequent relapses or hospitalizations. Real-world studies have shown that LAIs are particularly effective in reducing rehospitalization rates, especially in those with frequent admissions.
Individuals seeking a simpler regimen. For those who find the daily reminder of a pill burdensome, receiving an injection every few weeks or months can improve their quality of life.
Patients with specific side effects from oral medication. Sometimes, the steady drug levels from an injection can lead to fewer peak-related side effects compared to the oral equivalent.
Those with concerns about medication diversion. Injectables remove the possibility of medication being sold or misused by the patient.

Potential Risks and Side Effects

Just like oral medications, long-acting injectable mood stabilizers have potential risks and side effects that need to be carefully monitored. It is important to have an open discussion with a healthcare provider about these before beginning treatment. Side effects can include:

Injection site reactions: Pain, swelling, or redness at the site of the injection are common, especially after the first few doses.
Metabolic changes: This can include weight gain and increases in blood sugar or cholesterol levels, which can increase the risk of type 2 diabetes.
Movement disorders: Known as extrapyramidal symptoms (EPS), these include restlessness (akathisia) and uncontrollable muscle movements.
Drowsiness or sedation: Some patients may experience sleepiness or impaired coordination, particularly when starting treatment.
Cardiovascular issues: Potential for dizziness or fainting due to a drop in blood pressure when standing up too quickly (orthostatic hypotension).
Increased risk in elderly dementia patients: The FDA has issued warnings that antipsychotic use in elderly patients with dementia-related psychosis is associated with an increased risk of death.

Conclusion: The Evolving Role of Injectable Mood Stabilizers

Injectable mood stabilizers, primarily composed of long-acting injectable (LAI) antipsychotics, have emerged as a significant and effective option for the long-term management of chronic mood disorders, particularly bipolar I disorder. By mitigating the challenge of daily medication adherence, they offer a consistent and steady therapeutic approach that can dramatically reduce the frequency of mood relapses and hospitalizations. While not a universal solution, and requiring careful consideration of potential side effects, LAIs can be a life-changing treatment for individuals who have struggled with traditional oral medication regimens. The growing range of LAI options, with different administration frequencies, allows for a more personalized treatment strategy tailored to the patient's lifestyle and clinical needs. For patients with a history of poor adherence or frequent relapse, a conversation with a healthcare provider about an injectable mood stabilizer could be a pivotal step toward achieving long-term stability and improved quality of life. For more information, the National Alliance on Mental Illness (NAMI) provides comprehensive resources on long-acting injectables and other mental health treatments.

Frequently Asked Questions

Injectable mood stabilizers are not inherently better, but they are often more effective for patients who struggle with medication adherence, as they ensure a steady level of medication over a longer period. For those who can consistently take daily oral medication, the effectiveness may be similar, though LAIs can provide more stable drug levels with potentially fewer side effects related to drug level fluctuations.

The frequency depends on the specific medication and the individual's treatment plan. Some are given monthly, others every few weeks or months.

Common side effects include pain or swelling at the injection site, weight gain, metabolic changes (like increased blood sugar), drowsiness, dizziness, and movement disorders such as restlessness.

This should be decided in consultation with a healthcare provider. Injectables are often recommended for individuals with a history of poor medication adherence, frequent relapses or hospitalizations, or those seeking a less burdensome daily medication routine.

No, due to their long-acting nature, injectable medications cannot be stopped and immediately removed from the system like oral pills. It takes weeks to months for the drug to be fully eliminated, so side effects will persist for that time.

No. While some antipsychotics used as mood stabilizers have long-acting injectable forms (e.g., aripiprazole, risperidone), traditional mood stabilizers like lithium, valproate, and lamotrigine are not typically available in this format, though injectable antipsychotics are sometimes used alongside oral mood stabilizers.

In some cases, yes. When starting an LAI, you may need to continue taking oral medication for a few weeks to ensure stable drug levels until the injection's effects fully begin. Your doctor will provide a specific plan for your transition.