What is the shot for bipolar people?: Understanding long-acting injectable medications

Studies show that poor medication adherence significantly contributes to relapse and hospitalization in people with bipolar disorder. For many, the answer lies in understanding what is the shot for bipolar people and how long-acting injectable medications can help manage symptoms and prevent mood episodes.

Quick Summary

Long-acting injectable (LAI) medications provide consistent, sustained symptom management for bipolar I disorder. They can improve treatment adherence and reduce the risk of relapse and rehospitalization compared to oral medications.

Key Points

• Extended-Release Medication: The shot for bipolar people is a long-acting injectable (LAI) that provides a slow, steady release of antipsychotic medication over weeks or months, ensuring consistent treatment.

• Improved Treatment Adherence: LAIs address issues with daily pill-taking, which can be difficult during manic or depressive episodes, leading to better treatment adherence and long-term stability.

• Common Medications: Injectable options include aripiprazole (Abilify Maintena, Abilify Asimtufii), risperidone (Risperdal Consta), and olanzapine (Zyprexa Relprevv).

• Reduced Relapse Risk: Studies show LAIs can significantly reduce the risk of relapse, mood episodes, and rehospitalization for individuals with bipolar I disorder.

• Potential Side Effects: While generally well-tolerated, side effects can include injection site pain, weight gain, restlessness, and drowsiness, and should be discussed with a healthcare provider.

• Personalized Treatment: The best injectable option depends on individual symptoms, medication tolerance, and lifestyle needs, requiring a thorough discussion with a healthcare provider.

Long-Acting Injectables: A Solution for Bipolar Disorder

Long-acting injectables (LAIs) are a class of medications that deliver antipsychotic drugs slowly and steadily over an extended period. For people with bipolar I disorder, this can be a life-changing treatment option. Instead of taking daily pills, patients receive intramuscular injections every few weeks to months, administered by a healthcare professional. This approach helps maintain stable levels of medication in the bloodstream, providing consistent symptom control and reducing the risk of mood episode recurrence. The appeal of LAIs is particularly strong for individuals who struggle with the consistency required for daily oral medication due to symptoms like forgetfulness during mania or a general reluctance to take medication.

Types of Long-Acting Injectable Medications

Several long-acting injectable medications are approved or used off-label for the maintenance treatment of bipolar I disorder. The choice depends on the patient's specific needs, tolerability, and a discussion with their healthcare provider. Some of the most common options include:

• Aripiprazole: This atypical antipsychotic is available in several long-acting injectable forms, which are FDA-approved for bipolar I maintenance treatment.
  • Abilify Maintena: A once-monthly injection.
  • Abilify Asimtufii: A newer option that is administered once every two months.
  • Aristada (aripiprazole lauroxil): While primarily FDA-approved for schizophrenia, it is sometimes used off-label for bipolar disorder.
• Risperidone: Available in a long-acting injectable form called Risperdal Consta, which is approved for bipolar I maintenance and administered every two weeks.
• Olanzapine: Zyprexa Relprevv (olanzapine pamoate) is an injectable atypical antipsychotic used for the treatment of agitation in bipolar I disorder, administered every 2 to 4 weeks.

Benefits of Long-Acting Injections for Bipolar Management

Switching from daily oral medication to long-acting injectables offers a number of potential benefits, particularly concerning treatment adherence and long-term stability. The primary advantages include:

• Improved Adherence: Forgetting or intentionally missing doses is a significant problem in bipolar management. LAIs eliminate this daily burden, ensuring consistent medication levels and therapeutic effects.
• Reduced Relapse and Hospitalization: Consistent medication levels help prevent the mood swings that can lead to manic or depressive episodes, thereby reducing the need for emergency room visits and hospital stays.
• Greater Stability: The slow, steady release of medication avoids the peaks and troughs of drug concentration that can occur with daily oral pills. This smoother profile can lead to better symptom control and fewer side effects associated with fluctuating levels.
• Fewer Decisions: Receiving medication once every few weeks or months removes the daily decision of whether or not to take a pill, which can be challenging during episodes of mania or depression.

Potential Side Effects and Considerations

While beneficial, LAIs are not without potential side effects. Patients should discuss these with their healthcare provider to make an informed decision. Common side effects include:

1. Injection site reactions: Pain, swelling, redness, or tenderness at the injection site are common but usually temporary.
2. Weight gain: Some antipsychotics, including aripiprazole, can lead to weight gain, and regular monitoring of weight, cholesterol, and blood sugar levels is often recommended.
3. Restlessness (akathisia): Some patients may experience an inner sense of restlessness or a need to move.
4. Drowsiness or Fatigue: Feeling tired or sleepy is a possible side effect, especially when starting treatment.
5. Dizziness: Some people may feel dizzy or lightheaded, particularly when standing up.
6. Unusual movements (extrapyramidal symptoms): Involuntary movements, especially of the face or body, can occur.

Comparing Long-Acting Injectables for Bipolar I

Feature	Abilify Maintena (Aripiprazole)	Abilify Asimtufii (Aripiprazole)	Risperdal Consta (Risperidone)	Zyprexa Relprevv (Olanzapine)
FDA-Approved for Bipolar I?	Yes, for maintenance monotherapy.	Yes, for maintenance monotherapy.	Yes, for maintenance monotherapy.	Yes, for acute mania and agitation.
Dosing Frequency	Once every month.	Once every two months.	Once every two weeks.	Once every 2 to 4 weeks.
Initiation	Oral aripiprazole for 2 weeks.	Oral aripiprazole for 2 weeks or after dose stabilization on Abilify Maintena.	Oral risperidone or another oral antipsychotic for 3 weeks.	Not required for initiation of acute treatment.
Primary Side Effects	Weight gain, restlessness, injection site pain, sleepiness.	Weight gain, restlessness, injection site pain, sleepiness.	Weight gain, drowsiness, anxiety, restlessness.	Sedation, dizziness, injection site pain, weight gain.
Injection Site	Buttock or upper arm.	Buttock (gluteal muscle).	Buttock or upper arm.	Buttock (gluteal muscle).

Conclusion: A Long-Term Solution for Stability

For many individuals with bipolar I disorder, managing the condition requires consistent, long-term medication use. However, the complexities of the illness itself can make daily pill-taking a significant challenge, leading to poor adherence, mood episodes, and hospitalization. Long-acting injectable (LAI) antipsychotics offer a powerful alternative, ensuring medication is delivered consistently and effectively over weeks or months. By providing a steady therapeutic dose, LAIs can reduce the risk of relapse, enhance stability, and improve overall quality of life for patients and their families. The development of varied LAIs, including those with less frequent dosing like Abilify Asimtufii, expands the options available and allows for a more personalized treatment approach. It is essential for patients to work closely with their healthcare team to weigh the benefits and potential side effects to determine if a long-acting injectable is the right path for their long-term mental health management.

Learn more about mental health medications from NAMI.

Frequently Asked Questions

What is a long-acting injectable (LAI) for bipolar disorder?

A long-acting injectable (LAI) for bipolar disorder is an intramuscular shot that releases medication slowly over an extended period, often weeks or months. It provides a consistent dose to manage symptoms without the need for daily oral medication.

Which specific shots are used for bipolar people?

Common long-acting injectables include aripiprazole (Abilify Maintena, Abilify Asimtufii), risperidone (Risperdal Consta), and olanzapine pamoate (Zyprexa Relprevv). Aripiprazole is a common choice for maintenance treatment of bipolar I.

How often do you get the bipolar shot?

The frequency depends on the specific medication. For example, Abilify Maintena is administered once a month, while Abilify Asimtufii is given once every two months. Other injections may be given every two to four weeks.

What are the main benefits of injectable medication for bipolar disorder?

Injectable medications can improve treatment adherence by eliminating the need for daily pills. This leads to more stable medication levels, which reduces the risk of mood episodes, relapse, and hospitalization.

Are there side effects with injectable bipolar medications?

Yes, side effects can occur and may include pain at the injection site, weight gain, restlessness (akathisia), drowsiness, or dizziness. Your healthcare provider will monitor you for any potential side effects.

Is an injectable better than oral medication for bipolar disorder?

Neither is inherently 'better' for everyone. Injectables are often a good option for people who have difficulty with daily medication adherence. For others, oral medication may be preferred due to fears of needles or different side effect profiles. The best choice is a personalized decision made with a doctor.

Can children and adolescents get long-acting injectable medication for bipolar disorder?

Some LAIs are approved for adults only. While research shows effectiveness in adolescents for managing mania, some injectable medications, like Abilify Asimtufii and Maintena, are specifically indicated for adults with bipolar I.

How do injectable medications for bipolar disorder work?

Injectable antipsychotics work by slowly releasing the active medication into the bloodstream from the injection site. This mechanism ensures a consistent, therapeutic drug level is maintained over an extended period, helping to regulate mood and prevent episode recurrence.