Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Feb;27(1):7-16.
doi: 10.1111/bdi.13498. Epub 2024 Oct 22.

Early use of long-acting injectable antipsychotics in bipolar disorder type I: An expert consensus

Eduard Vieta  1 , Mauricio Tohen  2 , Diane McIntosh  3 , Lars Vedel Kessing  4   5 , Martha Sajatovic  6   7   8   9 , Roger S McIntyre  10   11
Affiliations
Review

Early use of long-acting injectable antipsychotics in bipolar disorder type I: An expert consensus

Eduard Vieta et al. Bipolar Disord. 2025 Feb.

Abstract

Introduction: Long-acting injectable antipsychotics (LAIs) are not routinely offered to patients living with bipolar disorder type I (BP-I), despite widespread evidence that supports their benefits over oral antipsychotics, particularly in early disease.

Methods: A round-table meeting of psychiatrists convened to discuss barriers and opportunities and provide consensus recommendations around the early use of LAIs for BP-I.

Results: LAIs are rarely prescribed to treat BP-I unless a patient has severe symptoms, sub-optimal adherence to oral antipsychotics, or has experienced multiple relapses. Beyond country-specific accessibility issues (e.g., healthcare infrastructure and availability/approval status), primary barriers to the effective use of LAIs were identified as attitudinal and knowledge/experience-based. Direct discussions between healthcare providers and patients about treatment preferences may not occur due to a preconceived notion that patients prefer oral antipsychotics. Moreover, as LAIs have historically been limited to the treatment of schizophrenia and the most severe cases of BP-I, healthcare providers might be unaware of the benefits LAIs provide in the overall management of BP-I. Improved treatment adherence associated with LAIs compared to oral antipsychotics may support improved outcomes for patients (e.g., reduced relapse and hospitalization). Involvement of all stakeholders (healthcare providers, patients, and their supporters) participating in the patient journey is critical in early and shared decision-making processes. Clinical and database studies could potentially bridge knowledge gaps to facilitate acceptance of LAIs.

Conclusion: This review discusses the benefits of LAIs in the management of BP-I and identifies barriers to use, while providing expert consensus recommendations for potential solutions to support informed treatment decision-making.

Keywords: antipsychotics; bipolar disorder type 1; consensus; patient‐reported outcome measures; psychosis; shared decision‐making; treatment adherence and compliance.

PubMed Disclaimer

Conflict of interest statement

E.V. has received grants and served as a consultant, advisor, or CME speaker for AB‐Biotics, Abbott, AbbVie, Aimentia, Angelini, Biogen, Biohaven, Boehringer Ingelheim, Casen‐Recordati, Celon, Compass, Dainippon Sumitomo, Ethypharm, Ferrer, Gedeon Richter, GH Research, GSK, Idorsia, Janssen, Lundbeck, Novartis, Organon, Otsuka, Rovi, Sage, Sanofi‐Aventis, Sunovion, Takeda, and Viatris. M.T. was an employee of Lilly (1997–2008) and has received honoraria from or consulted for Abbott, AbbVie, Alkermes, AstraZeneca, Atai Life Sciences, Biohaven Pharmaceuticals, Bristol Myers Squibb, Elan, Intra‐Cellular Therapies, Johnson & Johnson, Lilly, Lundbeck, Merck, Minerva, Neurocrine Biosciences, NeuroRX, NoemaPharma, Otsuka, Pfizer, Rapport Neurosciences, Roche, Sunovion, and Teva; his spouse was a full‐time employee at Lilly (1998–2013). D.M. is on advisory boards/speaker panels for AbbVie, Janssen Ortho, Lundbeck, Otsuka, and Sunovion. L.V.K. has been a consultant for Lundbeck and Teva. M.S. has research grants from Centers for Disease Control and Prevention, International Society for Bipolar Disorders, National Institutes of Health, Patient‐Centered Outcomes Research Institute; consultancy for Alkermes, Janssen, Lundbeck, Neurelis, Otsuka, Teva; royalties from Johns Hopkins University Press, Oxford University Press, Springer Press, UpToDate; and compensation for CME activities from American Academy of Child and Adolescent Psychiatry, American Epilepsy Society, American Physician Institute, Clinical Care Options, Neurocrine, and Psychopharmacology Institute. R.S.M. has received research grant support from CIHR/GACD/NSFC and the Milken Institute; speaker/consultation fees from AbbVie, Alkermes, Atai Life Sciences, Axsome, Bausch Health, Biogen, Boehringer Ingelheim, Eisai, Intra‐Cellular Therapies, Janssen, Kris, Lundbeck, Mitsubishi Tanabe, Neumora Therapeutics, Neurawell, Neurocrine, New Bridge Pharmaceuticals, Novo Nordisk, Otsuka, Pfizer, Purdue, Sage, Sanofi, Sunovion, Takeda, Viatris; and is a CEO of Braxia Scientific Corp.

Figures

FIGURE 1
FIGURE 1
Typical patient journey compared to the ideal LAI patient journey. HCP, healthcare provider; LAI, long‐acting injectable antipsychotic.
FIGURE 2
FIGURE 2
Relationships between stakeholders. HCP, healthcare provider; NGO, non‐governmental organization.
See this image and copyright information in PMC

References

    1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories . 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789‐1858. - PMC - PubMed
    1. World Health Organization . ICD‐11 for Mortality and Morbidity Statistics (Version: 01/2023): 6A60.2 Bipolar type I disorder, current episode hypomanic. 2023. Accessed October 12, 2023. https://icd.who.int/browse11/l‐m/en#/http%3a%2f%2fid.who.int%2ficd%2fent....
    1. World Health Organization . ICD‐11 for Mortality and Morbidity Statistics (Version: 01/2023): 6A60.3 Bipolar type I disorder, current episode depressive, mild. 2023. Accessed October 12, 2023. https://icd.who.int/browse11/l‐m/en#/http%3a%2f%2fid.who.int%2ficd%2fent....
    1. Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: a systematic review. World J Psychiatry. 2022;12(9):1204‐1232. - PMC - PubMed
    1. Dell'Osso B, Camuri G, Cremaschi L, et al. Lifetime presence of psychotic symptoms in bipolar disorder is associated with less favorable socio‐demographic and certain clinical features. Compr Psychiatry. 2017;76:169‐176. - PubMed

Substances