Depot antipsychotic medications in bipolar disorder: a review of the literature.

OBJECTIVE: To review the literature on the efficacy and safety of depot formulations of first- and second-generation antipsychotic medications (FGAs and SGAs) in patients with bipolar disorder. METHOD: We conducted a computer-aided MEDLINE search using the search terms 'depot antipsychotic', 'bipolar disorder' and 'compliance.' RESULTS: We identified eight published reports in bipolar patients regarding the use of depot FGAs, and six preliminary reports on the use of depot SGAs. These studies suggest that depots FGAs are efficacious in preventing manic episodes during the maintenance treatment of bipolar disorder. Several studies, however, indicate that depot FGAs may be associated with increased time with depressive symptoms, particularly in patients with a predominantly depressive course of illness. Preliminary data on the role of depot formulations of SGAs suggest that they reduce the frequency of both manic and depressive episodes during maintenance treatment, and are well tolerated by patients. CONCLUSION: After a careful risk-benefit analysis, depot antipsychotics may be considered for the long-term control of mood episodes in bipolar patients who have relapsed due to medication non-adherence or who have failed to respond to standard therapies. Depot FGAs should be avoided in patients with a high burden of illness from depressive symptoms and particularly in those judged to be at high risk of suicide. The available data on depot formulations of SGAs indicate that they are efficacious in the maintenance treatment of bipolar illness without increasing the burden of the depressive pole of the illness, but further systematic studies are required to definitively assess this.

Evaluation of three simple methods for predicting therapeutic lithium doses.

The bias and accuracy of three simple methods for predicting lithium doses were assessed in this prospective study. In each patient, we computed the predicted doses (PDs) of lithium by applying three formulas. The actual dose (AD), the lowest lithium dose that was enough to produce a serum lithium concentration higher than 0.80 mmol/l, was determined. The PD computed by each formula was then compared with the AD to identify the one with the least bias and the greatest accuracy in predicting therapeutic lithium doses. As mean prediction error (ME) is a convenient measure of bias, the prediction error (PE) of each comparison was computed by subtracting the AD from the PD. Accuracy was assessed as a function of the root-mean-squared prediction error (rMSE). Seventeen psychiatric inpatients participated in this study. The 95% confidence interval of ME of a proposed formula [Zetin, M., Garber, D., De Antonio, M., Schlegel, A., Feureisen, S., Fieve, R., Jewett, C., Reus, V., Huey, L.Y., 1986. Prediction of lithium dose: a mathematic alternative to the test-dose method. Journal of Clinical Psychiatry 47, 175-178] was across zero (-15.48 to 133.72). In addition, the rMSE of that formula was also the lowest one (152.66 mg/day). The method proposed by Zetin et al. (1986) is the least biased and the most accurate way to predict therapeutic lithium doses.