Paliperidone Palmitate Depot in the Long-term Treatment of Psychotic Bipolar Disorder

OBJECTIVES: The treatment of bipolar disorder (BD) cannot be limited to the remission of acute phases but includes the long-term treatment in order to prevent relapses, poor outcome, and chronicity. The purpose of this article is to present 3 cases of severe psychotic bipolar patients treated with monthly injection of paliperidone pamoate. METHODS: Three poor-compliant severe psychotic BD patients were initiated to paliperidone palmitate (100-150 mg monthly), and they were followed up for 12 months. Young Mania Rating Scale and Hamilton Depression Rating Scale were administered at baseline and during monthly follow-up visits. RESULTS: None of patients presented recurrences or relapses during the 12-month follow-up period. The patients did not develop adverse effects or significant changes in metabolism. CONCLUSIONS: These preliminary results indicate that paliperidone palmitate (100-150 mg monthly) may be a therapeutic option for long-term treatment of psychotic BD, particularly for poor-compliant severe patients. These results have to be confirmed in double-blind studies with bipolar patients not necessarily belonging to psychotic subtype.