Available Approved Bipolar Disorder Treatment Options

In this video, Leslie Citrome, MD, MPH, clinical professor of psychiatry and behavioral sciences, New York Medical College, Valhalla New York, discusses the 3 categories of available approved treatment options for bipolar disorder (BD) for acute mania/mixed episodes, acute bipolar depression, and maintenance.

Dr Citrome shares his thoughts on approved long-acting injectables (LAIs) as a "suitable intervention" for patients with BD and their impact on managing mania.

Dr Citrome presented his session, “Managing Agitation in Schizophrenia and Bipolar Disorder: What’s Available, What’s New, What’s Next,” in San Antonio at the 2021 Psych Congress.

Read the transcript: 

Dr. Leslie Citrome:  Hello. I'm Dr. Leslie Citrome, Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla, New York. I'd like to talk about the treatments available for bipolar disorder.

We can divide them into 3 different buckets. Those that are approved for acute mania or mixed episodes, those that are approved for acute bipolar depression, and those that are approved for maintenance treatment.

We have a lot of choices for acute mania or mixed episodes, and we have quite a few for maintenance treatment. We don't have that many for acute bipolar depression. There have been a few new additions to consider.

For acute mania and for maintenance, we now have a combination of olanzapine and samidorphan. This combination approach may help mitigate against the weight gain that's usually associated with olanzapine, at least in some patients.

Coming up in the possible not-too-distant future is the addition of lumateperone as a treatment for acute bipolar depression. Not only for bipolar type one … as either a monotherapy or adjunctive treatment.

Lastly, I want to mention the existence of 2 long-acting injectable antipsychotics approved today for bipolar maintenance treatment. These include risperidone microspheres and aripiprazole monohydrate. We don't often think about long-acting injectables as a suitable intervention for people with bipolar disorder, but we should.

The name of the game in the maintenance treatment of bipolar disorder is to do all we can to avoid the recurrence of mania. Mania is a problem. It has consequences. It can really destroy someone's life, someone's marriage, employment, source of income, financial stability.

They can all be impacted by a manic episode, so we want to do all we can to prevent the recurrence of mania. Perhaps one of the best ways to do that is to give a foundational treatment in the form of a long-acting injectable.

Risperidone microspheres is approved as a treatment both adjunctively and as a monotherapy and is administered every 2 weeks. Aripiprazole monohydrate is approved as a monotherapy and is administered monthly.

Both choices can be considered. In the end, though, patients may be completely unaware of the existence of these options, so I would urge you to consider offering them as a choice. Patients may find them intriguing. It could make their life easier, and ultimately, taking a long-acting injectable may help them achieve their goal of avoiding mania and maintaining stability.

With that, I hope this little discussion has been useful to you.

Leslie Citrome, MD, MPH, is Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla, New York, and has a private practice in Pomona, New York. He graduated from the McGill University Faculty of Medicine in Montreal, Canada and completed a Residency and Chief Residency in Psychiatry at the New York University School of Medicine. He also went on to complete a Masters in Public Health at Columbia University. 

Dr Citrome was the founding Director of the Clinical Research and Evaluation Facility at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York. After nearly 2 decades of government service, as a researcher in the psychopharmacological treatment of severe mental disorders, Dr. Citrome is now engaged as a consultant in clinical trial design and interpretation. He is a frequent lecturer on the quantitative assessment of clinical trial results using the metrics of evidence-based medicine. He is a member of the Board of Directors of the American Society of Clinical Psychopharmacology. 

Dr Citrome is the editor-in-chief of the International Journal of Clinical Practice. He has authored or co-authored over 500 published research reports, reviews, and book chapters within the biomedical literature. He is the author of the textbook, Handbook of Treatment-Resistant Schizophrenia, published in 2013 by Springer Healthcare.