Bipolar Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
CNS Drugs. 2012 May 1;26(5):403-20. doi: 10.2165/11631310-000000000-00000.
Depot antipsychotics have been used as a strategy to reduce non-adherence to medications in schizophrenia and bipolar disorder (BD). This article reviews the literature on the efficacy and safety of first- and second-generation depot antipsychotics (FGDA and SGDA, respectively) for the maintenance treatment of BD. Although FGDA have been studied in BD, they have not been approved for use in this disease. Among the SGDA, only depot risperidone has been studied and approved for the maintenance treatment of BD. We found eight studies on FGDA (three on flupenthixol, two on depot haloperidol, one on fluphenazine and flupenthixol, two on a mix of diverse antipsychotics) and ten studies on SGDA (all on depot risperidone). Differences in efficacy and safety were found between the two classes of depot antipsychotics. Although FGDA may be effective in reducing manic relapses, they possibly increase the risk of worsening depression. Depot risperidone is effective as a maintenance treatment in BD with effect noted predominantly for preventing mania. However, no worsening in depression was observed. Depot risperidone also is better tolerated than FGDA, mainly in relation to extrapyramidal symptoms. Studies with the new depot antipsychotics, olanzapine pamoate and paliperidone palmitate, are needed in BD patients. Further, there is currently little information on the metabolic changes (apart from bodyweight gain) that may occur with the use of depot risperidone in patients with bipolar disorder, and this issue needs further investigation.
长效抗精神病药已被用作减少精神分裂症和双相情感障碍（BD）患者药物不依从的策略。本文综述了第一代和第二代长效抗精神病药（FGDA 和 SGDA）用于 BD 维持治疗的疗效和安全性的文献。虽然 FGDA 已在 BD 中进行了研究，但尚未批准用于该疾病。在 SGDA 中，只有长效利培酮被研究并批准用于 BD 的维持治疗。我们发现了八项关于 FGDA 的研究（三项关于氟奋乃静，两项关于长效氟哌啶醇，一项关于奋乃静和氟奋乃静，两项关于多种抗精神病药的混合物）和十项关于 SGDA 的研究（全部关于长效利培酮）。两种长效抗精神病药类别的疗效和安全性存在差异。虽然 FGDA 可能有效减少躁狂发作，但它们可能增加恶化抑郁的风险。长效利培酮作为 BD 的维持治疗有效，主要表现在预防躁狂。但是，没有观察到抑郁恶化。长效利培酮的耐受性也优于 FGDA，主要与锥体外系症状有关。BD 患者需要进行新型长效抗精神病药，即奥氮平癸酸酯和棕榈酸帕利哌酮的研究。此外，目前关于使用长效利培酮可能在双相情感障碍患者中引起的代谢变化（除体重增加外）的信息很少，需要进一步研究。
