Q:  Stops Meds After Home From Hospital

My mother has bipolar disorder with rapid cycling.  She has been hospitalized 2 times this year.  As soon as she gets out of the hospital she stops taking her medication.  Is there an intrvenious medication that can be given?  If so, how are patients doing taking medicine this way?

Dear Ms. W' -- 
The only medications that can be given by injection that last a few weeks, as long as a month in one case, are the old-generation antipsychotics.  In the U.S. the trade names are Haldol and Prolixin (haloperidol and fluoperidol, respectively).  Their "decanoate" forms have been used this way for years.  

Unfortunately, there are no "mood stabilizers" -- the standard medications for bipolar disorder -- available in this way, nor any on the horizon that I've heard of.  One can give Zyprexa (olanzapine) as an injection but it only lasts a day or so that way.  

What you need is a medication mandate prior to leaving the hospital, however that is arranged; and then some consequence for refusing medication (in the hospital, we generally use the prospect of an involuntary medication injection).  There is an oral form of Zyprexa that dissolves within seconds on the tongue, which is now used to make sure a person can't "cheek" it and spit it out minutes later; sometimes that helps in this circumstance.  It's a terrible but unfortunately common dilemma. 

Dr. Phelps

Published July, 2001