Nonadherence with pharmacotherapy occurs frequently in bipolar patients, and is a common cause of relapse. Depot formulations of first-generation antipsychotic medications have been shown to reduce manic relapses during maintenance therapy in bipolar patients, but appear to increase liability for depressive episodes. A depot formulation of risperidone has recently become commercially available, but to date there is little evidence regarding its efficacy or safety in bipolar patients. Ten outpatients with bipolar I or II disorder, with a predominantly depressive course of illness, were prescribed risperidone Consta as an adjunct to mood stabilizing and other medications in routine clinical practice, and were followed during 2 years of maintenance therapy. The number of mood episodes, including depressive episodes, decreased in all patients compared with an equivalent pretreatment period. No patient required hospitalization for a mood episode. The number and doses of concomitant medications was reduced in most patients risperidone Consta was well tolerated, with minimal to modest weight gain, absent or reduced extrapyramidal symptoms, and few other side effects. Clinicians may consider risperidone Consta as an option in patients with refractory bipolar illness, including those with a predominantly depressive course, and particularly in patients' nonadherence with prescribed medications.