Ideal Adherence Interventions for Bipolar Patients

Patients diagnosed with bipolar disorder are at very high risk for medication nonadherence.

Finding ways to increase adherence among bipolar patients could reduce morbidity and mortality, but researchers have not been able to definitively determine which interventions work best in this population.

A meta-analysis published in a recent issue of the Journal of Affective Disorders examined adherence in bipolar patients. The authors reported that any intervention, especially one that is brief, can improve patients’ adherence.

The researchers looked for randomized, controlled studies on medication adherence in bipolar disorder. They gathered data on each study’s intervention design and delivery, characteristics, and adherence outcomes.

Among the 795 studies reviewed, 24 met the inclusion criteria, but only 18 provided enough data to be examined in the meta-analysis.

Most of the interventions studied were psychosocial in nature and acknowledged the individual patient’s belief system. Many used cognitive behavioral therapy approaches, and some involved family members.

A wide range of health care providers delivered the interventions, and they used group session, individual therapy, telephone, and e-mail to deliver adherence messages.

The researchers found that the use of brief, focused interventions more than doubled the odds that bipolar patients would adhere to their medications.

Combining medication adherence interventions with other types of self-management intervention (eg, lifestyle or mood management) did not necessarily increase adherence at the same level as brief interventions. In fact, it resulted in a lesser magnitude of change.

In addition, the researchers found that the effects of an intervention were lasting. At follow-up even as long as 2 years later, patients tended to remain more adherent to medications than at baseline. Of note, improvements in adherence can decrease bipolar patients’ chances of relapsing or being hospitalized.

The researchers recommended incorporating adherence interventions into routine clinical practice. Although they did not recommend a specific intervention, their findings suggest that any effort to help patients with bipolar disorder improve their adherence would be better than nothing.

“Our review shows that brief, focused interventions would be the best at targeting adherence specifically,” the researchers concluded. “Further investigation is needed to establish how multi-component interventions, although not as effective (but still having a positive effect) on adherence, impact on clinical outcomes.”