Mitigating Disastrous Medication Nonadherence in Bipolar Disorder

Medications are the mainstay treatment for bipolar disorder, more so than in many other conditions. Consequently, medication nonadherence is often disastrous for bipolar patients, as it can lead to poor impulse control, increased risk of hospitalization, and even suicide.

Experts indicate that nonadherence to drug therapy is, in fact, the modifiable risk factor with the most impact on the patient’s condition. Acknowledging that adverse effects can make or break a bipolar patient’s prognosis, researchers from Thomas Jefferson University in Philadelphia, Pennsylvania, have published the first comprehensive literature review covering this topic.

Patients with bipolar disorder who are nonadherent frequently point out adverse effects from prescribed mood stabilizers that are troubling or intolerable. To pinpoint which specific adverse effects have the greatest impact on medication nonadherence, the researchers systematically reviewed data from 66 articles, of which all but 16 involved clinical observations studies.

Few studies have addressed nonadherence to drug therapy in bipolar disorder, and the researchers noted that a lack of validated instruments to assess the medications’ adverse effects might be the cause. There are also few standardized methods for eliciting, recording, and reporting adverse effects. Regardless, the authors confirmed that adverse effects are among the most frequently reported reasons for nonadherence.

Because the study data suggested that clinicians are more likely than patients to dismiss the role adverse effects play in nonadherence, the clinical implication is that clinicians need to better empathize with patients’ experiences.

The researchers also reported that clinicians worry about several medically serious concerns, such as hypothyroidism, diabetes insipidus, and hypercalcemia, while their patients are much more concerned about weight gain, tremors, cognitive impairment, and sedation. Although the latter adverse events are less medically serious, they are personally intrusive and significantly more likely to reduce medication adherence.

Therefore, clinicians must take an active lead in discussing nonadherence with bipolar patients. This includes asking about weight gain, tremors, cognitive impairment, and sedation, as well as discussing ways to prevent, manage, or mitigate these adverse effects that trouble patients to the point where they may skip doses or stop medication entirely.