Regularity of self-reported daily dosage of mood stabilizers and antipsychotics in patients with bipolar disorder

Abstract

BackgroundPolypharmacy is often prescribed for bipolar disorder, yet medication non-adherence remains a serious problem. This study investigated the regularity in the daily dosage taken of mood stabilizers and second generation antipsychotics.MethodsDaily self-reported data on medications taken and mood were available from 241 patients with a diagnosis of bipolar disorder who received treatment as usual. Patients who took the same mood stabilizer or second generation antipsychotic for ≥ 100 days were included. Approximate entropy was used to determine serial regularity in daily dosage taken. Generalized estimating equations were used to estimate if demographic or clinical variables were associated with regularity.ResultsThere were 422 analysis periods available from the 241 patients. Patients took drugs on 84.4% of days. Considerable irregularity was found, mostly due to single-day omissions and dosage changes. Drug holidays (missing 3 or more consecutive days) were found in 35.8% of the analysis periods. Irregularity was associated with an increasing total number of psychotropic drugs taken (p = 0.009), the pill burden (p = 0.026), and the percent of days depressed (p = 0.049).ConclusionDespite low missing percent of days, daily drug dosage may be irregular primarily due to single day omissions and dosage changes. Drug holidays are common. Physicians should expect to see partial adherence in clinical practice, especially with complex drug regimens. Daily dosage irregularity may impact the continuity of drug action, contribute to individual variation in treatment response, and needs further study.

Real-World Patterns of Utilization and Costs Associated with Second-Generation Oral Antipsychotic Medication for the Treatment of Bipolar Disorder: A Literature Review

“… 29 In evaluating dosing regularity, drug holidays (missing ≥3 consecutive days of medication, found in 35.8% of analysis periods), single-day omissions (present in 64.7% of periods) and self-directed changes in daily dosing (86.7% of periods) were common. 37 …”

Potential Drug interactions with Drugs used for Bipolar Disorder: A Comparison of 6 Drug Interaction Database Programs

“…In a study of 353 patients with a stable treatment regimen for bipolar disorder, 231 patients took a unique medication regimen when considering only the psychiatric drugs [16]. A larger number of psychiatric drugs was associated with irregularity in the daily dosage taken of mood stabilizers and antidepressants in patients with bipolar disorder [76,77]. Since many patients with bipolar disorder are partially adherent or nonadherent, drug concentrations in the blood may not be at therapeutic levels [78].…”

Association between Adherence with an Atypical Antipsychotic and with Other Psychiatric Drugs in Patients with Bipolar Disorder

“…Taking more drugs for bipolar disorder was also associated with worse adherence with nonpsychiatric drugs [28]. The total number of psychiatric drugs and pill burden were also associated with irregularity in the daily dosage taken of antidepressants, mood stabilizers, and antipsychotics in patients with bipolar disorder [29,30].…”