Role of Adverse Effects in Medication Nonadherence in Bipolar Disorder

Abstract

Nonadherence to medications is common and associated with poor or limited clinical outcomes in the treatment of bipolar disorder. A review of the literature discloses that adverse effects are one of the commonly reported reasons for nonadherence to mood stabilizers by patients with bipolar disorder. Nevertheless, other than such broad summaries, relatively little attention has been given to the role of adverse effects in relation to nonadherence. This review article is the first to consolidate the available data on this topic. Weight gain, perceived cognitive impairment, tremors, and sedation are the adverse effects most likely to lead to nonadherence. Further research is needed to anticipate, identify, manage, and potentially minimize the impact of adverse effects.

Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians

“…If objective assessments reveal no cognitive change over time, this would provide an objective reference point for patients that reduces patients’ concerns about cognitive side effects. In this way, cognitive screening assessments may aid treatment adherence and thus indirectly improve patients’ prognosis. On the other hand, if cognition assessments do reveal cognitive decline in response to a new treatment, this could inform a change of the treatment plan to reduce the cognitive side effects.…”

<p>The Economic Burden of Bipolar Disorder in the United States: A Systematic Literature Review</p>

“…Treatment guidelines recommend patients receive long-term pharmacotherapy to reduce the recurrence of mood episodes and improve the stability of patients’ psychiatric and general health, their general functioning, and quality of life; however, this is a population in which medication adherence is typically poor. 22 , 28 , 69 Most currently prescribed mood stabilizing agents have undesirable side effects (eg, changes in cognitive function, tremor) that are poorly tolerated by patients 70 , 71 and also have the potential to induce or exacerbate comorbid conditions that may require intervention. 22 , 28 , 69 Choice of medication for BD is complex, balancing patient needs, symptoms, and treatment preferences with the risks of available therapies.…”

Bipolar disorder, comorbid anxiety disorders, gynecomastia and dental pain: case analysis with literature review

“…11,12,32,35 Non-adherence to psychotropic treatment is multifactorial; however, polypharmacy has an increased risk for drug-drug interactions and adverse effects which may lead to decreased adherence. 14,16,36,37 Consider that this patient decreased both escitalopram and buspirone by 50% simply to see whether he would feel better on a lower dose and, by so doing, precipitated a discontinuation syndrome. Since bipolar disorder management requires an appreciation of acute and long-term psychotropic efficacy, safety and tolerability, when treating patients with bipolar disorder with comorbidities, clinicians should also consider which psychotropics may effectively treat multiple conditions while considering both acute and long-term number needed to treat/number needed to harm ratios.…”