Medication adherence in a comparative effectiveness trial for bipolar disorder

Acta Psychiatr Scand. 2014 May;129(5):359-65. doi: 10.1111/acps.12202. Epub 2013 Oct 3.

Abstract

Objective: Psychopharmacology remains the foundation of treatment for bipolar disorder, but medication adherence in this population is low (range 20-64%). We examined medication adherence in a multisite, comparative effectiveness study of lithium.

Method: The Lithium Moderate Dose Use Study (LiTMUS) was a 6-month, six-site, randomized effectiveness trial of adjunctive moderate dose lithium therapy compared with optimized treatment in adult out-patients with bipolar I or II disorder (N=283). Medication adherence was measured at each study visit with the Tablet Routine Questionnaire.

Results: We found that 4.50% of participants reported missing at least 30% of their medications in the past week at baseline and non-adherence remained low throughout the trial (<7%). Poor medication adherence was associated with more manic symptoms and side-effects as well as lower lithium serum levels at mid- and post-treatment, but not with poor quality of life, overall severity of illness, or depressive symptoms.

Conclusion: Participants in LiTMUS were highly adherent with taking their medications. The lack of association with possible predictors of adherence, such as depression and quality of life, could be explained by the limited variance or other factors as well as by not using an objective measure of adherence.

Keywords: bipolar disorder; compliance; psychopharmacology.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Affect / drug effects*
  • Antidepressive Agents / administration & dosage
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / blood
  • Antimanic Agents / administration & dosage
  • Antimanic Agents / adverse effects
  • Antimanic Agents / blood
  • Bipolar Disorder* / diagnosis
  • Bipolar Disorder* / drug therapy
  • Bipolar Disorder* / psychology
  • Comparative Effectiveness Research
  • Depression* / drug therapy
  • Depression* / etiology
  • Drug Monitoring / methods
  • Female
  • Humans
  • Lithium Compounds* / administration & dosage
  • Lithium Compounds* / adverse effects
  • Lithium Compounds* / blood
  • Male
  • Medication Adherence*
  • Psychiatric Status Rating Scales
  • Quality of Life
  • Risk Factors
  • Treatment Outcome

Substances

  • Antidepressive Agents
  • Antimanic Agents
  • Lithium Compounds