Improving adherence in mood disorders: the struggle against relapse, recurrence and suicide risk

Abstract

Medication nonadherence is a major obstacle to translating treatment efficacy from research settings into effectiveness in clinical practice for patients with affective disorders. Adherence to beneficial drug therapy is associated with lower mortality compared with poor adherence. Reduced adherence is associated with increased suicide risk, especially when lithium is discontinued. The aim of this paper is to review the prevalence, predictors and methods for improving medication adherence in unipolar and bipolar affective disorders. Studies were identified through Medline and PsycInfo searches of English language publications between 1976 and 2009. This was supplemented by a hand search and the inclusion of selected descriptive articles on good clinical practice. Estimates of medication nonadherence for unipolar and bipolar disorders range from 10 to 60% (median: 40%). This prevalence has not changed significantly with the introduction of new medications. There is evidence that attitudes and beliefs are at least as important as side effects in predicting adherence. The limited number of empirical studies on reducing nonadherence indicate that, if recognized, the problem may be overcome. Clinical data highlight the importance of extended courses of medication in improving the long-term prognosis of patients with affective disorders.

Recommendations on screening for depression in adults

“…Potential harms of screening include false-positive diagnoses, with subsequent unnecessary treatment; adverse effects of medical therapy among people correctly identified as having depression; 24 and the consequences of labelling and stigma. 4 By definition, any health benefits of screening would accrue among newly identified cases of depression (not among patients who are known to have depression or are receiving treatment).…”

Medication therapy: adherence, knowledge and difficulties of elderly people from bipolar disorder

“…In this respect, the international literature shows that approximately 50% of bipolar patients interrupt the treatment at least once, while 30% of them do so at least twice (21) . It is noteworthy that non-adherence to medication significantly undermines the efficacy of it and is associated with poor prognosis, increased risk of relapse and suicide, and greater consumption of health system resources (22) .…”

Bipolar disorder and medication: adherence, patients' knowledge and serum monitoring of lithium carbonate

“…Thus, adherence to medication is essential for people with BD to respond satisfactorily to the treatment (3)(4) . Several factors, however, contribute to the poor adherence to medication, being the lack of knowledge about the medications an important factor (5)(6) .…”

“…The whole context shows that adherence to treatment (3)(4)8) , knowledge about the drug therapy (6)(7)(8) and serum monitoring of lithium carbonate levels (9,(10)(11)(12) are essential for the safety of patients who make use of this medication. These aspects are strictly related to the nursing practice, which plays a unique role in patients' For the collection of data, a review of medical records and structured interviews were performed, using a guide developed by the authors of the study with questions about socio-demographic information and patients' treatment, as well as a test evaluating patients' adherence to drug therapy (13) including lithium carbonate, and a scale to evaluate the interviewees' knowledge concerning the prescribed drug therapy (14) .…”