The presence of residual depressive symptoms may result in patients with bipolar disorder being nonadherent to their medication, study findings suggest.
Residual depressive symptoms and drug side effects were the only two factors to remain associated with total Medication Adherence Rating Scale (MARS) score after adjusting for multiple confounders and correcting for multiple testing, report Raoul Belzeaux (Hôpital Sainte Marguerite, Marseille, France) and co-workers.
They suggest the effect of residual depression could be down to related cognitive symptoms, such as impaired attention or memory. “Moreover, depressive mood alteration, low self-esteem and confidence in the future as well as anhedonia could also alter motivation and positive health behavior,” they write in the Journal of Affective Disorders.
The presence of residual depressive symptoms on the Montgomery Åsberg Depression Rating Scale and reported side effects on the Patient Inventory of Side Effects were both significantly associated with the MARS negative side effects and attitudes to psychotropic medication dimension, as well as with total scores. The most common types of side effects were digestive, sleep, sexual, cutaneous, and nonspecific (including weight gain, anxiety, malaise, and restlessness).
Age, illness duration, and Young Mania Rating Scale scores were not associated with medication adherence, but the type of bipolar diagnosis was significantly associated with the MARS attitude toward taking medication domain. Specifically, patients with an unspecified bipolar diagnosis had the worst attitude toward medication, followed by patients with bipolar II disorder and those with bipolar I disorder.
The 382 patients in the study comprised 52.9% with type I bipolarity, 36.4% with type II, and 10.7% with an unspecified type. Belzeaux et al speculate that patients who have less debilitating forms of mania may be reluctant to take medication for fear of “missing their highs.”
The researchers suggest that interventions such as psycho-education and mindfulness-based cognitive therapy may help to improve treatment adherence, but caution that these should be tailored to allow for the specific bipolar diagnosis and the potential impact of residual depressive symptoms on therapy.
“All these strategies could improve adherence to medication and pave the way to successful treatment of [bipolar disorder],” they conclude.
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