Six key factors determine medication adherence in people with bipolar disorder

People with bipolar disorder may not take their medication because of side effects, fear of addiction and a preference for alternative treatment - according to research from Norfolk and Suffolk NHS Foundation Trust (NSFT) and the University of East Anglia (UEA).

Nearly half of people with bipolar disorder do not take their medication as prescribed leading to relapse, hospitalization, and increased risk of suicide.

A new study, published today, reveals six key factors that stop people taking their medication as prescribed.

These include whether they are experiencing side effects, difficulties in remembering to take medication and a lack of support from family, friends and healthcare professionals.

A patient's own beliefs and knowledge about bipolar disorder and its treatment was also found to affect whether or not they take their meds, as well as fear of addiction, and a preference for alternative treatment.

The new study comes from a team of pharmacists, psychiatrists, and experts in behavioral science from NSFT, UEA, Devon Partnership Trust, and the University of Lyon.

Asta Ratna Prajapati, consultant pharmacist at NSFT and a post-graduate researcher at UEA's School of Pharmacy, led the research. The study was funded by a Health Education England (HEE) / National Institute for Health Research Clinical Doctoral Research Fellowship.

Bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs, known as mania or hypomania, and depressive lows.

Around half of people with bipolar disorder don't take their medication which can lead to a relapse of symptoms. And this can have a knock-on impact with problems at work, strained relationships with family and friends, hospitalization, and an increased risk of suicide. We wanted to better understand what stops people from taking their medication."

Asta Ratna Prajapati, Consultant Pharmacist at NSFT and Post-Graduate Researcher at School of Pharmacy, University of East Anglia

The research team looked at the evidence for what hinders people taking their medication for bipolar disorder. The research team carried out a systematic review and included 57 studies, mostly surveys and interviews, involving 32894 patients and healthcare professionals. The majority (79 per cent) of the studies were conducted in the USA and Europe.

"We found six key factors that affect whether people take their medication. The main reason being what the medication is like, whether there are side effects, and whether it works," said Prajapati.

"Secondly, we found that a patient's beliefs and knowledge about bipolar disorder and its treatment could stop them taking medication.

"We also found that how patients felt taking their medication had an impact - for example a fear of addiction or worry about negative side effects.

"Other factors included a lack of support, difficulty remembering taking medication and not wanting to take it for reasons including preferring alternative treatment.

"We recommend that the prescribers talk to patients about their thoughts and experiences of the medications they take, paying particular attention to these issues which may stop patients taking their meds."

The research team are now developing a tool to identify people who struggle to take their medication and their individual reasons. They hope it will help prescribers and patients work together and offer bespoke support to make medication taking easier.

Source:
Journal reference:

Prajapati, A. R., et al. (2021) Mapping modifiable determinants of medication adherence in bipolar disorder (BD) to the theoretical domains framework (TDF): a systematic review. Psychological Medicine Journal. doi.org/10.1017/S0033291721001446.

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