It's common for people with bipolar disorder to stop taking medications. Discover how to improve bipolar medications compliance.

Why individuals with Bipolar Disorder often do not take their medications

Welcome to our bipolar treatment adherence area. Here, we'll discuss why people with bipolar disorder stop taking their medications, the effects of that and what can be done to improve medication adherence.

Did you know that the single most significant reason why individuals with bipolar disorder fail to take their medication is because of their lack of awareness of their illness (anosognosia)? Other important reasons are concurrent alcohol or drug abuse and a poor relationship between psychiatrist and patient.

Medication side effects, widely assumed to be the most important reason for medication nonadherence, is in fact a less important reason compared to the other factors cited.

The failure of individuals with bipolar disorder to take prescribed medications (usually antipsychotics and/or mood stabilizers such as lithium) is one of the most serious problems in psychiatric care. It often leads to relapse of symptoms, rehospitalizations, homelessness, incarceration in jail or prison, victimization, or episodes of violence.

The failure to take medication is referred to as noncompliance or nonadherence; the latter is a better term. Nonadherence is also a problem for other medical conditions for which medication must be taken for long periods, including hypertension, diabetes, epilepsy, asthma, and tuberculosis. Nonadherence may be total but is more often partial; it has been suggested that partial adherence be defined as a failure to take 30 percent or more of the prescribed medication during the past month.

Scott J, Pope M. Nonadherence with mood stabilizers: prevalence and predictors. Journal of Clinical Psychiatry 63:384-390, 2002.

The major reasons for nonadherence with medications for individuals with bipolar disorder are the following.

Lack of awareness of illness, also called anosognosia.

Lack of awareness of illness is the single most important reason for nonadherance with medications.

In a recent review, 10 of 14 studies that examined awareness of illness and nonadherence in schizophrenia reported that the two are strongly associated.

Lacro J, Dunn LB, Dolder CR et al. Prevalence of risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. Journal of Clinical Psychiatry 63: 892-909, 2002.

The other four studies were carried out in countries in which there is a very high rate of patient adherence to medications (e.g., Ireland, 80 percent adherence) because most patients still do whatever the doctor tells them to do; this high adherence rate makes it difficult to measure the effects of lack of awareness.

Garavan J, Browne S, Gervin M et al. Compliance with neuroleptic medication in outpatients with schizophrenia; relationship to insight, subjective response to neuroleptics and attitudes to medication [abstract]. Schizophrenia Research 24:264-265, 1997.

Other recent studies have also reported a strong association between lack of awareness and medication nonadherence.

Nosé M, Barbui C, Tansella M. How often do patients with psychosis fail to adhere to treatment programmes? A systematic review. Psychological Medicine 33:1149-1160, 2003.

Mutsatsa SH, Joyce EM, Hutton SB et al. Clinical correlates of early medication adherence: West London first episode schizophrenia study. Acta Psychiatrica Scandinavica 108:439-446, 2003.

For example, a study of 218 outpatients reported that the correlation between awareness of illness and adherence with medication was highly statistically significant (p<0.007).

Trauer T, Sacks T. The relationship between insight and medication adherence in severely mentally ill clients treated in the community. Acta Psychiatrica Scandinavica 102:211-216, 2000.

When impaired awareness of illness is compared with other reasons for medication nonadherence, it is invariably found to be the single most important reason.

Faruqui RA, Andrews MD, Oyewole R et al. Clinical correlates of adherence to antipsychotic treatment in pre-discharge patients with schizophrenia [abstract]. Schizophrenia Research 60:322, 2003.

This is true for individuals with bipolar disorder as well as for those with schizophrenia.

Keck PE, McElroy SL, Strakowski SM et al. Compliance with maintenance treatment in bipolar disorder. Psychopharmacology Bulletin 33:87-91, 1997.

Greenhouse WJ, Björn M, Johnson SL. Coping and medication adherence in bipolar disorder. Journal of Affective Disorders 59:237-241, 2000.