Bipolar Patients More Likely to Take Medications for Comorbid Conditions

Whether it’s done intentionally or unconsciously, nonadherence to psychotropic medications is a significant problem in the treatment of bipolar disorder. A study published December 15, 2015, in Psychiatric Services in Advance now finds that patients with bipolar disorder may be more apt to take medication for a general medical condition than for their bipolar disorder, though adherence may be low in general.

“Patients with bipolar disorder often have comorbid medical conditions and die significantly earlier than the general population, most often from cardiovascular causes,” said the study’s lead author Jennifer Levin, Ph.D., a clinical psychologist and an assistant professor of psychiatry at Case Western, during an interview with Psychiatric News.

Although some studies have shown that data for nonadherence among patients with bipolar disorder extend to all medication types, little information is known regarding the relationship between medication-taking behaviors for psychotropic and nonpsychotropic medications by the same individual in this population.

To begin to fill in this gap in information, Levin and colleagues gathered patient-reported data from 88 patients with type I or type II bipolar disorder who reported psychotropic nonadherence (defined as having missed 20 percent or more of their current bipolar medication treatment for either the past week or month, as assessed by the Tablets Routine Questionnaire). Patients were asked questions regarding the presence or absence of hypertension, hyperlipidemia, diabetes, and depression and mania symptoms, as well as their adherence to nonpsychotropic medications prescribed.

“We found that individuals with bipolar disorder with comorbid medical conditions who are known to be nonadherent to their treatment regimen for bipolar disorder … are also nonadherent to their nonpsychotropic medications, although not to the same degree,” explained Levin.

In fact, the analysis showed that the median proportion of days with missed doses was 53.6 percent for psychotropic medications compared with 33.93 percent for nonpsychotropic medications. In addition, the researchers found that more severe psychiatric symptoms were significantly associated with nonadherence to nonpsychotropic medications. The most common medications taken by the participants to treat comorbid conditions included those intended for hypertension, cholesterol, and diabetes.

“The particular reasons for adherence to one medication versus another require further investigation,” Levin told Psychiatric News, “but our finding that an individual may adhere to one medication over another suggests that nonadherence is at least in part intentional or [a product of] inadequate organization and planning.”

Levin hypothesized that the significant difference found between nonadherence to psychotropics and nonadherence to nonpsychotropics may include patients’ fear of notable side effects associated with adhering to psychotropics, patients’ perceiving their symptoms as less severe than what the symptoms are, and stigma associated with taking drugs for mental illness.

According to Levin, the findings highlight why it is important for mental health professionals to address issues concerning both mental health and physical health by asking patients about adherence to each prescribed medication, rather than assuming that patients’ medication adherence patterns are the same for all drugs.

The study was funded by the National Institute of Mental Health. ■

An abstract of “Adherence to Psychotropic and Nonpsychotropic Medication Among Patients With Bipolar Disorder and General Medical Conditions” can be accessed here.