Treatment non-adherence in affective disorders.
OBJECTIVE
The aim of this paper is to review the prevalence, predictors and methods for improving medication adherence in unipolar and bipolar affective disorders.


METHODS
Studies were identified through Medline and PsycLit searches of English language publications between 1976 and 2001. This was supplemented by a hand search and the inclusion of selected descriptive articles on good clinical practice.


RESULTS
Estimates of medication non-adherence 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 of how to reduce non-adherence offer encouraging evidence that, if recognized, the problem can be overcome.


CONCLUSIONS
Only 1-2% of all publications on the treatment of affective disorders explore factors associated with medication non-adherence. This is disappointing as research and clinical data highlight the importance of extended courses of medication in improving the long-term prognosis of affective disorders.
Lingam
Ravi
R
Department of Psychiatry and Psychotherapy, Claremont House, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Scott
Jan
J
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001294:Attitude to Health; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology*; D003469:Culture; D003674:Defense Mechanisms; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011379:Prognosis; D055502:Secondary Prevention; D011795:Surveys and Questionnaires; D014149:Tranquilizing Agents / Q000009:adverse effects / Q000627:therapeutic use; D016312:Treatment Refusal / Q000523:psychology*
D000928:Antidepressive Agents; D014149:Tranquilizing Agents