Nonadherence with mood stabilizers: prevalence and predictors.
BACKGROUND
The prevalence of nonadherence with mood stabilizers ranges from about 18% to 52%. Only 1% of publications on mood stabilizers address this issue. This study aimed to explore the prevalence and predictors of nonadherence in a cohort of individuals with affective disorders receiving long-term treatment with mood stabilizers.


METHODS
Subjects receiving lithium, carbamazepine, and/or valproate were identified from biochemistry laboratory data. Ninety-eight of these subjects had major depressive disorder (N = 20) or bipolar disorder (N = 78) (DSM-IV) and gave informed consent to participate in a structured clinical interview to assess their medication adherence and the factors that influenced it.


RESULTS
Just under 50% of subjects (46/98) acknowledged some degree of medication nonadherence in the previous 2 years, and 32% (29/92) reported only partial adherence in the last month (missing 30% or more of their prescribed medication). Backward stepwise logistic regression demonstrated that partially adherent subjects were best distinguished from adherent subjects by a more frequent past history of nonadherence, denial of severity of illness, and greater duration of being prescribed a mood stabilizer.


CONCLUSIONS
Rates of mood stabilizer nonadherence are high. Attitudes and behaviors are better predictors of nonadherence than side effects from medication. Clinicians need to inquire routinely about problems with adherence.
Scott
Jan
J
University of Glasgow, Scotland. jan.scott@clinmed.gla.ac.uk
Pope
Marie
M
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000517:prevention & control / Q000523:psychology; D002220:Carbamazepine / Q000627:therapeutic use; D015331:Cohort Studies; D003717:Denial, Psychological; D003866:Depressive Disorder / Q000188:drug therapy* / Q000517:prevention & control / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011336:Probability; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D000928:Antidepressive Agents; D002220:Carbamazepine; D014635:Valproic Acid; D008094:Lithium