Improving adherence in mood disorders: the struggle against relapse, recurrence and suicide risk.
Medication nonadherence is a major obstacle to translating treatment efficacy from research settings into effectiveness in clinical practice for patients with affective disorders. Adherence to beneficial drug therapy is associated with lower mortality compared with poor adherence. Reduced adherence is associated with increased suicide risk, especially when lithium is discontinued. The aim of this paper is to review the prevalence, predictors and methods for improving medication adherence in unipolar and bipolar affective disorders. Studies were identified through Medline and PsycInfo searches of English language publications between 1976 and 2009. This was supplemented by a hand search and the inclusion of selected descriptive articles on good clinical practice. Estimates of medication nonadherence 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 on reducing nonadherence indicate that, if recognized, the problem may be overcome. Clinical data highlight the importance of extended courses of medication in improving the long-term prognosis of patients with affective disorders.
Pompili
Maurizio
M
Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Roma, Italy. maurizio.pompili@uniroma1.it
Serafini
Gianluca
G
Del Casale
Antonio
A
Rigucci
Silvia
S
Innamorati
Marco
M
Girardi
Paolo
P
Tatarelli
Roberto
R
Lester
David
D
D000928:Antidepressive Agents / Q000627:therapeutic use*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D019964:Mood Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D010353:Patient Education as Topic; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D013405:Suicide / Q000523:psychology*; D016896:Treatment Outcome
D000928:Antidepressive Agents