title: Medication adherence in a comparative effectiveness trial for bipolar disorder.
abstract: OBJECTIVE
  Psychopharmacology remains the foundation of treatment for bipolar disorder, but medication adherence in this population is low (range 20-64%). We examined medication adherence in a multisite, comparative effectiveness study of lithium.
  
  
  METHODS
  The Lithium Moderate Dose Use Study (LiTMUS) was a 6-month, six-site, randomized effectiveness trial of adjunctive moderate dose lithium therapy compared with optimized treatment in adult out-patients with bipolar I or II disorder (N=283). Medication adherence was measured at each study visit with the Tablet Routine Questionnaire.
  
  
  RESULTS
  We found that 4.50% of participants reported missing at least 30% of their medications in the past week at baseline and non-adherence remained low throughout the trial (<7%). Poor medication adherence was associated with more manic symptoms and side-effects as well as lower lithium serum levels at mid- and post-treatment, but not with poor quality of life, overall severity of illness, or depressive symptoms.
  
  
  CONCLUSIONS
  Participants in LiTMUS were highly adherent with taking their medications. The lack of association with possible predictors of adherence, such as depression and quality of life, could be explained by the limited variance or other factors as well as by not using an objective measure of adherence.
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Sylvia
authors.forename: N A
authors.initials: NA
authors.lastname: Reilly-Harrington
authors.forename: A C
authors.initials: AC
authors.lastname: Leon
authors.forename: C I
authors.initials: CI
authors.lastname: Kansky
authors.forename: J R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: C L
authors.initials: CL
authors.lastname: Bowden
authors.forename: T A
authors.initials: TA
authors.lastname: Ketter
authors.forename: E S
authors.initials: ES
authors.lastname: Friedman
authors.forename: D V
authors.initials: DV
authors.lastname: Iosifescu
authors.forename: M E
authors.initials: ME
authors.lastname: Thase
authors.forename: M J
authors.initials: MJ
authors.lastname: Ostacher
authors.forename: M
authors.initials: M
authors.lastname: Keyes
authors.forename: D
authors.initials: D
authors.lastname: Rabideau
authors.forename: A A
authors.initials: AA
authors.lastname: Nierenberg
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects*; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D018692:Antimanic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D057186:Comparative Effectiveness Research; D003863:Depression / Q000188:drug therapy / Q000209:etiology; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D008297:Male; D055118:Medication Adherence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D018020:Lithium Compounds
keywords: bipolar disorder; compliance; psychopharmacology