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Int J Bipolar Disord. 2018 May 1;6(1):10. doi: 10.1186/s40345-018-0118-8.

Regularity of self-reported daily dosage of mood stabilizers and antipsychotics in patients with bipolar disorder.

Author information

1
Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. maximilian.pilhatsch@uniklinikum-dresden.de.
2
ChronoRecord Association Inc., Fullerton, CA, USA.
3
Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA.
4
Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
5
Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
6
Mood Disorders Center of Ottawa, University of Toronto, Toronto, Canada.
7
Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
8
Department of Psychiatry, University of Massachusetts, Worcester, MA, USA.
9
Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA.
10
Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
11
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA.

Abstract

BACKGROUND:

Polypharmacy is often prescribed for bipolar disorder, yet medication non-adherence remains a serious problem. This study investigated the regularity in the daily dosage taken of mood stabilizers and second generation antipsychotics.

METHODS:

Daily self-reported data on medications taken and mood were available from 241 patients with a diagnosis of bipolar disorder who received treatment as usual. Patients who took the same mood stabilizer or second generation antipsychotic for ≥ 100 days were included. Approximate entropy was used to determine serial regularity in daily dosage taken. Generalized estimating equations were used to estimate if demographic or clinical variables were associated with regularity.

RESULTS:

There were 422 analysis periods available from the 241 patients. Patients took drugs on 84.4% of days. Considerable irregularity was found, mostly due to single-day omissions and dosage changes. Drug holidays (missing 3 or more consecutive days) were found in 35.8% of the analysis periods. Irregularity was associated with an increasing total number of psychotropic drugs taken (p = 0.009), the pill burden (p = 0.026), and the percent of days depressed (p = 0.049).

CONCLUSION:

Despite low missing percent of days, daily drug dosage may be irregular primarily due to single day omissions and dosage changes. Drug holidays are common. Physicians should expect to see partial adherence in clinical practice, especially with complex drug regimens. Daily dosage irregularity may impact the continuity of drug action, contribute to individual variation in treatment response, and needs further study.

KEYWORDS:

Adherence; Bipolar disorder; Mood stabilizers; Polypharmacy; Second generation antipsychotics

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