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Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors.

Vicki C Fung1, Lindsay N Overhage1, Louisa G Sylvia2

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Complex polypharmacy in bipolar disorder (BD) is linked to lower medication adherence and reduced treatment response. Clinicians should evaluate adherence before increasing medication complexity for BD patients.

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Area of Science:

  • Psychiatry and Behavioral Sciences
  • Clinical Pharmacology

Background:

  • Complex polypharmacy (CP) is prevalent in bipolar disorder (BD).
  • Understanding the interplay between CP, adherence, and clinical outcomes is crucial for effective BD management.

Purpose of the Study:

  • To assess the associations between complex polypharmacy (CP), medication adherence, and side effect burden in bipolar disorder (BD).
  • To identify patient traits associated with clinical improvement in relation to CP.

Main Methods:

  • Secondary analysis of 482 adult BD participants from the Bipolar CHOICE trial.
  • Multivariate models assessed associations between CP (≥3 BD medications) and non-adherence (>30% missed doses).
  • Logistic regression identified traits linked to remission in patients with majority CP use.

Main Results:

  • 43% of patients used any CP, with 25% using it for most of the study.
  • CP was associated with increased non-adherence (OR=2.51) but not greater side effect burden.
  • Among CP users, 16% achieved remission; non-adherence and comorbid anxiety disorders reduced remission likelihood.

Conclusions:

  • Bipolar disorder patients on CP exhibit lower adherence and poorer clinical response.
  • Assessing medication adherence is vital before initiating additional medications in CP regimens.
  • Non-adherence and specific comorbidities negatively impact remission rates in CP users.