Factors Affecting Long-term Lithium Compliance in Bipolar Patients

Background: Mood stabilizers such as lithium are effective agents to treat bipolar disorder and are known to decrease suicide rates. This paper looks to explore the variables associated with compliance and specifically compare and contrast compliant and non-compliant patient groups.

Methods: 111 euthymic bipolar patients aged 18-75 that had not been compliant with their lithium therapy completed a phone or paper questionnaire to assess reasons of non-adherence after obtaining informed written consent for this IRB-approved study. Symptoms were also assessed by nurses using the Columbia-Milhauser Mood scale, modified from the Hamilton Depression Inventory and the Biegel Mania Scale. These results were compared to those of 133 euthymic participants that were compliant with their lithium regimen.

Results: Chi-square tests revealed significant differences between the two patient groups regarding factors affecting compliance (P values range: 0.009 - <0.001). T-tests showed patients who discontinued lithium therapy not only had more depressive symptoms when compared with the compliant group, but also the depressive symptoms were more severe (P =0.02).

Conclusions: Indefinite length of medication treatment, stigma associated with mental illness, and having one’s mood controlled by medication seemed to be associated with patient lack of compliance with lithium. Further research needs to address how to overcome these challenges and improve compliance. The results should be interpreted with caution as naturalistic data and the above results may only apply to the assessed sample.