What is a big cause of non-adherence in bipolar disorder treatment?

According to Christoph Correll, MD, professor of psychiatry at Hofstra Northwell School of Medicine, New York, non-adherence is "a common problem in all of medicine. I would even add in all of life." And, when working with patients with psychotic disorders such as bipolar disorder or schizophrenia, ensuring that medication is still being taken regularly can be an even harder task. In a chat with Psych Congress Network on-site at the 2023 NP Institute, Desiree Matthews, PMHNP-BC, Director of Advanced Practice Providers at Monarch, Charlotte, North Carolina, examines which reasons she hears the most from patients with bipolar disorder as to why they are not taking their medication as they should.

For more expert insights on telehealth practice, visit our Bipolar Disorder Excellence Forum.

Save the date for NP Institute In-Person, March 20-23, 2024 in San Diego, California! For more information, visit the meeting website.

Read the Transcript: 

Psych Congress Network: What are the reasons that you hear in your practice for why a patient may not be adhering to their treatment plan for bipolar disorder?

Desiree Matthews, PHMNP-BC: So in my practice, taking care of my patients with bipolar disorder, I hear a lot of times a medication is prescribed, maybe by the hospital, maybe by us in outpatient, they come back 4 weeks later. I ask, "how are you doing? How's the medication? Are you taking it every day?" Oftentimes, they'll tell me, "no, I felt funny. I didn't feel like myself. I started to eat too much. I already noticed weight gain." So unfortunately we know a lot of our treatments for bipolar disorder unfortunately come with a lot of baggage with side effects and tolerability.

Unfortunately, even the most efficacious medication, if the patient doesn't feel that they're able to tolerate it and those side effects are kind of encroaching on their quality of life, they're going to end up stopping the medication. I would say one of the biggest reasons for discontinuing medication on the patient's side is, honestly as well as my side, is really weight gain. Weight gain is a deal breaker for many patients.

Desiree Matthews, PHMNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner. She received her Bachelor's of Nursing from University at Buffalo and her Master's of Nursing at Stony Brook University. She currently resides in Charlotte, NC, and practices at Monarch, a community mental health center providing telepsychiatry services to adult patients. Clinical interests include the treatment of schizophrenia, bipolar disorder, treatment-resistant unipolar depression, and drug-induced movement disorders, including tardive dyskinesia. She has provided faculty expertise and insight into the development of a clinical screener for TD called MIND-TD.