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September 3, 2014
by Cathy England, MA

Treatment Compliance in Bipolar Disorder

September 3, 2014 04:55 by Cathy England, MA  [About the Author]

Not Just Mood Swings

Bipolar Disorder was commonly referred to as Manic Depressive Disorder, and is a mental illness that is characterized by extreme changes in mood from very high or manic, and very low or depressed. It is considered to be one of the more disabling disorders especially when it goes untreated. During manic phases, people can be self-destructive and impulsive which can be difficult for others to deal with. Also during a manic phase, many people living with this illness are likely to “feel great” and might become non-compliant with the treatment that keeps them more stable.

Medications Only Work When you Take Them

Sajatovic, et al. (2008) indicate that there are a number of factors that contribute to adherence with medication schedules which include acceptance of diagnosis, adverse effects of medication, attitudes toward treatment, and symptom severity. This non-compliance with medication can be dangerous for a number of reasons. Many common medications used to treat the disorder should only be discontinued with a doctor’s guidance due to withdrawal symptoms and with the likelihood that symptoms will return. It is difficult for the individual to accept the fact that they may need to be on these medications on a long-term basis, and the nature of the disorder affects the attitudes toward taking the required regime. These authors found in their study of veterans that approximately 12% admitted to not taking medications as they are prescribed.  This was found to be lower than other studies which had shown non-compliance rates of close to 30%.

In another study, Sajatovic, et al. (2006) found that while anti-psychotic medication is common in the treatment of patients with more severe cases of Bipolar Disorder, up to 48% of these individuals are partially or totally non-compliant in regularly taking those medications. In this study, one of the most reported reasons for not taking medication was the desire to take illicit substances instead. The clinical implications of this according to the authors include worsening of symptoms, need for hospitalization and in the worst outcome, higher rates of suicide. They suggest that more research is needed into the reasons for and approaches to non-adherence.

Guadiano, Weinstock, and Miller (2008) addressed this need for new approaches to increasing patient adherence to treatment for Bipolar Disorder. The reported numbers in their study approached a 60% rate of non-compliance to recommended treatment. This is a staggering number given the severity of symptoms and effect on quality of life. These authors also pointed out that compliance needs to be evaluated beyond whether or not individuals take their prescribed medication. It should also include considerations of behavior like not attending recommended appointments, and not following lifestyle change recommendations.

Be an Encouragement

If you are reading this as a provider, caretaker, or loved one of a person with Bipolar Disorder it is important to encourage all people with the illness to comply with their treatment plan. Even complete compliance does not ensure that episodes of mania or depression might not occur. However, the research supports the idea that it greatly reduces the likelihood of such relapse. Individuals can be supported in various ways. In the study above, one of the potential interventions may be to include a family member or partner in psychotherapy in order to encourage accountability in treatment. One of the difficulties as a caretaker may be worry about facing the anger of the individual if pushed too hard about compliance issues (Guadiano, Weinstock, and Miller, 2008).

Seek Treatment

If you are a person reading this who has Bipolar Disorder, it is vitally important that you seek out treatment if you are not currently under medical care. It is then also important to follow the recommendations of the mental health professionals that you have entrusted with your care. The nature of the illness is that your brain can convince you that adherence is not needed, that you are not symptomatic, and that taking medications or attending therapy is no longer needed. However, most of the research indicates that this is ill-advised.

 Education is Key

In each of these studies it was recommended that further research into ways that adherence can be improved was recommended. This has not been widely studied, and yet it remains vitally important in the treatment of the disorder. Educating patients on the potential hazards may be a good place to start. The more the individual understands when they are in a stable phase, the more likely it is that they may keep up with treatment even when experiencing symptoms. It would seem that a multi-faceted approach to treatment including not just medication, but also therapy should probably be considered.


Guadiano, B., Weinstock, L., and Miller, I. (2008). Improving treatment adherence in bipolar disorder: A review of current psychosocial treatment efficacy and recommendations for future treatment development. Behavior Modification, 32(3), 267-301.

Sajatovic, M., Biswas, K., Kilbourne, A., Fenn, H., Williford, W. and Bauer, (2008). Factors associated with prospective long-term treatment adherence among individuals with bipolar disorder. Psychiatric Services, 59(7), 753-9.

Sajatovic, M., Valenstein, M., Blow, F. C., Ganoczy, D. and Ignacio, R. V. (2006), Treatment adherence with antipsychotic medications in bipolar disorder. Bipolar Disorders, 8: 232–241. 

About the Author

Cathy England, MA Cathy England, MA

Cathy holds a Master’s degree in Psychology and has 13 years of work experience in counseling and social work. Cathy is an advocate for mental health awareness and enjoys educating people about mental health and the ways that it impacts people and communities. Most of her experience has been in work with court dependent or delinquent adolescents and their families. Cathy has also worked as a volunteer as a Court Appointed Special Advocate (CASA) for children under court supervision.

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