Bipolar Disorder Treatment Factors That Affect Treatment Adherence in Bipolar Disorder By Kendra Cherry, MSEd Kendra Cherry, MSEd Facebook Twitter Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book." Learn about our editorial process Updated on February 23, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Grace Cary / Getty Images Table of Contents View All Table of Contents Factors That Impact Adherence Ways to Improve Adherence While treatments are available to help manage the symptoms of bipolar disorder, research suggests that around half of all people with the condition stop adhering to their treatment at some point. It is not uncommon for people with chronic health conditions to stop adhering to their treatments to some degree. The non-adherence rates for bipolar disorder are consistent with the rates for other types of chronic conditions. While various definitions exist, treatment adherence generally involves the extent to which a person follows their healthcare provider's recommendations for medications, diet, therapy, and lifestyle changes designed to treat their ailment or condition. Not adhering to treatment recommendations can lead to worsening symptoms and a poorer prognosis. Because of this, it is important to understand why some people don’t take their medications as prescribed and look for ways to help improve treatment adherence. Factors That Impact Adherence The factors that affect treatment adherence among people with bipolar disorder can vary from one person to the next and are often complex. Early research on adherence to lithium treatment for bipolar disorder found that there were four key domains that played a role in people sticking to their medication. These were: The patientThe illnessThe medication effectsThe doctor These four areas exert their own effects but also interact with one another. For example, a person's individual attitudes toward their treatment may be influenced by the severity of their symptoms, the side effects they experience, and their relationship with their doctor or therapist. Research has also shown that there are a number of other key factors that have a role in treatment adherence. These factors are listed below. Affordability Cost is often a significant barrier to treatment adherence in bipolar disorder. Studies have suggested that as many as half of all people with the condition do not receive appropriate treatment due to systemic issues such as lack of insurance or an inability to afford appropriate care. Beliefs About Medication A person's attitudes and beliefs about their bipolar medication can often affect whether they are willing to stick to their doctor's recommendations. People who believe that their medications don't really help, for example, are far less likely to keep taking them. Some of the negative attitudes that impact adherence include: Believing they are not effective Fear of becoming dependent Fear of being controlled or losing independence Fear of side effects Missing elevated moods associated with bipolar mania Thinking symptoms are not severe enough to require medication Such attitudes can be shaped in a variety of ways. They might be related to a person's perceptions of their experience with treatment, influenced by family or friends, or related to general attitudes about health and wellness. Family Influences Social influences, particularly those of family members, close friends, or other loved ones, can also have an impact on whether or not people adhere to their bipolar treatment. Poor support from family members, a dysfunctional family atmosphere, criticism, and negative attitudes toward treatment have all been linked to bipolar treatment non-adherence. Mental Health Stigma Stigma toward mental illness can also be a factor in whether or not people stick to their treatment over the long-term. People with bipolar disorder may fear the negative opinions of others, which may lead to them either not seeking treatment or not following their doctor’s recommendations. Relationship With Doctor An individual’s relationship with their healthcare provider, often referred to as a treatment alliance, can also have an important influence on whether a person sticks to their doctor’s medical advice. A number of studies have shown that people who have a strong treatment alliance with their provider are much more likely to adhere to their treatment plan. People are more likely to experience this when they genuinely like their doctor, when they feel that they are collaborating with their provider in their treatment, and when the individual and their provider agree on the goals of treatment. So how do people with bipolar disorder and providers form a strong alliance that will improve adherence? A number of factors can play a role, but good communication is often key. People need to feel that they can talk openly with their doctor and know that their concerns are taken seriously. Satisfaction With Treatment Overall satisfaction with treatment also influences how well people stick to their treatment plan. It is perhaps not surprising that people who are happy with their treatment and don’t experience negative side effects from medication end up adhering more closely over the long term. Those who have unpleasant side effects or who feel that their treatment isn’t really doing much to treat symptoms, however, are more likely to not take their medication. Understanding of Bipolar Disorder Lack of knowledge about the condition is often another reason why people struggle to stick to their treatment plan. When people don't understand bipolar disorder, including the way it can influence behavior and the impact that treatment can have, they may not believe that they really need to take their medications or continue their therapy. The reasons why people don't fully understand their condition can be due to a number of different things. They may not seek knowledge or their doctor may not effectively communicate what they need to know. Are There Different Types of Bipolar Disorder? Ways to Improve Adherence While research has shown that treatment non-adherence is quite common in bipolar disorder as well as other chronic health conditions, there may be effective ways to improve the likelihood that you will persist with treatment over time. Some strategies that might help include the following: Build a Connection With Your Doctor It is essential to trust and feel comfortable talking to your doctor. This means finding a doctor who listens, shares your goals, and wants to collaborate with you to find the best approach. Be Honest About How You’re Feeling It is also important for you to be open and honest with your doctor. If you aren’t happy with some aspect of your treatment or if you are experiencing side effects that make you not want to take your medication, let your doctor know. Research suggests that doctors often underestimate how well their patients are sticking to their treatments. The only way your doctor can know there is a problem is often if you tell them. Learn More About Bipolar Disorder Being informed about your condition won’t only help you make better choices, it may also make it more likely that you’ll continue with your treatments. Find Social Support Friends and family can be helpful, but if they can’t or won’t provide what you need, consider seeking out support from others. Local support groups can be a great place to meet others who have experience with bipolar disorder. Online bipolar support groups can also be beneficial. Even if you are pretty good about following your treatments most of the time, it is common periodically to slip up when it comes to having a lifelong condition. Finding ways to improve treatment adherence can help improve your prognosis and outcomes over the long term. Always be sure to talk to your doctor or mental health professional if there are factors that are interfering with your ability to continue with your bipolar treatment plan. How the Stigma of Mental Health Is Spread by Mass Media 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Chakrabarti S. Treatment-adherence in bipolar disorder: A patient-centred approach. World J Psychiatry. 2016;6(4):399-409. doi:10.5498/wjp.v6.i4.399 Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304-314. doi:10.4065/mcp.2010.0575 Jamison KR, Gerner RH, Goodwin FK. Patient and physician attitudes toward lithium: relationship to compliance. Arch Gen Psychiatry. 1979 Jul 20;36(8 Spec No):866-9. doi:10.1001/archpsyc.1979.01780080040011 Busby KK, Sajatovic M. REVIEW: Patient, treatment, and systems-level factors in bipolar disorder nonadherence: A summary of the literature. CNS Neurosci Ther. 2010;16(5):308-15. doi: 10.1111/j.1755-5949.2010.00191.x Sajatovic M, Levin J, Fuentes-Casiano E, Cassidy KA, Tatsuoka C, Jenkins JH. Illness experience and reasons for nonadherence among individuals with bipolar disorder who are poorly adherent with medication. Compr Psychiatry. 2011;52(3):280-7. doi:10.1016/j.comppsych.2010.07.002 Kamaradova D, Latalova K, Prasko J, et al. Connection between self-stigma, adherence to treatment, and discontinuation of medication. Patient Prefer Adherence. 2016;10:1289-1298. doi:10.2147/PPA.S99136 Chakrabarti S. Treatment alliance and adherence in bipolar disorder. World J Psychiatry. 2018;8(5):114-124. doi:10.5498/wjp.v8.i5.114 By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book." 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