Journal of Affective Disorders Reports (Jul 2025)
Mood stabilizer adherence patterns among adults with bipolar disorder: A single-center retrospective analysis
Abstract
Background: Bipolar disorder (BD) is a severe psychiatric disorder frequently associated with psychotropic non-adherence. Few studies have quantified real-world adherence patterns among people prescribed lithium or valproate for BD. Methods: This single-center retrospective study examined adherence to lithium and valproate among adults hospitalized for BD between January 2017 and January 2022. The primary outcomes were the differences in the 6-month average proportion of days covered (PDC), for months 1 – 6 and 7 – 12 post-discharge, between the lithium and valproate groups. Secondary outcomes included the 12-month psychiatric readmission rate and demographic/comorbid associations with PDC. PDC was calculated by querying SureScripts fill records and confirming dispensing dates with pharmacies. Results: Of 75 eligible adults, 56.0 % were discharged on lithium and 44.0 % on valproate. People discharged on lithium exhibited higher PDC during months 1 – 6 (0.36 versus 0.25 in the valproate group) and 7 – 12 (0.27 versus 0.16); these differences lacked statistical significance. Significant difference in ≥ 1 psychiatric re-admission during months 1 – 12 was observed between people discharged on lithium (9.5 %) and those discharged on valproate (30.3 %) (p = 0.035). Male sex and comorbid substance use disorder were associated with significantly lower PDC. Conclusion: People discharged on lithium or valproate are vulnerable to mood stabilizer non-adherence following psychiatric hospitalization. Future research should examine psychotropic adherence trajectories in larger subpopulations of people with BD. Limitations: Data derived from medication fill records may overestimate adherence in people who miss doses after dispensing and underestimate adherence in people who switch mood stabilizer therapy under a clinician’s direction.
