Antipsychotic treatment experiences of people with bipolar I disorder: patient perspectives from an online survey

• Published in: BMC psychiatry 2020-07, Vol.20 (1), p.354-12, Article 354
• Main Authors: Bessonova, Leona, Velligan, Dawn I, Weiden, Peter J, O'Sullivan, Amy K, Yarlas, Aaron, Bayliss, Martha, Baranwal, Nishtha, Rychlec, Kaitlin, Carpenter-Conlin, Julia, Doane, Michael J, Sajatovic, Martha
• Format: Article
• Language: English
• Subjects: Adherence; Adult; Age; Antipsychotic; Antipsychotic agents; Antipsychotic Agents - adverse effects; Antipsychotics; Anxiety; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar I disorder; Care and treatment; Cross-Sectional Studies; Female; Humans; Internet; Male; Mental disorders; Mental health; Participation; Patient compliance; Patients; Preference; Psychiatry; Side effects; Social aspects; Surveys and Questionnaires; Symptom management; Weight Gain
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-020-02767-x

Oral antipsychotic (AP) medications are frequently prescribed to people with bipolar I disorder (BD-I). A cross-sectional online survey examined the experiences of people living with BD-I with a history of recent AP use. Adults with self-reported physician-diagnosed BD-I (N = 200) who received oral APs during the prior year completed a survey on AP-related experiences, including side effects and their perceived burden on social functioning, adherence, and work. Items also assessed preferences for trade-offs (balancing symptom management and side effects) when considering a hypothetical new AP. The perceived impact of specific, prevalent side effects on adherence, work, and preferences for a hypothetical AP were also examined. Analyses were descriptive. The survey sample had a mean age of 43.2 (SD = 12.4) years, was 60% female, and 31% nonwhite. Almost all participants (98%) had experienced AP side effects. Common self-reported side effects were feeling drowsy or tired (83%), lack of emotion (79%), anxiety (79%), dry mouth (76%), and weight gain (76%). Weight gain was cited as the most bothersome side effect, rated by most participants (68%) as "very" or "extremely bothersome." Nearly half of participants (49%) reported that AP side effects negatively impacted their job performance; almost all (92%) reported that side effects - most commonly anxiety and lack of emotion - negatively impacted social relationships (e.g., family or romantic partners). The most commonly-reported reason for stopping AP use was dislike of side effects (48%). Side effects most likely to lead to stopping or taking less of AP treatment included "feeling like a 'zombie'" (29%), feeling drowsy or tired (25%), and weight gain (24%). When considering a hypothetical new AP, the most common side effects participants wanted to avoid included AP-induced anxiety (50%), weight gain (48%), and "feeling like a 'zombie'" (47%). Side effects of APs were both common and bothersome, and impacted social functioning, adherence, and work. Findings highlight the prevailing unmet need for new APs with more favorable benefit-risk profiles.