Medication treatment perceptions, concerns and expectations among depressed individuals with Type I Bipolar Disorder

J Affect Disord. 2009 Jun;115(3):360-6. doi: 10.1016/j.jad.2008.10.002. Epub 2008 Nov 8.


Background: Subjective experience of illness affects outcomes among populations with bipolar disorder (BD). This cross-sectional study combined qualitative and quantitative approaches to evaluate perceived treatment effects, concerns and expectations among 90 individuals with BD.

Methods: Adults with Type I BD, mean age 36.6 years, 51% women, completed a semi-structured interview that was audio taped, transcribed, coded and analyzed along emergent themes. Quantitative scales measured depressive symptoms (Hamilton Depression Scale/HAM-D), psychopathology (Clinical Global Impression/CGI), and insight and treatment attitudes (Insight and Treatment Attitudes Questionnaire/ITAQ).

Results: Individuals had moderate depression and psychopathology with good insight into need for treatment. Drug treatment was perceived as beneficial, by "stabilizing" or "balancing" mood (42%, N=38), decreasing anxiety/depressive symptoms (19%, N=17) and improving sleep (10%, N=9). While 39%, (N=35) of individuals denied medication concerns, nearly 29%, (N=26) feared possible long-term effects, particularly diabetes or liver/kidney damage. Media stories and advertisements contributed to medication fears. Hopes and expectations for treatment ranged from those that were symptom or functional status-based, such as desiring mood stabilization and elimination of specific symptoms (23%, N=21), to more global hopes such as "being normal" (20%, N=18) or "cured" (18%, N=16).

Limitations: Limitations include relatively small sample, lack of a comparator, inclusion of only depressed individuals and those willing to discuss their illness experience.

Conclusions: While individuals with BD appreciate the effects of medications, concerns regarding adverse effects and discrepancy between actual and hoped-for outcomes can be substantial. Subjective experience with medications using qualitative and quantitative methods should be explored in order to optimize treatment collaboration and outcomes.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Affect / drug effects
  • Anticonvulsants / administration & dosage
  • Anticonvulsants / adverse effects
  • Antipsychotic Agents / administration & dosage
  • Antipsychotic Agents / adverse effects
  • Anxiety / drug therapy
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / psychology
  • Cross-Sectional Studies
  • Depression / drug therapy*
  • Depression / psychology
  • Diabetes Mellitus / chemically induced
  • Fear / psychology
  • Female
  • Humans
  • Kidney Diseases / chemically induced
  • Lithium Compounds / administration & dosage
  • Lithium Compounds / adverse effects
  • Male
  • Medication Adherence / psychology*
  • Medication Adherence / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Psychiatric Status Rating Scales
  • Research Design
  • Sleep / drug effects
  • Surveys and Questionnaires
  • Treatment Refusal / psychology*
  • Treatment Refusal / statistics & numerical data
  • Young Adult


  • Anticonvulsants
  • Antipsychotic Agents
  • Lithium Compounds