In undergoing psychiatric treatment for mental illnesses, it is very common to be prescribed medication. While medication can be an important and helpful part of treatment, the process of finding the right medication for each patient can be a tedious and sometimes hazardous process.  It is common practice for patients with mental illnesses, such as schizophrenia [1] , depression [2]  and bipolar [3], to switch through multiple psychiatric medications.

The Australian Genetics of Depression Survey, which includes 13,000 participants with clinical depression, reported that one in ten participants have used five or more antidepressants during their psychiatric treatment [2] The survey also reported that patients with depression will often cycle through multiple antidepressants using a trial and error approach to find the medication that best suits the patient. [2] However, by using the trial and error methodology, this process can take a very long before benefits are observed [2] and of more concern, patients may experience adverse health side effects from changing and stopping medication.

Adverse side-effects are an unfortunately common occurrence for patients taking psychiatric medication. The Australian Genetics of Depression Survey reported 76% of participants with clinical depression had some medication related side-effects and 38% of participants reported that side-effects of the medication were so severe that they had to either stop or change the medication. Participants in the survey reported antidepressant side-effects of nausea, headaches, drowsiness, and fatigue [2]. Other side-effects of antidepressants may include physical withdrawal pains from forgetting to take medication and ensuing anxiety over forgetting to take the medication again [4].

Adverse side-effects can also occur from abruptly stopping psychiatric medication. This can result in complications such as the rapid return of the illness being treated  [2], mild to moderate discontinuation symptoms[5], or in some severe cases, such as the cessation of a high dose of benzodiazepines, potentially life threatening seizures [5].

Fortunately, these side-effects can be reduced:

Firstly, it is strongly advised to take the medication switching or stopping process gradually, carefully, and slowly. [3] [5]

Secondly, harmful side-effects can be reduced for patients by maintaining constant engagement with their clinician through actively participating in their treatment by asking questions and providing feedback, closely monitoring their own behaviour and ensuring that their medication changes remain under active clinician supervision. [5]

Monitoring can be particularly critical to a medication switching period. According to Dr. Ross J. Baldessarini, the professor of psychiatry and neuroscience at Harvard Medical School and director of the psychopharmacology program at the McLean Division of Massachusetts General Hospital, the initial period following medication discontinuation is the most critical period and should be closely monitored, as some people may not experience the withdrawal and harmful symptoms of stopping medication for weeks, or even months after stopping the medication. [5]

Interactive electronic monitoring

An interactive electronic approach for self-monitoring offers a monitoring technique that includes a more accurate, comprehensive, and real-time assessment within naturalistic settings [6]. This type of monitoring is ideal for patients who are undergoing the medication switching process and need to constantly provide their clinician with accurate and extensive details about their mood states and behaviour.

There are several advantages to electronic monitoring as opposed to pen and paper data collection, such as:

• Making data immediately available for analyses through online and digital formats [6]
• By being able to log data in real time, patients are not subject to the same potential recall bias as when reporting data retrospectively using a pen and paper method. [7][8][9][10]
• Daily information regarding patient behaviour that may have been lost due to cognitive dysfunction [6], impairments, stressful life or health factors, or simply forgetting, is readily recorded by an electronic system as opposed to depending on self-reporting with the pen and paper method.

Interactive Electronic Monitoring through Monsenso’s mHealth Solution 

Monsenso’s mHealth solution is an interactive electronic monitoring system which utilises a double loop feedback model. The first loop consists of the patient’s smartphone app and a web portal is connected to the second loop, which is the clinician’s web portal. The smartphone app uses sensors to automatically collect data from the patients, and allows patients to fill out a daily self-assessment regarding the state of their symptoms and their medicinal intake. This data is sent immediately to the connected clinician’s web portal.

Monsenso’s interactive electronic monitoring system can have these important benefits by optimising the consultation and engagement flow between patient and clinician:

1. Offers the ability to verify the timing and compliance of data collection. [11]
2. The smartphone app can send a daily notification with a reminder for the patient to complete the self-assessment or take their medication.
3. Patients can fill out a customised diary note about the potential side-effects of medication or their symptoms to share with clinicians.
4. Clinicians can obtain daily, real time, and comprehensive information about the clinical state of the patient, such as the state and occurrence of their symptoms and their medicinal intake.
5. Patients and clinicians can obtain measures of daily variability of clinical states and behaviours of the patient.[11]
6. This data is visualised in a line chart, where patients and clinicians can view the chart together to discover time-trends and relationships between behavioural variables and clinical states. [11]
7. This information and awareness can foster patients to make earlier adjustments to their behaviour, as well as engage in a more focused treatment. [11]
8. This information can also provide preparation for a clinician in administering rapid early intervention. [11]

The Monsenso mHealth solution can provide the carefully supervised and comprehensive monitoring of patients’ behaviour necessary to help ease the medication and stopping switching process.

[1] Effectiveness of switching antipsychotic medications. Susan M., et al. American Journal of Psychiatry 163.12.2090-2095. (2006)

[2] What Patients say about taking antidepressants. What patients say about taking antidepressants | 6 minutes. https://www.6minutes.com.au/node/20078

[3]  Getting Through a Major Medication Change. International Bipolar Foundation. http://www.ibpf.org/blog/getting-through-major-medication-change

[4]  My Impossible Quest for the Right Depression Meds.  I.Masad. Marie Claire. (2017, June 14) http://www.marieclaire.com/health-fitness/features/a20452/finding-the-right-depression-medication/ 

[5] Discontinuing Psychiatric Medications: What You Need to Know. M. Tartakovsky. Psych Central. (2016, July 17) https://psychcentral.com/lib/discontinuing-psychiatric-medications-what-you-need-to-know/

[6] Cognitive symptoms in patients with major depressive disorder and their implications for clinical practice. G. Papakostas. The Journal of clinical psychiatry 75.1 (2014):8-14.

[7] New technologies to improve clinical trials. Kobak, Kenneth A., et al. Journal of clinical psychopharmacology 21.3 (2001): 255-256.

[8] Patient compliance with paper and electronic diaries. Stone, Arthur A., et al. Controlled clinical trials 24.2 (2003): 182-199.

[9] The electronic assessment of the longitudinal course of bipolar disorder: the ChronoRecord software. Whybrow, P. C., et al Pharmacopsychiatry 36.S 3 (2003): 244-249.

[10] Trends in ambulatory self-report: the role of momentary experience in psychosomatic medicine. Conner, Tamlin S., and Lisa Feldman Barrett. Psychosomatic medicine 74.4 (2012): 327.

[11] Usability, Acceptability, and Adherence to an Electronic Self-Monitoring System in Patients With Major Depression Discharged From Inpatient Wards. Lauritsen, Lise, et al. Journal of medical Internet research 19.4 (2017).