How electronic monitoring can assist a psychiatric medication change

How electronic monitoring can assist a psychiatric medication change

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.

[3]  Getting Through a Major Medication Change. International Bipolar Foundation.

[4]  My Impossible Quest for the Right Depression Meds.  I.Masad. Marie Claire. (2017, June 14) 

[5] Discontinuing Psychiatric Medications: What You Need to Know. M. Tartakovsky. Psych Central. (2016, July 17)

[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).

Empowering patients with digital technology

Empowering patients with digital technology

On the previous blog post, “Transforming health and social care with digital technology” connected health or technology-enabled care (TEC) was defined as the collective term used for telecare, telehealth, telemedicine, mHealth, digital health, and eHealth services. This type of technology can empower patients and carers by giving them more control over their health and social care needs. It can also help individuals to obtain more information regarding their health.

In broad terms, TEC can:

  • Improve self-management through remote monitoring, education, and treatment adherence
  • Tackle areas of unmet needs that traditional treatment struggles to address, such as mental health
  • Supports the development of online patient portals and patient communities
  • Transforms the relationship between patients, carers and healthcare providers to focus on co-creation

Enables self-management

Nowadays, patients and their carers use technology to research information online, identify treatment options, rate providers, and share their experiences. Healthcare needs to acknowledge that emerging technologies offer a tremendous opportunity to transform the way people engage with their health.

Besides connecting patients and providers, digital technology leads to better outcomes and a more personalised service by educating patients in regards to their health-related issues, enabling remote monitoring, and supporting treatment adherence.

Informs and educates patients and carers

It is estimated that 75% of the UK population goes online for health information. Websites, apps, videos, texts and free online courses are being used to educate and provide information to patients and their family caregivers [1].

Figure 1 displays the most common category of mobile apps: fitness, medical reference and wellness apps, which provide information with other very limited functionalities.

Figure 1. Digital health app category, percentage share in 2014.

Figure 1

The use of digital technology to educate patients and carers is a crucial driver of patient engagement. Surveys suggest that patients are more likely to make better choices and be engaged in their health if they can access information quickly.

Digital technology connects patients and providers, leading to better health outcomes and a more convenient and personalised service, through informing/educating, two-way remote monitoring, and supporting treatment adherence [2].

TEC can help carers understand and support those they care for by:

  • Providing psychological reassurance
  • Enabling carers to co-ordinate their work-life-care balance through supporting flexible hours and remote working patterns (approximately 2.3 million people have had to give up work to become carers and three million have reduced their hours)
  • Delivering peer-to-peer support

Facilitates remote patient monitoring (RPM)

Remote monitoring uses technology to monitor changes in patients’ health status outside conventional clinical settings.

Historically, it allows a patient to use a device to perform a routine test and send the test data to a healthcare provider. Initially, it depended on a healthcare provider recommending its use to patients. However, digital technology has increased the potential for remote monitoring and, with the advent of apps and wearables, patients are increasingly bringing the innovation to doctors [3].

New advances in the development of biosensing wearables are spreading their capability beyond simply tracking activity. New devices can monitor a broad range of physiology (from posture to brain activity) and convert this information into outputs, through advanced connectivity and computing power.

Biosensing wearables can support people with chronic conditions, automating monitoring and detecting real time changes in an individual’s health status. Data from biosensing wearables can be uploaded to an Electronic Patient Record (EPR) and this information can be used to display an overview of a patient’s medical history in real-time, supporting early diagnoses and early intervention.

If a negative change occurs, patients, family caregivers and healthcare providers can be alerted quickly, preventing emergency admissions.

Increases treatment adherence

In bad cases, failure to follow treatment can cause a patient’s condition to deteriorate, leading to an increased likelihood of hospital admission, permanent disability, or death. Electronic reminders and alerts, via text SMS or apps, can remind patients to follow their treatment regimens, thus improving health outcomes.

The World Health Organisation has calculated that adherence to long-term therapies in developed countries is around 50%, and is even lower in developing countries [4].

In the UK, between one-third and half of all medicines prescribed for long-term conditions are not taken as recommended. It is estimated that the cost of unused or unwanted medicine is around 100 million GBP per annum [5].

Improved adherence allows healthcare providers and pharmaceutical companies to obtain a better understanding of the impact of drugs, including any complications or drug interactions, providing useful data for research. An increasing number of pharmaceutical companies are investing in digital TEC projects to increase patient adherence to the drugs they produce. Likewise, patients and carers are increasingly using digital health software to register and monitor medication intake [6].


[1] Valuing Carers 2011: calculating the value of carers’ support, Carers UK and academics at the University of Leeds, May 2011.

[2] Putting patients first. The NHS England business plan for 2013/14 and 2015/16.

[3] Primary care working differently: Telehealth and telecare –a game changer for health and social care, Deloitte UK Centre for Health Solutions, December 2012.

[4] Medication Adherence: WHO Cares? Mayo Clinic 2011.

[5] Aston Medication Adherence Study, Aston University. See also:

[6] Mobile apps, fighting for patient adherence, Mobile health global, December 2014. See also

[7] Psychological Therapies, Annual Report on the use of IAPT services: England – 2013/14 Experimental Statistics, Health and Social Care Information Centre, September 2014.