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Medication Non-Compliance

One night in 2007, I started a new antipsychotic. It was to be taken at dinner time. I did as told and took it at the universal dinnertime of 6 pm.

By 7 pm, I had mostly lost touch with reality. I was suddenly so tired that my eyes wouldn’t open but I was far too anxious, scared and twitchy to go to sleep. I felt incredibly ill. I was frantic, terrified and panicked. I was thrashing in a sharp, steel cage between sleep and wake with no way out. I cannot express to you the horror of that night.

Bipolar medication side effects suck.

Immediate Medication Non-Compliance

Medication non-compliance is when a person is prescribed a medication and then decides to alter the taking of that regimen unilaterally. By immediate, I mean that right after the initial prescription, the person stops taking the medication. So, if a person stops taking a medication on day 4 due to side effects but doesn’t see their doctor for 2 months, that is non-compliance, although not the most bothersome kind.

Long-Term Bipolar Medication Non-Compliance

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The more problematic bipolar medication non-compliance scenario is when a person has been on a medication for a longer period of time and suddenly stops taking it. Again, this is often due to side effects. People get tired of gaining weight, or hand tremors, or unstoppable hunger, or sleeping 12 hours a day or constant nausea and they stop taking the drug. This is often an immediate discontinuation of the drug without a taper as they are doing it without talking to their doctor, and of course, discontinuation disrupts their routine.

Yay! I’m Better! Non-Compliance

Perhaps the sneakiest form of non-compliance comes when the bipolar medication works and the person is feeling better. The stars have aligned, the doctor was brilliant, the patient was lucky and suddenly they start feeling like themselves again. For the first time in a long time they are happy, stable, sane. And of course, as everyone knows, sane people don’t need medication. So they stop taking their medication. Why would they take it if they feel good? The fact that it was the medication that caused this feeling is overlooked.

Effects of Medication Non-Compliance

The problem is, suddenly stopping a drug without medical supervision is the wrong approach. People do it, often, because they know the doctor wouldn’t like them going off of medication. Their doctor might pressure them to stay on the medication. And they don’t want that. They want off. I understand this reasoning, but it isn’t a good enough reason not to talk to a doctor.

When people stop their drug suddenly, they go through withdrawal. Withdrawal can be very nasty, or very mild, depending on the drug and the person. In most cases the person is not going to enjoy it in the least, and it very likely could induce depression or mania.

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Once the withdrawal is over the person is left without medication. The person is left without the one thing that was treating their mental illness. The person is left without their safety net. While sometimes at first, it feels really good to be without all the side effects, inevitably you are left with what you started with – an untreated mental illness.

Bipolar medication non-compliance can lead to: depression, mania, hypomania, self-harm, psychosis, hospitalization or even death. It is extremely serious.

Other Reasons for Medication Non-Compliance:

  • A worsening of the illness
  • Medication not working
  • An attempt to assert control over their situation
  • An attempt to be seen as normal by other people
  • Lack of money to purchase drugs
  • Not seeing the doctor for a prescription
  • And on and on and on

I Want Off My Drug

OK, so I completely get why people want off their drugs. I’ve had horrible things happen to me, others have had horrible things happen to them, getting off a drug is a perfectly reasonable response in many cases. So:

  1. Talk to your doctor
  2. Make you needs known openly and honestly
  3. If your doctor doesn’t agree, work out an alternative solution you can both live with
  4. Don’t leave their office until you’re satisfied you can live with the plan
  5. Always taper off a drug
  6. Keep all doctor’s appointments
  7. Report any mood changes to your doctor

That’s it. Just talk to your doctor. I know it’s sometimes harder than it sounds, but that’s what you need to do. Drug non-compliance is often a sign of a worsening mental illness. If that’s not you then you need to have the rationality to do the above.

Don’t make a mistake today that could land you in the hospital tomorrow.

You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

20 thoughts on “Medication Non-Compliance”

  1. I feel like crap on these drugs. Sure, I can be a public nuisance off the drugs, but at least, whilst off the drugs, I feel emotion and have energy. I feel suicidal, weak and tired all the time on these drugs. Psychiatrists should not be allowed to enforce treatment! Glad I chose not to have children!

  2. I agree with Anne. I just found out my son has stopped his meds. I think it is an individual’s choice of course but should be done with care. I am hoping his therapist will talk to him to evaluate him. I can tell he’s losing weight which I think is the reason he stopped. I do not blame anyone that stops the meds if they can function off them without any major problems. I hope and pray he does not try suicide again, for I am afraid he will succeed one of these days if he does.

  3. I was diagnosed with Bipolar and I got off my medication. I experienced side effects but for the most part, I am completely fine and able to manage myself better without medications. Sure life is hard, but my doctor would never have helped anyway? Plus I was more likelier to end up in a mental hospital while on medication.

  4. as the mother of a bipolar person who consistently stops taking her meds and ends up suicidal and hospitalized, I would ask that before we all jump on the “you don’t need meds” bandwagon, we state that every single person is different, every single person has their own regimen to follow and their own DNA, their own reactions, interactions, etc. and to consult SOMEONE before stopping.

    she is currently hospitalized. it could be short term, it could be long term, but for her the one thing that makes life consistent and safe for her and her children, are medications and therapy.

  5. What the heck is wrong with wanting control over the situation. It is the person’s life your dealing with here, and they have the right to choose if they want medication or not. Some people really don’t need it.

  6. I also agree wholeheartedly with Richard and TJ.’s comments

    While I fully understand family and friends anger & frustration the fact is they are not the ones taking these meds. It would be nice once in a while if they could just try to see things from our point of view. As Natasha has mentioned above there are a lot of reasons for non-compliance. Just because we are drugged doesn’t necessarily mean we are better… No one wants to be sick or miserable. And not to sound selfish but it can be soooo frustrating and irritating when family blindly and unquestionably support a doctors decision no matter how detrimental that decision is to our overall health, (mind body and spirt)

    Finding another pdoc is not as easy at it sounds. They’re usually in short supply, especially if you live in a rural area. I’ve found the really good ones often aren’t taking any new patients.

  7. I agree with Sue that medication is helpful in a crisis situation but I am beginning to realize that this may not be the case over the long haul. When I retire in 3 years I’m going to try to ween myself off them. I’m on such low doses anyway. I would try it now but I don’t want to risk ending up in hospital again and maybe lose my job this time. Once I have a retirement income and my life is less stressful Ill feel safer to experiment a bit. I often feel like the side effects definately out weigh the benefits, but I don’t complain too much to my doctor because I don’t want to have to increase my medication or chance switching to a worse one. To those that know me, they believe the medication is the answer to all my/their problems but they’d be wrong. On the outside everything looks fine but on the inside I’m not exactly tiptoeing through the tulips with joy on these medications. Lets face it, doctors are in bed with the pharmaceutical companies, they keep each other in business. In the meantime I am going to try to try to live a healthy lifestyle and read my self help books for new ideas. Unfortunately working with a counselor is not a option for me at this time so I also go through self help workbooks that are useful

  8. The reason I have stopped taking my medications in the past was the psychiatrist seemed to feel that if one drug didn’t work, let’s just switch to another! I was put on Depakote for my bipolar 1 and got a rash all over my body and was then placed on Lomictal. Although it did calm my symptoms it also numbs my feelings. The doctor added Seroquel which caused me to gain 40 pounds in two months. Psychotropic drugs do help in a crisis but I think there are better paths for long term management of my illness.

  9. One of the things I hate to hear from friends and family is that the “Yay! I’m better reason” seems to be the only one they are aware of, and are therefore cruel and judgmental about anyone wishing NOT to be medicated. Those that know that I’m bipolar often regale me with lovely tales of someone they know who went off their medication… and catastrophe ensued. When this person resumed medication all was bright and happy again.
    The problem is they are NOT me. They are not even the ones suffering from the same disease!
    I am sorely tired of the dry mouth & eyes, the aching, the blurred vision, the tremors, the fatigue, the muddled thoughts, the dimmed feelings – justing being “blah”. I desperately wish for a vacation from these effects and am now weighing them against my suicidal episodes. Right now being suicidal is looking better than all these stupid side-effects.
    Yes. That’s how much I hate these side-effects. I wonder, too, if it’s an indication that I am not as stable on these drugs as I should be.

  10. I personally gained 50 pounds on seroquel causing me to stop it without a doctors supervision. I taped myself down from 300 to 150 to 100 to 50 mg. So I was smart about it. I just gained so much weight I was done. My pdoc found out through my parents and ended up doubling my dose of latuda which I can barely hold down so I’ve speed taking that. Another side effect that’s not worth it. I barely eat and lost 16 lbs in a week Thanks to my new bulemic diet and is starting to cause anorexia as well from me not wanting to touch good at all. Not worth gaining an eating disorder personally. So I know what you mean.

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