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Missing a Dose of Psych Meds

August 10, 2012 Natasha Tracy

If there’s one thing to remember about psychiatric (psych) meds it’s that you need to take them and you need to take them on time. This is because medication puts chemicals into your bloodstream and in order to keep a consistent level of these chemicals in your bloodstream, you must take the drug as prescribed. This is particularly critical in bipolar disorder as it’s easy to become unstable with an uneven level of psych med in your blood.

But we’re all human. We all mess up and forget things and we all miss a dose from time to time. So how do you handle missing a dose of a psych med?

Missing a Psych Med Dose - Results

The first thing to realize is that if you miss a psych med dose you may experience withdrawal. Now, doctors might call this a variety of things (like “discontinuation syndrome”) but it feels an awful lot like withdrawal to me.

As an example, there is one medication I’m on that’s particularly nasty for withdrawal and if I miss a dose I start to cry and become suicidal within hours of the missed dose. I literally go from a normal me to a wet and sopping mess within four hours.

And the trouble with this, other than the fact that I decimate a Kleenex box, is that I may not realize I have missed a dose. So it may not occur to me that the extreme symptoms I’m feeling are medication-related and not bipolar-related, as such.

Don’t Miss a Psych Med Dose

So it’s really critical for me that I not put myself in that situation. Bad things, quite obviously, can happen when one is suicidal.

There are many ways to help you remember to take your medications, but one of the most common, and probably most effective, is to use a pill box of some kind. Spend a bit of time Sunday night lying out your pills for the next week in individual boxes so that every morning when you wake up (or before you go to bed), you can just pop open a box and everything you need is there for you.

If You Miss a Psych Med Dose

If you do think you’ve missed a psych med dose:

  1. Make sure you did, in fact, miss the dose (Sometimes it’s hard to remember if you took a pill. A pill box really helps with this.)
  2. Generally the rule is to take the missed dose as soon as possible – unless it’s close to the next dose in which case never double-up *
  3. Call a doctor if you’re experiencing any out-of-the-ordinary symptoms about which you are concerned

Overall, missing one dose of medication is unlikely to hurt you, per se. It may, however, cause you some discomfort so try to put procedures into place so that you avoid the problem rather than having to deal with it afterwards.

(This all assumes that you’ve only missed one dose. If you miss multiple doses you may experience a returning of psychiatric symptoms and you may need to contact your doctor about how best to handle that.)

* This should not be considered medical advice and you should always check with a professional if you have any doubt as to what to do about a missed medication dose.

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

APA Reference
Tracy, N. (2012, August 10). Missing a Dose of Psych Meds, HealthyPlace. Retrieved on 2019, July 16 from https://www.healthyplace.com/blogs/breakingbipolar/2012/08/missing-dose-psych-meds



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 BurbleTwitter, Instagram and Facebook.

tamtam
says:
December, 11 2018 at 8:50 am
Hi, I am severely depressed and forgot my small dose of lithium last night. 150mg. now i'm a complete mess. I guess I am super sensitive. have only been on It a week. please help me
Susan
says:
October, 25 2018 at 12:31 am
I feel for you trying to overcome lithium. Over 300 makes gives me tremors. I get really depressed and have had 5 suicide attempts in 6yrs. Don't give up! There will be the perfect ? soon! ??
Anonymous
says:
July, 20 2018 at 3:01 pm
I would like to share this amongst all you kind folks suffering from bipolar or manic depression its been a solid 6 years now i ve been taking lithium and my original dose started at 900 then was reduced to 750 over a period of time and now i m standing at 600 that being said i never came across an individual who over came lithium that completely erased it from there system i hope one day by some miracle i can get a response and be relieved from this dependency on this drug if i can hold on strong and over come then that for me would be one of the most greatest achievements to overcome my many thanks Anonymous
Elaine
says:
June, 28 2018 at 8:45 am
I rarely miss doses of my medications, but yes, it does happen from time to time even with pill boxes and rituals (taking with breakfast and dinner). It seems to most often happen with my evening dose. Actually, I usually do eventually figure out that I missed it when 12 am rolls around and I'm awake and bright-eyed and bushy tailed. I then take it and can't fall asleep until 3:30 am or so. That sucks, because then I have a Seroquel XR "hangover" regardless of how late I sleep in the morning. Normally taking my evening meds at 7 pm allows me to wake up at 6:30 am feeling well. Generally, the time I fall asleep is a factor, too. Ideally I should fall asleep by 11 pm or earlier.

It's odd. Last week the above-mentioned happened and I felt great at 6 am on 3.5 hours sleep. That's not my norm. The "hangover" is the norm in those cases, like when I again left taking my meds to 12 am two nights ago. I felt so sick yesterday morning and was so out of it that I totally forgot my morning meds, too. I suffered the whole day in bed, cancelling appointments with a constant headache. Luckily I got back on track and feel good this morning.
Rado
says:
April, 15 2018 at 1:07 am
Hi my sister she was on lithium she run out her medication and there was no prescription in pharmacy as GP fail to send one so she try get through the weekend with out it.First thing Monday she phone GP and ask him to get prescription to pharmacy which never happened until Thursday which was to late police find her death on the beach on Thursday early morning. Don't even think to go without those tablets or come of them rapidly?
Jameson Joyce
says:
December, 3 2017 at 2:22 pm
II am diagnosed bipolar (30yrs) my current medication consists of Mirtazipine 30mg / Procyclidine 5mg / Quetiapine 150mg / Venlafaxine 225mg (modified release) Therre is a regular mess up in my meds getting to me, GP delays the prescription, Pharmacy don't have it ready and its a weekend (Pharmacy blames GP, GP blames Pharmacy, long and short is I end up missing 2 days worth. By the second day I experience the shakes, I get an almost constant disturbing 'wooshing' experience in my head, a slight movement feels and sounds like there's an express train running through my head, I get the sweats, and its worse when I lay down (so not much sleep, I've been awake for 2 days) now thats just how it feels physically, mentally I start fretting of anything and everything, I sense the black clouds arriving and everything is an effort, I lose all tolerance with those around me, to the point I can be rude and 'snappy'. (I waffle a lot when writing - my apologies). Not so long ago I put this to a GP who told me that on the meds I'm on I wouldn't experience these symptoms in just the space of 2 days (he managed to make me feel like a fraud) So I also put it to the Pharmacist who said that I definitely would experience these symptoms. I'd like to here from anyone that might have experienced something similar in the same kind of time frame.

In reply to by Anonymous (not verified)

Katherine
says:
April, 17 2018 at 1:57 pm
I totally agree with the whooshing feeling! I'm on venlafaxine as well and if I miss even 1 day of my dosage I feel like I have a bad case of the flu for the entire day.

In reply to by Anonymous (not verified)

Karen
says:
September, 1 2018 at 5:19 am
Yep, whooshing sensation is making me very unstable right now after missing desvenlafaxine and lithium this morning. So it doesn’t need to be a long time period Like you I also take mirtazapine and I find with that one that I just don’t sleep if I miss it.
Pamela Bowles
says:
August, 28 2017 at 10:13 am
I take Quetiapine for withdrawing from a benzodiazepine drug which I took for insomnia. I mistook the psychotic with a benzo tablet. IThey look both the same in their silver sleeves so I was left wondering what tablet I had taken. Or how much I took of the psychotic pill. My insomnia returned .. I am hoping I will be ok tonight.
Triniece Hayes
says:
August, 12 2017 at 1:43 pm
My son bipolar,he missed 4 doses ,now he is been crying alot.i made him take his pills..he just sits and thinks..
Lin Dorton
says:
July, 30 2017 at 9:23 am
I am so glad I came across your site, have bookmarked your blog. I suffer bipolar disorder, take meds for it, but have a complicated situation since my partner was diagnosed with schizophrenia. I am an online moderator (read and delete inappropriate comments on news sites) and I have been so stressed out over both work and home life - oh and the Trump nonsense- that I do not feel like I can function normally on a day to day basis. I will read more of your site and then ask specific questions or discuss problems I may have. I have had no one to speak to since I live out of the country and have no friends other than my mate. I am not well in this situation. And it is getting worse. Thanks for reading.
Plumtart
says:
July, 9 2017 at 10:41 pm
My experience is that if I forgot the dose of 160mg zeldox etc before bedtime, I would not be able to fall asleep. Sometimes I forgot to check but now I should be able to remind myself that if I couldn't fall asleep, it is because I forgot the take the pills
Angel
says:
January, 22 2016 at 9:32 pm
@Asia I know you are probably overwhelmed right now but just know that you are not alone in this and you will be a better and authentic YOU once you are stabilized. Thinking good thoughts for you.
I was diagnosed with Bipolar 28 years ago having mostly mixed episodes. I am on Lithium, Lamictal, and Trileptal and after having ECT five years ago have been very stable with no hospitalizations. I get a lil anxious if Im spending the night somewhere and have forgotten meds but have never had an adverse reaction to 1 or 2 missed doses. I think its important to say that everyones illness is different and everyones body is vastly different. The biggest lesson I have learned is to trust my gut. However, I would never find it a good decision to increase/decrease/stop taking any prescribed meds without Doc approval.
Brittany
says:
August, 14 2015 at 4:22 pm
I take lithium 2x a day. About 2 weeks ago, I missed my night dose two days in a row. I went into full-blown mania for 4 days, totally made me realize just how bad I was before meds. I missed my night dose last night and Ive been up and down all afternoon today. Maybe an extended release is the solution? Its such a pain to take my meds at the same time because my work schedule is so crazy as well.
pip
says:
July, 18 2015 at 1:47 pm
I think I skipped my lithium dose for three days, only just realised, and I have been feeling really tired, and sleeping 12 hours every night and napping for a few hours during the day. I didnt know why I was feeling like this until I realised I had not put lithium in my pill box. Also been feeling depressed, only a little, and irritable.
Dan
says:
June, 13 2015 at 3:04 am
I missed two doses. One before ect as im supposed to and two after. It was devastating. Became very compulsive thinking back on life. Felt witjdrawlish as well. A big no no to miss multiple
jae
says:
June, 9 2015 at 7:37 am
I found this website by doing a google search as well. For the first time since about 2005 I completely missed a days worth of meds and didn't realize it until I had a massive breakdown on the phone with my father. When I looked in my pillbox to take Sunday's dose I saw that I'd missed Saturday's. It had been about 30 hours and really did throuw me into a tailspin.

Within about an hour of taking the meds (as well as a hot shower and a dose of klonopin which is PRN for me), I started to feel "normal" again, but I've been exhausted for the last few days. The kind of exhausted one feels when they're coming out of an episode of either mania or depression.

Has anyone else had this experience (assuming there are people still reading and responding to this thread)?
Sandy
says:
April, 23 2015 at 6:49 am
I came to this discussion through a search. I am purposely not taking 1/2 my lithium dose right now. It's been a few days now. I am sick and tired of the hair loss and the weight gain. I plan to discuss it with a doctor here in a couple of weeks. I had been asking my doctor if I could switch but he wasn't listening. Have you ever done anything like this?
Danny
says:
March, 15 2015 at 8:50 pm
@Asia What I've realized six years after the diagnosis and two years after starting medications is that I'm truly not myself when I'm *not* on meds. It's when I'm on meds that I'm truly myself and when I don't take the meds my life falls apart - I don't want to be the person I am when I'm off meds. All that anxiety, all that fear, all that rage... No, I'm more fully myself when I'm on the meds. Hope this helps.
mojo
says:
March, 1 2015 at 4:36 pm
I missed my meds last night by accidentally taking my morning meds by mistake. I did not sleep last night and got a lot done today but did have a migraine and some body ache. At one point I cried a lot. Anyways my day seemed easier and I wasn't as sluggish as normal. Makes me wonder about my meds. Anyways just thought I would share. Good article.
Asia
says:
June, 24 2014 at 7:42 pm
Diagnosed last year and im just having a hard time dealing with the meds
I've always been an angry person who didn't kno how to control it....guess thats y I need the meds.....but I feel Trapped...like im not the Real me...win im on the meds!!! Anxiety is another issues!!! I just need help ...for more understanding???
Asia
says:
June, 24 2014 at 7:38 pm
Ive been diagnosed with birthday polar last year...and its been really hard.
Dr Musli Ferati
says:
August, 17 2012 at 3:17 am
Psychopharmacologic approaching is the main way to treat any psychiatric entity. As you remark, it has an algorrhythm how to take the drugs that serves in psychiatric treatment. Without this algorrhythm the treatment would be inappropriate and counteracting, as well.But in daily psychiatric practicewe face with many deviation of medication, such is for example a missing dose of medication and so on.The reasons for this malpractice in psychiatry are different and of manifold nature. By me as clinical psychiatrist the principal factor of misuse of psychiatric medication is the stuborn attitude that medication is a form of addiction, that presents the worst health statement than itself psychiatric illness. The second reason for misuse of medication is the fact that psychopharmacologic treatment is long term treatment without any dramatic change of psychiatric symptoms. As third case of psychopharmacologic malpractice indicates their side effects that frightenedpsychiatric patient and their close relatives. In order to avoid these and other malpractice experiences in psyciatric treatment, it ought to explain to patient in understandable manner the course of psychopharmacologic treatment, with his good and bad effects.

In reply to by Anonymous (not verified)

A secret
says:
June, 11 2018 at 7:23 pm
How about when your doctor don't listen and continue to go up on the dose of medication that's making you ill? I'm given medicine and I'm told to workout and I'm drugged up and can barley move and see. I can't breath at night time and I've told this quack everything from the weight gain, headaches, breathing issues, skin rashes, eye disorders, and now I have an issue with my heart. Yes I spot took the medicine because I couldn't breath. He ignored me. So please respond.
June, 12 2018 at 8:31 am
Hi June,

I'm sorry to hear you are in that situation. I know what it's like not to have doctors listen to you and it's very hard.

I would recommend you seek out a new doctor, or, at the very least, a second opinion. It sounds like he's not the doctor for you.

- Natasha Tracy
Meaghan
says:
March, 23 2019 at 8:36 pm
Find another psych!!! Immediately. Like you said yourself...a quack.
randall ross
says:
August, 16 2012 at 6:29 pm
that would be great if you only missed 1 pill i take 9 pills in the mourning and 11 pills at night
DH Westlake
says:
August, 15 2012 at 7:39 am
no one should skip doses -- but i see SO MANY ppl triggering episodes and stress because they have missed 1 pill within 2-4 hrs after the miss -- that the fretting is causing more issues --
Natasha Tracy
says:
August, 14 2012 at 5:47 pm
Hi D H,

Yes, that does have something to do with it but some meds have a _very_ short half-life.

Missing a dose can be a very big deal depending on the med and the person.

- Natasha
d h westlake
says:
August, 14 2012 at 5:35 pm
In reality doesnt the half life of the med and how long youve been taking it come into play --- there is a strong placebo effect that comes into play with the taking and not taking of many psych meds depending on the person and their dx -- -- YES no one should miss any dose but in reality its effects are still in you for quite a while --and 1 missed dose really isnt gonna throw you into the heights or depths of bipolarity
randall ross
says:
August, 14 2012 at 11:43 am
i have a pill box but somtimes i have to go to the lap band doctor so i miss the morning meds . by the time i able to take the night meds . i am already starting to get manic . and it takes a couple of days to feel better .
Veronica
says:
August, 13 2012 at 6:30 pm
I miss lithium doses every once in a while, and I have a massive pill box. 4 times a day every day. Lithium is different but i'm NOT SAYING TO SKIP WHEN YOU WANT. I am a psych major, and Lithium Carbonate is an unknown-method mood stabilizer. In conjunction with my other meds, it's a minimal effect. Miss too many benzos (xanax, valium, etc) you will get the shakes or worse (personal experience).

In reply to by Anonymous (not verified)

Jeff Ezell
says:
April, 5 2017 at 12:59 pm
I missed 3 dose of my lithium other night at a friend house. I did not have any symptoms. Been on this 27 yrs, any reply?
Kirsty
says:
August, 11 2012 at 7:33 pm
The number of meds I take daily won't fit into regular pill boxes and I find it too cumbersome to have several in use, instead I use a chart. I have an A5 notebook and each Sunday I print out a chart and stick it in the book. I put meds and time down the page, date across the top. As I take each med I tick the box. I also take the chart to psych sessions and he uses the opposite page to write in any changes in meds.
Maureen Powell
says:
August, 11 2012 at 11:50 am
It is also possible to get medications from the pharmacy in blister packs (also called compliance packs) from the pharmacy. I don't know about the US or elsewhere, but here in Canada blister packs are available at most pharmacies and do not cost more than getting the pills in bottles. I used to put my meds in pill boxes, but sometimes I didn't have the energy, especially when I had to split some pills to get the right dosage. With blister packs, someone else takes care of it for me.
cindyaka
says:
August, 11 2012 at 7:07 am
I too have missed an occasional dose when I can't remember if I took it. I prepare my husband's meds in a pill box each morning and night. I've found that taking the pills at the same time as him helps me remember,as I have a visual cue from his pill boxes. For the most part I am able to keep to a 12 hour schedule between pills.
mef123
says:
August, 11 2012 at 1:15 am
I missed one of my meds a couple of weeks ago. I do have a pill case but forgot to put it in the night section. I didn't realize until the last day. The consequence was me getting depressed, crying, staring at walls, suicidal thoughts, self harm. Once I started taking it again it only took about a week to kick in. It was an eye opener. I do need these meds and they do help and I really do have bipolar.

Michele

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