As part of a new series, Mental Illness from a Lived Experience, I wrote about six reasons a person would stop taking their prescription when the treatment is working. This series is part of the Monthly Mental Health Newsletter from Maree Dee -- Embracing Faith & Mental Illness. Maree helps caretakers of loved ones struggling with mental health disorders. It is a new Q&A section to give caretakers a perspective from the loved one battling mental illness. Make sure to jump over to her page and sign up for monthly newsletters. Click here to see this month's newsletter in entirety.
Q: Darcie, when meds are working, why would a person stop taking them?
I recently let myself cry for the first time in over three years about my mental disorder and the lifelong chore of taking medicine to treat my unruly neurons. I was finally diagnosed with Bipolar Disorder with Severe Manic Episodes in 2018 after three visits to the hospital. I experienced three rapid onset brief psychosis episodes within a two-and-a-half-year period. I have been in complete remission since March of 2018 after God led me to the right doctor and treatment plan during my third stay in a hospital. Things like to happen in three’s for me, so once I started the third treatment plan, I knew something felt different, and I experienced an overwhelming sense of contentment. I looked straight forward and started living my life again. We even welcomed our second beautiful, healthy boy in March of 2019, and I stayed on my medicine the entire time without any setbacks. My gynecologist loved to say, “Everything is boringly normal” at my checkups, and I looked forward to hearing those words each time. So, why did I cry recently? I had my typical six-month checkup with my psychiatrist, discussing lab work. Although I do not currently experience side effects with my medicines, all praise to the Lord, long-term use can cause significant health issues. These adverse effects include cataracts, blood sugar issues, and increased cholesterol levels. After all of the adverse side effects experienced with the previous treatments, I had finally found peace about taking my current medicines. And my psychiatrist threw a wrench into my tranquility. I discussed this relapse moment with the wise Dr. Bob, my therapist, and he honestly said, “I don’t know that you will ever be completely okay with it.” And he is right. We will never be completely okay with so many things in our life, but we can learn to live our fullest and best lives even with a thorn in our side (2 Corinthians 12). So, how do you help your loved one find contentment with their treatment plan? Encourage your loved one to be open about their struggle with medicine with you and the doctor. You accept that they may never be completely okay with it, communicate that you acknowledge this struggle and that it is normal, and explain that you are there for support and a listening ear.
A: So what are some reasons a person stops taking meds when the treatment is working?
Unfortunately, a person may enjoy being manic, so they purposefully stop taking their prescription. It would be wise to seek a therapist or doctor experienced with mania in this situation.
The cost of prescriptions is another factor driving nonadherence. Even with good insurance, I have seen my prescription prices increase in the last few months. Check with your loved ones if you think they have difficulty affording the prescriptions. There are prescription programs that help negotiate a better price.
If your loved one does not have a good relationship with their psychiatrist, the chance of nonadherence is higher. Finding a good doctor is one of the most important and arduous tasks. I understand the difficulty of finding a good doctor and securing an appointment with them. Unfortunately, there is a shortage of mental health providers and usually a long wait to get in as a new patient. I went through several hospital psychiatrists who did not have my best interest. Still, thankfully I secured a spot with a private Christian psychiatrist who I enjoy seeing and can trust.
Many patients stop taking the meds because of medication side effects and health risks of long-term use. This reason is undoubtedly valid, and it is something your loved one will need your help weighing the pros and cons. The great thing about living in this age is the constant advancement in science and technology. Chances are there are new options to try if a particular medicine is causing adverse side effects, and a professional psychiatrist can help with a plan to switch drugs. If the patient has seen good results with the medication but is experiencing some adverse side effects, talk with the doctor about safely lowering the dosage as an option to alleviate discomfort. Make sure to find a doctor who will do blood tests or request labs done by your general physician to stay on top of unfavorable health conditions.
When you start to feel good again, your mind can trick you into thinking the medicine is not needed. According to an article on Mental Illness Policy Org, “The single most significant reason individuals with schizophrenia and bipolar disorder fail to take their medication is their lack of awareness of their illness (anosognosia).” Anosognosia is the belief that you are not sick. The article says, “A growing body of evidence points to the fact that for many people with serious mental illness, lack of insight is a medically based condition. About half of the people with schizophrenia and bipolar disorder may not be getting the treatment they need because of a brain deficit that renders them unable to perceive that they are ill.” This article also has a valuable section on building trust with your loved one citing, “You have to find out what motivates them to take their medications, then reflect that reason and highlight the perceived benefits.”
The most obvious answer to this question is the stigma associated with mental illness and psychiatric medicines. A person can experience a wild mix of shame and embarrassment when finally accepting they need help to feel better. My brother told me taking meds for my disorder is no different than a person with diabetes taking insulin after he disclosed his use of an antidepressant for over a decade. His confession made me look at the use of medicine to treat my misfiring neurons in an entirely new light.
