When Your Adult Child Breaks Your Heart

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Treatment Compliance Issues in Mentally Ill Adults

Why do some struggling adults stop taking their medication?

It's common for people with mental health conditions to suddenly stop taking their medication, or to altogether avoid seeking a prescription. This choice can be profoundly frustrating for loved ones and clinicians alike, particularly when the disorder is one – such as anxiety – that is often easily treated with the right medication. While the decision to avoid medication isn't always a wise one, understanding the motives behind patients' decisions to stop taking medication can help clinicians, community organizations, friends, and family work together to encourage healthy choices without undermining the autonomy of people struggling with mental illness.

Medication Side Effects

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All medications have side effects, but the way those side effects function varies from person to person. One person taking an antidepressant might gain a pound or two, while another person sees her weight balloon by 20 or 30 pounds. Th unpredictability of side effects can be a strong deterrent to those who have previously experienced negative side effects. Side effects of mental illness medications range from mild to severe, but some of the most common include:

• Sexual dysfunction

• Weight gain

• Physical symptoms, such as nausea or headaches

• Changes in mood or thoughts

• Skin problems

• Changes in sleep patterns

• Changes in diet and eating patterns

• Changes in the menstrual cycle for women

Less commonly, patients can suffer more severe side effects, such as uncontrollable rage, allergic reactions, seizures, and suicidal thoughts. In these cases, patients should almost always be taken off the medication and put on a different drug.

Side effects tend to come before positive benefits of a medication. A depressed patient, for example, might experience sexual dysfunction within a few days of taking medication. Over time, this effect often dissipates, but many patients stop taking their medication before this has a chance to happen.

Concerns about side effects are not misplaced, and patients have a right to choose which side effects they can and can't tolerate. A strong working relationship with a competent psychiatrist can help a person struggling with mental illness choose the right medication. Oftentimes adding another medication or replacing one medication with another is all it takes to see an improvement in both symptoms of the disorder and side effects.

Denial About Illness

Anosognosia is the medical term for people who deny that they are ill. One study found that 55 percent of people who refuse to take their medication do so because they don't believe they're actually sick. In some cases, people who get better on medication become convinced that they've been “healed,” failing to recognize that the medication did the healing. In others, people simply can't accept that their thinking is abnormal. Mental illnesses carry a significant stigma, so it's understandable that some people do not want to believe they're mentally ill. Reducing mental health stigma and avoiding labeling people with mental illness can help solve this challenge, since 6 percent of people with mental illness report that they avoid medication because they're worried what others would think.

Fear and Procrastination

Mental health conditions can make everyday tasks seem daunting, even frightening. A person with an anxiety disorder may be anxious about making a psychiatrist appointment, even when she knows medication can help. A person struggling with depression may plan to call the psychiatrist every day for a month, only to endlessly procrastinate in a haze of self-loathing and hopelessness.

Some people don't outright refuse to take medication. Instead, their choices prevent them from taking medication. In many cases, the assistance of a friend or family member can help. A spouse can make the psychiatrist appointment, or a friend can agree to accompany her friend on her first trip to the doctor. Reassuring these patients that medication can and does work can also help. Some people are so beleaguered by their symptoms that they become convinced that medication won't work, and they therefore don't want to expend the energy necessary to obtain medication.

The Wrong Provider

A strong relationship with at least one mental health provider is key to medication compliance. If a person feels bullied or pressured by her psychiatrist or therapist, she may stop treatment altogether. Taking time to find the right provider—and firing providers who use high-pressure or coercive tactics—can help remedy this challenge. No provider is right for everyone, and it's vital to find a provider whose values, treatment style, and approach to medication work for the person seeking treatment.

Personal Autonomy

Quality mental health care isn't always easy to access. Some people with mental illnesses have had bad experiences with rude, unqualified, or high-pressure mental health professionals. This can cause them to worry that medication will undermine their personal autonomy, either because the medication will change their personality or because it will put them under the control of a doctor. In one survey, 7 percent of people reported that they avoided medication because they were worried about being hospitalized against their will. Another 5 percent reported that they were displeased with the quality of services available.

There's an ongoing debate in the mental health field about the personal autonomy of people with mental illnesses. A few mental health professionals advocate for more power to force treatment on people with mental illnesses. But most doctors agree that it's not appropriate to force medication or treatment unless a person poses a danger to himself or others. Informed consent is a sacred part of medical ethics, and mental illness alone is not sufficient reason to force medication on a person.

Friends and family can help alleviate concerns about personal autonomy by avoiding threats. Consider also abandoning the subject of medication and talking about other ways to manage your loved one's illness. Some people avoid psychoactive medications specifically because they feel so much pressure from loved ones to try them. Steering clear of medication in these cases serves as an assertion of personal autonomy.

Treating Mental Illness Without Medication

Medication combined with therapy is the single most effective method for treating mental illness. Severe mental illnesses, such as schizophrenia, and severe cases of more common ailments such as depression and anxiety may require medication to see an improvement. In many cases, though, it's possible to treat mental illnesses without medication, though treatment may go more slowly.

Some options for medication-free treatment include:

• Therapy coupled with support from friends and family. Therapy alone won't be enough if a person isn't committed to change, but assistance from loved ones to implement healthy changes can make a huge difference.

• Healthy lifestyle choices such as exercising. Some studies have shown that exercise is as effective at treating depression as antidepressants.

• Breathing techniques and meditation. Deep breathing and meditation are particularly helpful for those struggling with anxiety and post-traumatic stress disorder.

• Neurofeedback

Brain stimulation treatments such as electro-convulsive therapy

• Maintaining a regular schedule. Consistency is key for fighting mental illness, particularly when the illness undermines a person's schedule. For example, a person with ADHD who tends to procrastinate can benefit from a routine.

• Improving living conditions. People living in abusive, impoverished, or otherwise high-stress environments may not get better—even with medication—until they are removed from the environment.

References:

Medication noncompliance among mentally ill. (n.d.). Retrieved from http://mentalillnesspolicy.org/medical/medication-noncompliance.html

Mental health medications. (n.d.). Retrieved from http://www.nimh.nih.gov/health/publications/mental-health-medicat...

Why do some individuals with serious mental illness refuse to take medication? (n.d.). Retrieved from http%3A%2F%2Ftreatmentadvocacycenter.org%2Fresources%2Fconsequences-of-lack-of-treatment%2Fanosognosia%2F1375-why-individuals-with-severe-psychiatric-disorders-often-do-not-take-their-medications

 

Joel Young, M.D., who teaches psychiatry at Wayne State University, is the Medical Director of the Rochester Center for Behavioral Medicine, near Detroit.

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