Bipolar 2 From Inside and Out

The Compliant Patient

My mother was not a compliant patient. She would have side effects from medication and just stop taking them: The meds gave her sores in her mouth or nauseated her.  And that’s valid. We’ve all had medications that we couldn’t tolerate because of the side effects. But Mom stopped taking them without telling her doctor. Once she went to the emergency room, where they had a list of the meds she was supposedly still on and I had to tell intake, “No, she stopped taking that one. And that one too, I think.” (She was not mentally ill, but that’s where I’m going with this.)

There is only one psychotropic medication I know of (though there may be others by now that I haven’t heard about), where the potential side effects are so horrible – potentially lethal – that patients are advised to stop taking them immediately and get medical help right away.  The side effect is called Stevens-Johnson Syndrome and it is a potentially fatal rash.  I wrote about it a few years ago, (https://wp.me/p4e9Hv-1g)

Other than that one instance, psychotropic medications should never be discontinued unless you have consulted your physician. You never know what withdrawal symptoms lie in wait for you, but they’re bound to be unpleasant, even if they don’t cause you to relapse, which could easily happen. Withdrawal from any drug is not fun; it’s to be avoided.

Nonetheless, I read posts in support groups all the time which say that people have decided by themselves to stop taking a medication, or even all their medications on their own. I have friends who have taken their treatment into their own hands this way.

There are several reasons they sometimes give for giving up medications. One is that the meds aren’t working. What they really mean is that the meds aren’t working yet. Many psychotropics don’t show positive effects until they have built up in your bloodstream, which can easily take four to six weeks. Expecting results in a day or two is unreasonable.

Others stop taking their meds because they “feel better” and think they no longer need the pills. This is just ridiculous. The meds are the reason that you feel better. Your psychiatric condition does not just go away, like the flu, when you feel better. Your disorder may soon come roaring back (or creeping back). And the thing is, when you restart a medication, it sometimes no longer works as effectively. Then you have to start all over with a new prescription and have another four to six weeks of symptoms while you wait to find out if it works or doesn’t.

Still other people simply don’t like taking medications.  This I don’t understand.  People take meds for flu and infections and such conditions and never seem to resent them. Maybe it’s the idea that you could well be – will likely be – on psychotropics for the rest of your life. But lots of people have meds they need for life – insulin, cholesterol meds, anti-inflammatories, asthma meds, thyroid meds, and others. People don’t quit taking those just because they don’t like to take pills or injections.

I think the real reason people don’t like to take their psychiatric meds is that they’re psychiatric meds. There is still massive stigma around the subject of mental illness. Taking medication for a mental illness means admitting you have one, which some people are reluctant to do.

Or they may be giving in to “pill-shaming.” There are plenty of people, perhaps in your own family – and certainly across the Internet – who will tell you that all you need is self-love or affirmations or sunshine or exercise or vitamins or meditation or willpower to banish your mental illness. Funny how they never tell people that sunshine will cure their broken leg or that exercise will cure their breast cancer.

I hesitate to say that I love my psychotropics, but in a way I do. They have brought me out of states of mind that were harmful to me. They have made it possible for me to function and create and communicate. They probably have saved my life.

Occasionally I let my psychiatrist know that I may need a change in dosage or that one of meds is no longer working. I’ve even reviewed with him whether there are any meds I could quit taking (there aren’t at the moment). But I keep taking them faithfully, every day, morning and night.

I need the psychotropics. So I am a compliant patient.

Comments on: "The Compliant Patient" (7)

  1. I think sometimes people mistake compliance for blindly following along and putting up with side effects. I think ideally managing meds should be a collaborative process with neither the doctor nor the patient making unannounced changes.

    Liked by 1 person

  2. I think it is often self-imposed stigma coupled with some denial when it comes to psych meds being discontinued. I cringe when I see posts about being “medication free” from those with bipolar disorder. I do sometimes wonder what it would be like, but then I remind myself of what it WAS like before meds. Stopping meds wouldn’t make me the person I was before getting sick. Thank you for writing about this.

    Liked by 1 person

  3. Huskiebear said:

    My mother was chronically depressed, with periods of acute anxiety. I only realized this after my own diagnosis and starting treatment with prozac in the mid 90’s. She had been prescribed Valium – really the only drug available at the time – for many years and when she stopped taking it, compl

    Liked by 1 person

  4. Heather Hooper said:

    I’m considering dropping my dose of Venlafaxine a little bit to see what happens. Why? I’ve been on it for years, along with lamotrigine. It almost certainly isn’t working (or if it is, my depression is the worst I’ve ever seen), and I have a long history of having anti-depressants just tail off into uselessness. I’m in therapy, and I’ve been stuck for over a year. I think the meds might be keeping me from feeling enough to progress. I’m on the maximum dose of Venlafaxine (375mg/day), and the side effects are pretty awful. I’ve also screwed up and taken double the dosage a few times, and I went into serotonin syndrome once. Fun.

    I’m not bipolar, I have MDD, but thought I’d chime in.

    (And yes, I’m informing my doctor and doing it *incredibly* slowly)

    Great blog!

    Like

    • I’ve screwed up a couple of times. Once I took my Ambien in the morning instead of at night. I slept all day, but I was OK with that. (I was diagnosed with major depression before I was told I had bipolar 2, so I can relate.)

      Liked by 1 person

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