Many people with bipolar stop taking their medications at some point in their treatment. This is a reality that patients, doctors, and family members often wrestle with. But it’s important to understand some of the possible reasons why. Understanding that there are often compelling factors in someone’s decision to stop their meds can help loved ones approach the problem without judgment. And for people with bipolar disorder it is critical to honestly evaluate why they want to stop taking their medication, because then they can tackle these issues directly and without judging themselves.

Non-compliance or non-adherence? Anyone who’s ever taken bipolar medication has heard the term non-compliance. It means not doing what your doctor and therapist tell you to do. In most cases, it means not taking your meds as prescribed. Unfortunately, the term carries a subtle connotation that the patient is not being a good little girl or boy. As such, many people with bipolar understandably find it offensive, preferring instead to use the term non-adherence.

Outside observers often seem to think that the main reason people with bipolar stop taking their meds is because these people are just irrational, irritable, and obstinate… especially when they start becoming manic. Although mania could be a contributing factor in some cases, people often have other reasons for stopping their medications, including the following:

• The meds don’t seem to be working or aren’t working soon enough.
• The meds do work – “I feel fine, I don’t need these medications.” Of course the reason someone is feeling fine is often because they’re taking the meds. By the way, this phenomenon isn’t exclusive to people with bipolar disorder. Many patients without bipolar disorder who take medications to treat other illnesses stop taking their medications as soon as they begin feeling better even when their doctor and pharmacist instruct them specifically to finish the prescription.
• The side effects are intolerable. Some of the side effects can be scary and things that nobody would want to deal with, such as weight gain, memory loss, fatigue, and insomnia, not to mention potential medical problems like kidney or liver malfunction.
• It’s a real pain to remember to take the meds at the right time, every day; to find a way to keep track of when meds did or did not get taken; to find out what to do if a dose or several doses are missed, even accidentally; to keep the prescriptions refilled (especially if the insurance company is being difficult). The logistics of taking medications regularly – and the cost, too – can create genuine problems with sticking to them. And all of these challenges can be more difficult when someone isn’t feeling well – and can seem unnecessary when someone is feeling fine.
• Psychiatric medications carry a stigma. In our society, there’s a strong undercurrent of belief that medications for treating mental illnesses are only for lesser beings who cannot will themselves out of it. This is a huge issue and one we will discuss in other posts, including “Do You Feel Stigmatized by Your Bipolar Medications?” 
• Understandably, many people enjoy the high side of bipolar disorder. They feel that the meds “flatten” them – and take away their creativity and spark.

We cover these “non-compliance” issues in Bipolar Disorder For Dummies and provide some strategies for overcoming the challenges, including the following:

• The most important first step is to be honest about taking or not taking medications and to deal with it as just another challenge on the journey. It is an expected bump in the road and it is not helpful to think of it as catastrophic.
• Honest communication with your doctor is critical – some of these problems can be handled, for example, with dosage or timing adjustments or by switching to an extended release version of a particular medication (if one is available).
• Bringing in other people to help can sometimes ease the logistical burdens.
• Sorting out the stigma and fear will be an ongoing and necessary discussion as part of solving this problem.

There may not always be a simple or obvious answer, but talking honestly and keeping judgment and criticism out of the mix when addressing the issue will go a long way toward finding creative solutions.

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• Back to Work with Bipolar Disorder: Part I

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    Last reviewed: 15 Aug 2008