I’m currently co-facilitating a NAMI Family-to-Family course. Class 6 is all about medications and includes a very important section on medication adherence. In the class, we discussed the various reasons, many of which are valid, that people with brain disorders stop taking their medications.

Atypical antipsychotics, for example, have a nasty reputation for causing significant weight gain. Many psychotropic medications have negative sexual side effects, including diminished libido and an inability to climax. Some people, especially those who have experienced hypomania feel as though the medications flat line them – as we say in Bipolar Disorder For Dummies, “Normal is boring.”

As we discussed this in Class 6, it struck me that in some ways, anti-manic medications, including lithium, Depakote, and the atypical antipsychotics are like Kryptonite to Superman. If, in hypomania, you feel energized, creative, powerful, and incredibly sexy, of course you’re going to hesitate to take anything that threatens to ruin those positive feelings… at least until you experience your first full blown manic episode.

I’m not encouraging anyone to stop their medications. The point of all of this in the NAMI class is that it’s important to recognize not only the medications and their side effects, but also the emotional responses to medications… which are present whether we’re talking about psychotropic or non-psychotropic medications.

Acknowledging and discussing these issues is an important first step toward adherence:

1. Empathize. Admit that the medication choices our loved ones are presented with are often lousy.
2. Discuss these issues with our loved one – get it out in the open.
3. Work with the doctor to find a treatment package that maximizes symptom reduction and minimizes undesirable side effects.

Class 6 also provides concrete advice on how to help your loved one move from medication rejection to grudging acceptance to medication adherence, but you’ll need to take the Family-to-Family course to find out. NAMI also offers a Peer-to-Peer course for consumers. Go to NAMI.org, find your local affiliate, and contact them to register for an upcoming course.

In Class 6, we discussed the cost-benefit analysis that our loved ones with brain disorders often engage in to determine what, for them, is the lesser of two evils. We would like to hear about your experience. What are some of the treatment options you or your loved one has had to wrestle with, what choices were ultimately made, and why?

Photo by Mark and Allegra Jarosky-Biava, available under a Creative Commons attribution license.

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    Last reviewed: 10 Oct 2011