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.

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.