Bipolar disorder is a serious, debilitating illness. The mood swings alone can be devastating, but we also suffer between episodes. This is why equally serious medications have been developed to treat bipolar disorder. They’re not perfect by any means. There are plenty of side effects including weight gain, loss of sex drive, drowsiness, nausea and tremors. That’s the short list. Some can also make you feel like you’re in a fog or feel like a zombie. It’s really easy to use these as an excuse to stop taking your medications, especially during a manic state. However, there are other reasons researchers have found as to why bipolar disorder patients are so bad at staying on a medication regimen. One of those reasons may be due to our natural impulsiveness.
Here’s the thing: Do not discontinue your medication without talking to a doctor. If it’s an emergency, go to the ER. For most psychiatric medications, withdrawal can cause serious psychiatric and physical symptoms. It’s dangerous. Not kidding.
Somewhere between up to 60% of bipolar disorder patients do not follow the treatment plans set for them. Sometimes it’s intentional. Sometimes it isn’t. People will often go back and forth on adhering to their treatments or not. There are actually quite a few reasons people don’t take their medication. It’s a complicated situation that stems from a complicated disorder. Here are some examples of reasons given by patients from a 2013 survey from Susanne Gibson, et al.:
- “I was once very active and went to the gym 4 times a week, now I have become lethargic and fatigued from my medication”
- “I am really fed up with … having to have a blood test every four weeks”
- “I just wish I didn’t need to take so much medication” (Confession: I’ve done this one.)
- “Didn’t like the sedative side effects” (I’ve also done this one.)
- “I had been coping well for a significant period of time”
- “Somehow I forgot to take the medication, maybe because I was feeling well”
- “Too low felt there was no point as was going to kill myself anyway”
- “I was high as a kite”
- “They were not willing to listen to the prescription mess up that had occurred and just said I had decided to stop taking meds myself”
Simply forgetting to take medication is easy. People with bipolar disorder have trouble with memory, so it’s understandable. This memory problem doesn’t just exist during manic or depressive episodes. It can and does happen all the time. It’s part of what’s called “cognitive impairment” which encompasses a whole host of symptoms including problems with memory, attention, decision making and inhibition.
Those last two were the focus of a 2015 study from Raoul Belzeaux, et al. in the Journal of Affective Disorders. They found that medication non-adherence (not taking your meds) was correlated to non-planning impulsivity.
Non-planning impulsivity in this case is basically a lack of forethought and resilience. Impulsivity/Impulsiveness is a major symptom of mania, but some of the trait is also present between episodes. When decision making and inhibition are impaired, it makes it that much easier to skip your meds.
This can come into play when a patient is feeling better. You may think that because you are feeling better you no longer need to take your medication without considering that your medication may be what is making you feel better. Poor decision making means you discontinue treatment without speaking to a doctor and inhibition means you risk it without considering the consequences.
It can also work in the reverse. When a patient is feeling bad and on medication, you may discontinue it whether it’s the source of the symptoms or not. Same consequences. Same lack of consideration.
There is good news!
The same medications that are being skipped because of impulsivity can actually treat that impulsivity. We’re talking mood stabilizers like Lamictal and lithium as well as anti-psychotics.
There is more good news!
If the main reason you skip out on your meds is that you simply forget, there are ways to combat that.
- Make it a part of your routine. If you always brush your teeth and take your meds at the same time, it will make it more likely that you won’t do one without the other.
- Set an alarm on your phone. This especially works if you’re supposed to take meds in the afternoon when you’re on the go.
- There are plenty of apps designed with bipolar disorder in mind to help track symptoms, moods and routines. Ones like iMoodJournal also let you set an alarm to track sleep and medication. (This is not an endorsement. They didn’t pay me to say this.)
Going to say this one more time. Do not discontinue your medication without talking to a doctor. If it’s an emergency, go to the ER. For most psychiatric medications, withdrawal can cause serious psychiatric and physical symptoms. It’s dangerous. Not kidding.
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Photo credit: Richard Davis