Antipsychotics are among the most popular medications prescribed for bipolar disorder. Not only can they be used in acute situations of mania/hypomania or psychosis, but 40% of people with bipolar disorder are prescribed antipsychotics for maintenance therapy. Additionally, half of patients in one study entered remission from depressive episodes after being treated with antipsychotics. Despite this, there is still a major problem getting patients to comply with treatment plans with a rate of less than 50% actually adhering to them. New research looked at 36 separate studies to find out why patients are noncompliant when it comes to taking antipsychotic medications.
As effective as antipsychotics are, they are only effective if people actually take them regularly. Leaving them sitting in a bottle in the medicine cabinet is going to do nothing to help treat mental illness. It is, frankly, a waste of time and money to go through the process of seeing a mental health professional for help and then not adhering to the treatment plan agreed upon.
Even a short break in taking antipsychotics increases the chance of relapse, hospitalization, violence, arrests, reduced quality of life and suicide attempts.
That said, there are many reasons why people do not comply with these treatment plans. A new publication in the journal Patient Preference and Adherence with research led by Dawn I. Velligan sought to find out the most common reasons why people with severe mental illnesses like bipolar disorder and schizophrenia do not take their medications as subscribed. The researchers found five common themes among the 36 separate studies they found regarding medication compliance.
1 Poor insight into our illness
Not recognizing that we have an illness or need treatment is clinically described by the terms “lack of insight” and anosognosia. About 40% of people with bipolar disorder experience this. It is mostly associated with acute mania. When a person feels euphoric or just well they might not think they need medication anymore even though these are periods when antipsychotics are most needed.
2 Substance abuse
People with bipolar disorder experience substance abuse at a rate seven times higher than the national average. This includes alcohol, cannabis and illicit drugs. The researchers found that the regular use of cannabis had the highest correlation with medication non-adherence. This could be due to a person “self-medicating” as opposed to seeking professional medical help.
3 Negative attitudes toward medication
Some people simply don’t like the idea of having to rely on and regularly take medication. Severe mental illness is a lifelong diagnosis so the thought of having to take at least one medication every day for the rest of our lives can be daunting. There is also a stigma against mental illness. Taking medication daily is a constant reminder of having this illness that some people are ashamed of having. Some people may even have loved ones encouraging them not to take their needed medications.
4 Medication side-effects
Antipsychotics come with a long list of side effects. These include drowsiness, digestive issues, dizziness, tremors, weight gain and cognitive impairment. For some people these effects are understandably intolerable. Instead of returning to their prescriber, explaining how the medication is negatively affecting them and asking to try something else, some people just stop taking their medication altogether.
5 Cognitive impairments
Cognitive impairments common in bipolar disorder include problems with attention, memory, critical thinking, motor skills and social functioning. Those living alone with major cognitive deficits may not be functional enough to keep up with a regular medication regimen, especially without proper social support. In these cases it’s important to have a caretaker involved to make sure the patient has the best care possible.
There are other reasons why people are non-compliant when it comes to taking antipsychotics regularly. These include being unable to afford the medications, poor relationships with prescribers and accidental non-compliance. After all, we’re not perfect. Sometimes we just forget.
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