This is the start of a new series on a very vital and contentious issue - meds compliance. The politically correct term these days is meds adherence, but I fail to see the point in replacing a term that everyone understands with a euphemism. Let's get started:
The best med in the world is useless if we don't take it, and our track record on this count is not good. According to some studies I dug out:
- Fifty percent of patients on mood stabilizers acknowledged some degree of noncompliance in the previous two years.
- In one trial, forty-five percent of patients stopped taking lithium within 45 days.
- In one arm of an NIMH-underwritten trial for schizophrenia, no one completed the study.
- Only 28 percent of patients in one study stayed on their SSRI after six months.
- Only 21 percent of patients in one trial stayed on their Zyprexa over two years.
It's very easy to fault the patient, of course. We are all fully aware that noncompliance virtually guarantees relapse and hospitalization, yet most of us tempt fate, anyway. It's not just our illness that causes us to not think straight; we have our own personal issues, as well. We may not take kindly to acknowledging authority. Maybe we lack insight or motivation or are not very good at picking up social cues. Maybe we are also dealing with alcohol or substance use, or have major anxiety or trauma going on.
Clearly, we lack the insight to know what's good for us. Our meds work - just ask any pharm rep. That same pharm rep will also tell you that losing your sex drive, gaining 60 pounds in two months, and otherwise feeling like a fat stupid zombie eunuch are only minor worries. And if your psychiatrist happens to be in thrall to a particular pharm rep (particularly if she looks like Heidi Klum, which most of the female reps do), then your concerns are not going to get a decent airing.
In the meantime: Don't argue with your psychiatrist. Just take your meds. Otherwise, bad things will happen.
One study I dug out found that clinicians thought patients quit their lithium owing to "missing their highs." The patients cited other reasons. Clearly a major disconnect exists. In an ideal world, patients and their doctors would see eye-to-eye. In the real world, that is not going to happen in the course of a 10-minute meds check. You will, instead, be sent out the door with a prescription, with little or no explanation.
The psychiatrist is naive enough to believe you will just do what he or she tells you. The evidence, on the other hand, overwhelmingly points out you are being set up to fail. The cause may be your own personal failings. It may be that the med is not right for you. Whatever the reason, we know there's zero percent of the med working if you don't take it.
Maybe you can help me out here. Pick a random med out of your cocktail. Did your psychiatrist explain to you when he or she prescribed this med:
- What precise aspect of your illness the med is supposed to be addressing?
- In which phase of the illness the med is supposed to be working on, and for how long?
- How the med is supposed to figure in your recovery?
- How the med works and interacts with other meds you are taking?
- All side effects issues?
- Scientific evidence of the med's efficacy and safety?
- His or her own personal clinical experience in prescribing this med?
Equally, important: Did you ask your prescribing doctor at least three of these questions? Did you get satisfactory answers?
In the coming weeks, we will be exploring in depth a whole host of issues related to meds compliance. I will be serving up far more questions than answers, and will be looking to your feedback for guidance. Hopefully, together, we can start connecting the dots. Please don't hesitate to offer up your own insights and tell your own stories. Comments below ...