You will never now how grateful I am for your post on med compliance.  It said (in the right way) what I had tried to express in non-productive and frustrating ways for years.  I may print it and take it to my psychiatrist next time I go.  It is so true that psychiatrists are good at crisis management and stabilization.  And so true that once the crisis is over and stability achieved, it is often the case that the patient no longer needs 40mg of Zyprexa.  Maybe 20 or even 10mg will do.  And a lot of patients find this out by experimenting on their own.  Like I have.  My psychiatrist's opinion is if a certain med at a certain (high) dose is keeping me out of the hospital, then I should be content to take it and live with the unbearable side effects for the rest of my life.  Which I have never done.  I take more when I need it and less, or none, when I don't.  And this is working quite well for me.

For a long time I felt tremendously guilty for being "noncompliant" and constantly castigated myself for not thrusting aside other health concerns (obesity, metabolic syndrome, high blood pressure, possible diabetes) because my doctor said things like "better fat and sane than skinny and insane."  Like those were the only 2 options.  And because it took a high dose of Zyprexa to get me stabilized, every time he lets me try a different antipsychotic, he starts me off at the highest dose.  Of course, for me that means there is a greater chance of more severe side effects.  And I end up going back to Zyprexa and adjusting my own dose.

I don't often feel guilty about managing my own meds anymore.  Yes, I see my psychiatrist every 3 months because I need someone to prescribe what I DO need to take every day.  But there is not much in the way of conversation or compromise.  He makes light of the side effects (like my weight has doubled) as if they are nothing and waves me out of his office with a prescription and "I'll see you back here in 3 months."  So we play this game.

An aside: my mother had cut out a newspaper article for me to read this morning.  It was about how a pharmaceutical company was experimenting with paying patients to take their meds as prescribed.  (Rather obvious that they are trying to protect their bottom line.)  I said, "Well, that is interesting."  And Mom said, "It is ridiculous. If someone doesn't take the medication like their doctor has prescribed, then they should just let them die."  I guess that goes for me, too, huh Mom.  She will rarely take a full series of antibiotics because they give her diarrhea.  But my case is "different."

I have heard of the better "to be fat and sane than skinny and insane" come from not only others with Bipolar but also from the very healthcare professionals that are supposed to be treating patients.

When I was first diagnosed I did, and still do, believe in the diagnosis to be right but because I was confused and uneducated on Bipolar as a whole... my pdoc at the time put the fear in me that I'd have to stay on 5 or more meds all the days of my life and if I did not... I'd relapse worse than what I was when I came in voluntarily.  It was a certainty, he said.

The social workers, in the day room, all said "meds are not to cure your illness but to make the quality of your life much better but only after you and your doctor figure the right cocktail.  That right cocktail may take a year or more and many med trials but once that happens, and given about 6 months to a year of that working, then you'll notice some improvement."

So, I'm sitting there in an antipsychotic daze thinking..."OMG, my life is going to be like this or worse for at least 1-maybe 2 years before I might find some resemblence to improvement?"

The pdoc, at that hospitalization, actually said to me that he'd prescribe Depakote but it made women fat and when a female patient was already overweight (like I was), he did not feel it fair to give them a med that would pile on the pounds.  He knew, he said, that once they started to feel better mentally and then would see the addition of pounds, they'd just become depressed and suicidal all over again so... he just didn't do it yet, his colleagues didn't care and would prescribe it.

I thought... "well, at least he is honest."

I tell the pdocs, and I've had so many due to insurance changes and financial changes, that I can't tolerate the "normal" dosages... they scoff and smile and say "just take the medication, see me back in a couple of months, and call if you have any questions or concerns in between."  I question about a new med and I've had some ask "you got that from the internet didn't you?" or "are you going to ask your friends on your Bipolar message board or are you going to listen to we who are medically trained?"

Probably one reason John...they don't recommend DBSA or NAMI or any of the other groups.

Never will forget the nurse, in one doc's office, that looked at me so patronizingly when I tried to explain some adverse reactions to a med and she said "well, you know hon how you'll be without the medication and the doc really wants you on it so why don't you just go home and take it like he said to cause you know how you'll be if you don't."

I withdrew from that med in particular by getting advice from my Primary Care doc and quit going to that pdoc.  He and his nurse, did not know me.  They only saw Bipolar.

Donna-1

10/ 3/10 3:42pm

You're right.  I have had a pdoc ask me if I got a side effect off the internet.  Made me furious!  And when I got furious, he laughed and said, "I haven't seen you angry before!"  He wasn't interested in the quality of life I had, he just wanted to make another check mark in the "stabilized" column.  I got a new doctor not long afterwards, and have had him for 13 yrs even though he isn't a bit better.  After 3 psychiatrists who were just alike, I decided to ignore them and just take the medications in a way that DID increase the quality of life.  I tried once to get my primary care doc (who is very kind and understanding) to take over my psychiatric care.  She said she couldn't because she might step on the toes of my psychiatrist and "doctors don't just take away the patient of another doctor, especially a specialist."  Hey, I thought I was the one paying for this appointment and I didn't give a damn about whether my incompetent psychiatrist felt violated by my much more competent primary care doc. I guess I could ask her for a referal to a different psychiatrist if she knows a really good one.