Meds Compliance: Is Noncompliance an Option?

John McManamy Health Guide
  • I never thought I would be writing this kind of piece, but one of my readers, Donna, put it right out there:

    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.

    I have always urged a compliance strategy based on a strong working relationship between doctor and patient. But what if the doctor refuses to listen? Donna goes on to say that she developed a hypothyroid problem. Her primary care physician urged her to have her psychiatrist stop the recently-prescribed Geodon. The psychiatrist said it couldn't be the Geodon. In Donna's words: "So I looked up the side effects of Geodon.  And right there under infrequent side effects was, you guessed it: HYPOTHYROIDISM."

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    Donna was responding to one of the pieces in my series on meds compliance. Tabby had this to add:

    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?"

    In another comment, Tabby offered this provocative observation:

    The docs are there to prescribe the meds to alleviate or eradicate the physical manifestation of symptoms that cause the most distress to, not only the individual, but to the individual's individuals that have problems being around that said individual.

    According to Tabby, it doesn't matter that the patient becomes an "obese, heart damaged, thryoid dead, joint destroyed, insulin dysfunctioning zombie eunuch" on the meds, so long as "the individual's individuals are happier with the individual's behavior."

    Donna serves up her own personal experience individual's individual-wise:

    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."

    The $64,000 question, then: When confronted with psychiatrists who refuse to listen, is noncompliance with meds or partial compliance an acceptable recovery strategy?

    It's a question I thought I'd never have to ask. According to one study, only one in four patients stay on their antidepressant after six months. It's a question a lot of you have obviously answered, already.

Published On: October 08, 2010