Meds Compliance: Looking Beyond, Looking Ahead ...
Over the past two months, we have been discussing the vital issue of meds compliance. So, if we remain compliant we will get well, right? Not so fast. Last year, on my blog, Knowledge is Necessity, I ran a poll through the month of February. "How do you rate your meds in managing your illness?" I asked.
Fifty percent responded that meds were their single most important tool and another 32 percent that their meds were "important, but no more so than their other tools." In other words, four in five patients put meds at the top of their list, either as a solo act or with a dance partner.
Now compare these results with a poll I did the month before. This time, I asked my readers how well they were doing. One in four replied they were "in crisis or close to crisis." Four in ten reported they were "stable but not well." Just one in five said they were on the way to recovery, and only 14 percent responded that they were back to where they wanted to be or better than they ever could have imagined.
Let's see what happens when we combine the results of both polls:
- 50 percent who rate their meds as their number one management tool vs 14 percent who are actually well.
- 82 percent who rate their meds as important vs 34 percent on their way to recovery or are actually well.
Granted, neither poll was scientific, and those who answered my second poll may not have been the same people who responded to my first. But even taking all that into account, we are looking at numbers that boggle the mind. What is going on?
For one, those new to their diagnosis are heavily reliant on their meds to do the heavy lifting. As their condition improves, along with their ability to manage their illness through other means, meds become increasingly less important. We may still take our meds, but we are more likely to view missing out on a decent night's sleep or taking a walk as more consequential than missing a meds dose.
Thus, those still into the "meds are important" phase of their treatment are likely to be those doing less well. Those doing well have a different attitude. A study several years ago by Melbourne researcher Sarah Russell bears this out.
Dr Russell recruited a hundred bipolar patients who were doing well and asked them what they did to stay well. Meds figured in the equation, but they were way down low on their list of priorities. Instead, the people Dr Russell talked to emphasized various mindfulness and stress reduction techniques, rigorous sleep management, smart life decisions, and so on.
Her findings were confirmed in a Canadian study published this year. Researchers interviewed 33 "high functioning" bipolar patients. To no one's surprise, the individuals in both studies identified very similar stay well strategies. As one patient described it in the second study:
To me it’s an ongoing basis where it’s like a ship that’s always righting itself, you know. Or when you’re driving, you’re sort of correcting as you’re trying to drive in a straight line. So those were the things that I see, and then I make minor adjustments and hopefully I don’t have to make major adjustments because I’ve been always making these corrections.
The "well" patient understands this. Unfortunately, if my two polls are anything to go by, way too many of us are not there yet. We seem to be "stuck," unable to move forward, over-reliant on our meds, not sufficiently booted up to make various recovery practices part of our routine. What gives?
Much more to come ...