Adherence to Medication & Coping with Side Effects
If there's one thing I've learned over the years it's that medication is a touchy subject. Irritated and exhausted doctors often ask what can be done to improve, "patient compliance". I might respond by saying something along the lines of, "we might start by talking about adherence rather than compliance". Am I simply playing with semantics? My perspective, shared by many others, is that compliance points to the simple act of following orders (medical advice if you prefer). It is one-way traffic along the lines of, "I'd like to try you on this. Come back and see me in a month." The first you get to know of the dosage is when you read it on the bottle and the side effects are explained on the leaflet that accompanies it. You know, the one with the world's smallest typeface.
Alright, I might be exaggerating, but my point is that the term ‘adherence' implies a different dynamic. If we adhere to something we choose to give it our support rather than simply doing it because someone thinks we should or that it's good for us. It suggests we have an informed choice and we may exercise that choice, or not, according to our circumstances or personal evaluation.
So, why don't people adhere to medication? Well, the reasons are many and varied. Some people reading this will have struggled to finish a 10 day course of antibiotics. Imagine then, if you can, being asked to take medication for the rest of your life. And, what about the prospect of one or more drugs so potent that levels need to be monitored by blood tests? You start to see the picture? It may be that people simply stop taking medication because they've had enough. Some may take medication at the wrong time or in the wrong doses. Some may dislike the idea of their moods being controlled by chemical means. Some miss their highs; they feel at their best and sometimes their most creative at these points, now taken from them by mood stabilizers. The circumstances differ but they are all examples of non-adherence.
High on the list of causes must be side effects. Some people simply struggle to see the benefit of medication. It can make them feel sick, drowsy, disconnected, unmotivated and not themselves. They take it because of the consequences of not taking it. Perhaps they take it for their work, their family, their marriage? Perhaps they take it because they know there is a need for predictability and consistency? Perhaps, of course, they take it for themselves. There is nothing appealing about a depressive state and not everyone likes a high, which can make them feel agitated and exhausted.
A good working relationship with a concerned and interested doctor can make all the difference between a positive and a negative experience with medication. A good doctor will take time to explain the pro's and con's of certain medications. What might happen if you combine medications and whether the benefits might outweigh the costs.
Weight gain is a common side effect of drugs such as lithium, some antidepressants and antipsychotics. The mechanisms underlying weight gain may vary but they include thyroid underactivity due to drugs, changes in metabolism and fluid retention. A drug like Lithium can cause an increase in thirst so it's better to stay away from sugary drinks. Some drugs can have an effect on appetite so the advice is to steer clear of sugary and/or high carb' foods. Exercise will also help burn of the excess calories.
Some people find that medication gives them a stomach upset. They feel nausea and gastrointestinal irritation. For this reason it is best to take medication after meals.
Tremors, stiffness, dry eyes, muscular pains - the list could go on. Sometimes just a slight reduction in dosage can make all the difference. There are also drugs that can act as counter-measures to some of the more distressing side effects.
The emphasis in the sharepost has been on side-effects, but also the importance of the doctor-patient relationship. Of course not everyone with bipolar will experience side effects. Some people will experience side effects with some drugs and not others. For some the dosage is a significant factor. The relationship with your doctor needs to be a positive experience for you. You are the person who is taking the drugs so you need to feel you have option to change. Perhaps it is this sense of control with the decision making process that is one key difference between the person who is willing to engage with treatment and one who rejects it?