This is an important question that can cause a great deal of friction between the person with bipolar disorder and her family. Heated arguments can arise over the daily question of, “Did you take your medication?” Followed by the rebuttal, “I’m not a child! I can manage my own medication!”
The negotiation around managing medications can be a sensitive one, and it’s one that will evolve over time. In other words, if someone has no difficulty with her medications, takes them regularly and is not in a depressed or suicidal state, she should manage her own medication. On the other end of things, we could have a person who frequently stops her psychiatric medications, quickly falls into a mood episode, and/or has periods of suicidality that might include thoughts, or a history, of taking overdoses with her medications. This person will need assistance and some safeguards with the medication. Then we have everything in the middle.
Finding the balance between supporting autonomy and independence and trying to prevent your adult child from having mood episodes is tricky. A few suggestions that could help include:
• Avoid using medication as a punishment or in a coercive way, i.e., “If you don’t take your medication you’ll have to go to the hospital.”
• If someone has a history of overdose, try to limit the amount of medication in his possession at any given time. Weekly, or even daily, pill boxes can be helpful.
• If your adult child is eligible for either in-home (visiting nurse) services or receives case-management or ACTT services these are often able to provide medication management in the home. This would be prescribed by the psychiatrist/APRN and helps take the family out of the discussion altogether.
• Try a motivational approach toward talking about medication. Avoid debate, listen, empathize, and help the person find her own reasons for why taking the medication makes sense.