To start, we need to lose the assumption that people take medications just as the doctor orders them. We don’t. Studies show that roughly 25 percent of medications are not taken as prescribed. When we head into psychiatric medications, this number doubles.
In bipolar disorder, one in two patients will stop her medication in the first twelve months of treatment. It is quite common for people to have several episodes in which they will experiment with their dosage and/or go off their medications altogether.
But the big question remains: If the medications can help control the mood swings, why would someone stop?
As we’ll see, these are not benign substances. Here’s a list of commonly cited reasons why people stop their medications:
• Don’t believe they have an illness, This could be both a lack of insight (anosognosia), and/or something more existential
• “I don’t have bipolar disorder, Doctor! You do!”
• “Maybe my mood swings are just a little bigger than other people’s. I don’t want to medicate away my true feelings,” or “The medication dampens my creativity.”
• Side effects, Feeling over-sedated, sluggish, or slowed down.
Weight gain and sexual dysfunction are often-cited reasons for stopping medication, but each medication has its own list of common and more rare side effects.
• Financial issues
• Lack of insurance that covers medications.
• Medicaid “spend downs”
• Access to medications, no transportation and/or pharmacy doesn’t deliver
• Stigma and shame, Wanting to see what will happen if they go off the medication
• “Maybe I don’t really need them.”
• “I was feeling better and thought I could come off of them.”
• Using drugs or alcohol
• “I wanted to get high and didn’t think I should mix the medication with (drug of choice)
• Concerns about long-term health effects
• “I heard that lithium is bad for the kidneys and the thyroid gland, I got scared and stopped taking it.”
• Pressure to not take medication from friends, family, or other social contacts
• “My church doesn’t believe in taking medications.”
• “Someone at AA told me that taking medication is just another addiction.”
• “My father/mother/girlfriend/sister told me I don’t need to take it.”
• “My father said it’s a sign of weakness to take medications.
He said I should be able to kick this on my own.”
• Pregnancy-related concerns
• “I’m trying to get pregnant and don’t want my baby to be adversely affected by medications in my system.”
• “I just found out I’m pregnant and stopped all my medications.”
• “I want to breastfeed and was told I couldn’t if I’m on psychiatric medications.”
• Performance-related concerns
• “I can get a lot more done when I’m manic.”
• “I’m more creative off of the medication.”
This list covers many of the common responses and should underscore the variability of why people will go off medication. Why a particular person does is vitally important to understand, so we can address the reason through education, adjustment of medication, and various therapeutic means.