Why do bipolar and schizophrenic persons quit taking medicine?
Talk to any medical professional about the trials and tribulations of dealing with bipolar patients and they will tell you that the single most bothersome thing is the frequency with which manic-depressives quit taking their meds.
This problem isn’t unique to bipolar patients, but it is more insidious and often more surprising. Schizophrenics, who quit taking their meds, are identified fairly quickly. Those with depression who quit taking their meds stay in their houses – this is troublesome but not a public nuisance.
People with bipolar disorder are usually quite memorable both at the best of times and the worst of times. They are vivacious; they are shining; they are exasperating; they are amazing, and they are irritating. Generally in order to be diagnosed, a bipolar patient will present one of two ways – either severely depressed or psychotic but their illness has gone unnoticed or unaddressed for a long time.
To be fair, psychiatric patients of any type may quit taking their meds for a number of legitimate reasons. Well, semi-legitimate.
Legitimately, a psychiatric patient of any type will have consulted with his or her physician before quitting can be medically supervised while doing so. Even with medical supervision, the only really legitimate reason for a psychiatric patient to quit taking their meds completely is a person who has been taking anti-depressants for a short period of time (less than one year) who has only had one episode of clinical depression. In this case, a psychiatrist would agree that a patient who does not have a long term history of depression can taper off the medication because they may not need it forever. This patient is rare. Once another episode of depression or mood disorder occurs, virtually everyone will agree that it is a chronic problem that should be addressed with medication. Permanently.
One legitimate reason for temporarily discontinuing use would be pregnancy, to avoid potential harm to the fetus. In most cases, the medication would be re-started as soon as the patient is able.
Patients may also approach their physician about discontinuing a specific medication to switch to another. Reasons for this might be ineffectiveness, intolerable side effects or cost.
Unfortunately, for most psychiatric patients there is no legitimate reason to discontinue medication altogether. The physician will suggest or even prescribe an alternative medication. The patient may feel that they have been unheard by their physician and while this may be the case, for most patients who “quit”, it is actually more likely that they have not talked to the physician at all.
Bipolar patients and those with other psychiatric conditions most often quit taking their medication without medical supervision or intervention in secret. Oddly, this is because the brain is a tricky thing – most often they quit when they are doing well. When the medication is working, they begin to believe that they do not need the medication – that they are “OK”.
Most psychiatric patients don’t want to have a mental disorder – or more likely they don’t want to be told that they have a mental disorder. This may be in part due to the social stigma, but it may also be because they really like the way they are. Medication often takes away the “spark” that has made them vivacious, memorable, brilliant and even irritating or dangerous.
It is very difficult to go from “outstanding” – whether it is good or bad to normal. Bipolar patients in particular also quit taking their medication because their brains are bored. The brain is used to go up and down, backwards and forwards, in and out. When medication is working, the roller coaster goes away.
This may be good for a while, after the crisis because life has gotten way out of whack, they need time to recover, rest, and breathe. But when the fires are put out, and the dust clears, the brain begins to crave the excitement.
Again, this really means the medication is working, and they will quit, yet again, starting the cycle all over again.
So, what can a caretaker, a parent, a spouse, or a friend do? Likely any attempt at supervision or intervention will be met with anger, avoidance or outright denial.
As bipolar disorder, and schizophrenia most often emerges in the late teens or early adulthood, is should be predictable that they do not want supervision. They do not want to be told that someone else knows best.
When confronted or even questioned, the bipolar will almost always say that everything is OK – even if it is far from OK. In short, they will lie.
Again, what can a caretaker, a parent, a spouse, or a friend do? In short, especially in the newly diagnosed (and for a bipolar or schizophrenic the definition of newly would be likely less than 10 years), there will be no opportunity for supervision. They will be secretive and untruthful. You must wait for the crash and be there to assist with the crisis and recovery – only to repeat it again in a few months or years.
The good news is that eventually, the periods between “the crashes” will likely lengthen. When they are thinking clearly, when the medication is working – ask them why they do it. Encourage them to participate in therapy, join a bipolar or mental disorder group. Realize they may not always go.
Over a period of years, perhaps decades – the patient may eventually become to accept that they truly do need the medication. Likely they will never be completely compliant but one can always hope.
A caregiver, a parent, a spouse, a friend can look for signs – if you are close, you may be able to keep track of their medication, physician visits, refills but you may not be able to. You should prepare yourself when you see signs: a developing increase in communication, vivacity, anger – likely followed by erratic behavior and hiding.
Intervene as much as you can but know that your may not be able to stop them. They quit medication when it is working because it makes them….normal.